Clinical assessment of suicide risk

Running Head: CASE STUDY: CLINICAL ASSESSMENT
CASE STUDY: CLINICAL ASSESSMENT
Name of the Student:
Name of the University:
Author Note:

Answer 1
RLT nursing model (Williams, 2017) defines patient capability within the context of their age in -
procedure, their degree of risk, and essential factors in designing a treatment plan. Instituting the
Therapeutic thought process (Hunter & Arthur, 2016) includes an evaluation of the patient's
condition. Edward (Ted) Williams 82 is postoperative and has intermittent colostomy that may impact
different facets of his life. RLT nursing methodology is focused on everyday living activities (ADLs)
and measures improvements in the patient's health and quality of life (Roper, Logan & Tierney,
2009). Possibly having a stoma would contribute to patient seeking assistance for personal care,
dressing, stoma care and thereby becoming less confident and dependent for his ADLs (Williams,
2017). The cognitive behavioral difficulties Ted may encounter include poor self-esteem, fear,
pessimistic thinking or stoma-related feeling vulnerable. This is likely that he may suffer marital
problems and depression. He may be having sexual distress and stress (Aktas & Gocman, 2015). The
case study states that Ted has a companion named Gwen, who resides in the same retirement
community. He may worry about her seeing him in this condition. The other causes may have an
effect on the fact that Ted became a widow and might miss his wife and children. Even though, Ted
has a girlfriend that is just a few years younger to him but still he feel alone. Psychosocial change will
restrict his social network and free time, because Ted may even be reluctant to go out sense moral
health declining. In various societies the psychological influence of developing a stoma is viewed
significantly.
Answer 2
During this step of the CRC (Hunter & Arthur, 2016), nurses ought to closely evaluate Ted's
previous medical background, illness background, existing recovery strategy, test findings, and
present vital signs. The case study states that Ted had just undergone surgery following a bowel
resection and a temporary colostomy. Moreover, he previously was observed to have a malign mass

post undergoing a colonoscopy and a biopsy, active heart failure, type II diabetes mellitus, obese and
had gout. Observing the case study it has been revealed that Ted showed signs of nausea when he was
administered with his diabetes medicine on his fourth day post-surgery. He was seen to have vomited
twice and that was feeling dizzy.His elevated vital signs indicates the presence of any kind of
infection. The nurse may also note regarding the perioperative control of fluid and electrolytes.
Plasma volume management (EDWARDS & GROCOTT, 2015) is necessary to provide a sufficient
preload to the heart to improve ventricular contractility and cardiac performance. Adequate
intravascular volume is also required for optimum oxygen supply to the tissue. However, the supply
of tissue oxygen may be jeopardized by an increased amount of interstitial fluid, since this can result
in edema, microvasculature stress, and decreases in oxygen diffusion distances. Control of the pain
(Tan, Law & Gan, 2015) in Ted's situation is crucial because control of the pain may help accelerate
recovery of the patient and can decrease their risk of experiencing other problems following surgery,
such as pneumonia and blood clots.
The nurses may recognize according to the above signs some potential disorders that Ted
most definitely suffering from. As Ted is postoperative, has had no performance since the surgery. So,
it can be recognized that gastrointestinal motility dysfunction could have existed, most possibly owing
to the operation of bowel resection. It is termed Postoperative ileus (Venara et al., 2016). This is a
disorder that is distinguished by both bowel distention and a loss of digestive sounds. Ted has a
distended stomach, as well as slow bowel effects. Postoperative ileus is often marked by the
deposition of gas in the GI tract, resulting in impaired storage and flatus movement, as with Ted.
Vomiting and diarrhea (Doenges, Moorhouse & Murr, 2016) are often a primary symptom of the
disease. The patients were shown not being able to handle a liquid or semi-liquid diet. The medication
used to treat pain can even raise his likelihood of post-operative ileus. The surgical technique
activates the afferent nerves in terms of pathophysiology, owing to the incision produced.
Disintegration of sympathetic / parasympathetic nerves in the gastrointestinal tract contributes to a
corresponding protracted period of inflammation. Surgical stimulation of the macrophages contributes
to the entrance of infectious agents such as neutrophils and monocytes into the body. However, the
majority of this process remains as an open question.

The second crucial challenge Ted may experience is linked to his coarse motivating crackles
and painful cough. There is a large array of conditions which can contribute to inspiring coarse
crackles being made. Yet recognizing that Ted has a history of cardiac disease is important, so he is
actually on Captopril medicine, which is also recommended for congestive heart failure. It has been
shown that symptoms may increase in patients with CHF following major surgery, such as intestinal
resection. Sometimes, CHF may induce pulmonary edema (Purvey & Allen, 2017) indicating that
fluid has collected in the alveolar region. This results in active palpitations, cough and inspiratory
crackles, each of which is noticeable in the case of Ted, like hypertension. The pathophysiology is
that when the heart cannot regulate adequately, and the blood corroborates into the veins which
transport the blood via the lungs. If blood vessel pressure gets elevated, the fluid can be forced into
the alveolar space, causing pulmonary oedema. Pulmonary oedema (Purvey & Allen, 2017) is the
main cause of motivating coarse crackles in the patient. This may also be due to pneumonia, but
because Ted has a medical record of cardiac failure which is considered as the main reason in his
case.
Answer 3
As Ted reports problems in collecting stools, he could not have his intestines enlarged to op,
because he was already on narcotics. Nurses must establish goals to supply Ted with necessary
therapies in keeping with the next step of the CRC. The aim of nursing care is to provide care for his
postoperative ileus and pulmonary edema. Regulation and scheduling of health facilities (Ambe et al.,
2018) for people with ileostomy or colostomy includes: helping persons and/or groups during
adjustment, preventing complications, encouraging self-care freedom, offering information on
procedures / prognosis, medical conditions and potential issues.
 Ted here, in the case report, was reported to feel pain on a scale of 4-5 out of 10, which
appears to escalate with palpation up to 7. Uncomfortable sensory and cognitive encounter
arising from real or possible tissue harm or defined in terms of such disruption need to be
assessed. Nurses are required to include soothing services, e.g. back massage, mouth wash,

repositioning (use suitable support measures if required). Assuring Ted that a move in his
place will not do harm to the stoma has to be addressed. Assess the degree of discomfort and
efficacy of analgesia which may expose problems as abdominal pain normally decreases
slowly on the third or fourth day after operation, persistent or intensified pain may indicate
prolonged healing or peristomal inflammation of the skin.
 Postoperative ileus (Zhang & Xu, 2017) would in most situations be controlled with
assistance and daily monitoring. Reviewing the nutritional routine and volume, the form of
fluid consumption requires to be evaluated for an sufficient consumption of fiber and the
roughage produces a bulk of the fluid, so the quality of the stool should be calculated.
Disrupted emergence or lack of effluent coupled with auscultated intestinal sounds is often
detected. Delay may suggest chronic ileus or stoma obstruction, which may arise
postoperatively due to oedema, poorly fitted to the pouch.
 Appropriate intravascular volume is also required to provide all the tissue with the full
amount of oxygen (EDWARDS & GROCOTT, 2015). Added amount of interstitial fluid can,
therefore, negatively impact the supply of tissue oxygen, because this can result in oedema,
reduced wavelengths of oxygen diffusion and microvascular stress.
 Nurses ought to advise and motivate Ted to sit horizontally with a lifted head to prevent
extended sitting. It will continue to facilitate the drainage of perineal wounds / drains as well
as reduce the chance of pooling. It has been found that repeated sitting raises perineal
discomfort, decreases the drainage of wounds and increasing slow healing.
 Postoperative ileus (Zhang & Xu, 2017) also contributes to prolonged hospital stays and
higher prices, and may create pain for the patient. At this point, it is vitally necessary for
nurses to motivate and help him throughout his treatment. Nurses are often required to remind
him of his postoperative state. Encouraging Ted to verbalize his thoughts towards ostomy, as
well as to understand the normality of emotions of frustration and sadness, will be assured. It
helps to make the individual understand that emotions are not uncommon and that it is not
appropriate or beneficial to feel bad about them. While the incorporation of the stoma
(Arvelos Mendes et al., 2018).into the physical appearance can take months or even years,

gazing at the stoma and making remarks (made in a natural, objective manner) will assist the
individual with this recognition.
Question 4)
Metoclopramide is a prokinetic agent (Agah et al., 2015) that may theoretically be used to
monitor POIs. It is widely used as an antiemetic and as a way of progressing nasoduodenal feeding-
tube. Metoclopramide acts by stimulating gastric emptying and activates gastric, pyloric, and small-
bowel muscle movement, which has little to no impact on the colon (Acosta & Camilleri, 2015). A
retrospective, randomized analysis evaluated metoclopramide in 100 patients that performed elective
abdominal colorectal surgical procedures to reduce the duration of the ileus following colorectal
surgery (Thiele et al., 2015). Not all patients were given metoclopramide. The medicine was given
Intravenous every 8 hours from completion of the operation before toleration with a solid-food diet. It
has been established that metoclopramide does not change POI course substantially (Liu & Abell,
2017). A double-blind, controlled 60-patient analysis showed metoclopramide had a detrimental
impact on POI resolution. It is necessary to bear in mind that metoclopramide may induce sedation,
motor restlessness symptoms and other extrapyramidal reactions.
The medication used for POI owing to its mode of action in the GI tract is Alvimopan lso
referred to as ENTEREG. These includes alvimopan (Xu et al., 2016), a peripheral μ-opioid receptor
(PAM-OR) antagonist. Acceleration to upper and lower gastrointestinal regeneration is demonstrated
after partial broad or small intestinal resection surgery with primary anastomosis. They are mainly
administered orally and each capsules produce 12 mg of alvimopan on anhydrous basis suspended in
the inactive component polyethylene glycol. Patients who are administered ENTEREG can suffer
constipation, dyspepsia, and flatulence. This is primarily used to eliminate postoperative ileus after
minor or significant resection of the intestine and accelerates the regeneration of the gastrointestinal
tract (Leissner et al., 2017). In exploratory experiments in healthy participants, alvimopan 3 mg three
times daily tended to minimize the gap in gastrointestinal movement of morphine 30 mg twice daily
as assessed by radiopaque markers.

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