Clinical Assessment Case Study Assignment

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

2CLINICAL ASSESSMENT: CASE STUDY
Answer 1:
The development of the clinical learning method (Hunter & Arthur, 2016) involves an
evaluation of the state of the individual. Edward (Ted) Williams 82 is postoperative and has an
irregular colostomy that can impact various aspects of his life. The RLT clinical approach
focuses on day-to-day daily practices (ADLs) and interventions to enhance patient safety and
quality of life (Roper, Logan & Tierney, 2009). The RLT nursing model (Williams, 2017)
describes the ability of patients within the sense of their age, their element of risk as well as the
main variables in the nature of the care program. Cognitive and behavioral struggles Ted may
experience might involve in developing low self-esteem, anxiety, negative outlook, or feeling
prone to stoma. It is likely to exacerbate relationship issues and distress (Jayarajah &
Samarasekera, 2017). He could have sexual anxiety and depression. It is more likely that
possessing a stoma will allow Ted to try personalized attention, stoma treatment and thereby
becoming quite comfortable and reliant on his ADLs (Williams, 2017). Also even if though, Ted
has a girlfriend who's only a couple years younger than him but he always seem to be depressed.
Psychological and social reform may limit his social network and leisure time, as Ted will also
be unable to make sense of mental wellbeing loss. The case analysis reveals that Ted has a friend
called Gwen that lives in the same retirement center. He may be concerned about having him in
this state. The psychological effect of creating a stoma is shown dramatically in various cultures.
The other factors might have an effect on the reality that Ted was a widow and would miss his
wife and children.

3CLINICAL ASSESSMENT: CASE STUDY
Answer 2:
The case analysis reveals that Ted had only undergone surgery after an intestinal
resection and a partial colostomy. In fact, it was historically shown to include a malignant mass
after performing colonoscopy and biopsy, severe cardiac disease, type II diabetes mellitus,
obesity and gout. During this step of the CRC (Hunter & Arthur, 2016), nurses will carefully
examine Ted's past medical history, disease context, current treatment plan, study results, and
vital signs.
Observing the case report, it was observed that Ted displayed symptoms of sickness
when he was offered his diabetes medication on the fourth day of his operation. The
exceptionally high vital signs signify the existence of some type of infection. The nurse can
therefore remember the perioperative regulation of fluids and electrolytes. It is very important to
have adequate preload to the heart to boost pulmonary contractility and cardiac efficiency, often
referred to as Plasma Volume Management (EDWARDS & GROCOTT, 2015). Optimal
intravascular volume is also necessary for maximum possible supply of oxygen to the tissue. The
case study also provides evidence that Ted was said to have vomited twice, and he felt nauseous.
Since Ted was postoperative, he has had no improvement after surgery. This is also
known that gastrointestinal motility failure may have occurred, most definitely due to intestinal
resection surgery, which can be also referred to as postoperative ileus (Venara et al., 2016).
Nurses can know as mentioned above some of the possible conditions that Ted is most likely to
suffer from. It is a condition that varies between intestinal distention and lack of digestive
sounds. Ted has a distended neck, as well as sluggish abdominal effects. Postoperative ileus is
also characterized by accumulation of gas in the GI tract, resulting in compromised absorption
and flattened activity, as with Ted. Medications are mainly used to relieve pain, which can also

4CLINICAL ASSESSMENT: CASE STUDY
improve the risk of post-operative ileus. In terms of pathophysiology, the surgical procedure
stimulates the afferent nerves due to the incision made. Diarrhoea and vomiting (Doenges,
Moorhouse & Murr, 2016) are also the main signs of the illness. Surgical activation of the
macrophages leads to the entry through the body of infectious agents such as neutrophils and
monocytes. Degeneration of sympathetic / parasympathetic nerves in the gastrointestinal tract
leads to a subsequent extended duration of inflammation.
There is a broad variety of factors that may lead to the creation of coarse crackles.
Nevertheless, it is necessary to remember that Ted has a history of heart problems, and he is
currently on Captopril medication, which is often prescribed for congestive heart failure. Ted's
second critical obstacle could be attributable to his highly inspiring crackles and debilitating
cough. Symptoms have been seen to improve in patients with CHF after significant surgery, such
as intestinal resection. CHF can often cause pulmonary oedema (Purvey & Allen, 2017)
suggesting that fluid has been deposited in the alveolar area. The pathophysiology means that,
because the heart cannot control correctly, the blood means found in the veins that carry the
blood into the lungs. This causes in aggressive palpitations, cough and optimistic crackles, most
of which becomes evident in the case of Ted, such as hypertension. Pulmonary oedema (Purvey
& Allen, 2017) is the major driving source of serious crackling in the patient. When blood
pressure is raised, the fluid may be squeezed into alveolar space, creating pulmonary oedema. It
may indeed be attributed to influenza, however also Ted has a previous record with heart disease,
which is believed to be the primary factor in his situation.

5CLINICAL ASSESSMENT: CASE STUDY
Answer 3:
When Ted mentions difficulties with extracting stools, his intestines should not have been
swollen to op because he was still on opioids. Regulation and preparation of health facilities
(Ambe et al., 2018) for people with ileostomy or colostomy includes: assisting individuals and/or
communities through transition, avoiding accidents, promoting self-care, sharing details on
procedures / prognosis, medical problems and future concerns. Nurses will establish goals for
supplying Ted with the appropriate treatments in accordance with the next phase in the CRC.
The purpose of palliative care is to take care of his postoperative ileus and pulmonary edema.
 Post operative ileus (Zhang & Xu, 2017) will be managed with assistance and regular
supervision in certain cases. When evaluating the dietary routine and quantity, the type of
fluid intake needs to be measured for adequate fiber intake and the roughage creates a
bulk of the fluid, and the consistency of the stool should be determined. Disrupted
incidence or absence of effluent combined with auscultated intestinal sounds is
sometimes observed. Delay may indicate persistent ileus or stoma obstruction that may
occur postoperatively due to oedema, which is improperly suited to the pouch.
 The condition might also lead to extended hospital stays and higher costs which can
trigger discomfort to the patient. Throughout this level, nurses are vitally required to
empower and support them during their care . Nurses are also called in to inform him of
his postoperative state. Encouraging Ted to verbalize his emotions about ostomy, as well
as to acknowledge the normality of feelings of disappointment and sorrow, would be
ensured. This allows the person to realize that feelings are not rare and that it is not
necessary or helpful to feel bad about them. Although integrating the stoma (Arvelos
Mendes et al., 2018) into the outward image may take months or even years, gazing at the

6CLINICAL ASSESSMENT: CASE STUDY
stoma and making observations (made in a normal, analytical manner) can assist the
patient with this identification.
 Nursing staff may very well encourage and empower Ted to sit upright with an elevated
head to avoid a prolonged sitting (Doenges, Moorhouse and Murr, 2016). These should
help to promote the drainage of perineal wounds / drains and raising the risk of pooling.
Repeated sittings have been shown to induce perineal pain, reduce wound leakage and
improve slow healing.
 Necessary intravascular volume is also needed to provide sufficient oxygen to all tissues
(EDWARDS & GROCOTT, 2015). The additional volume of interstitial fluid may also
have a detrimental effect on the availability of tissue oxygen, because this may contribute
to oedema, decreased oxygen diffusion wavelengths and microvascular tension.
 In most cases with routine assistance and frequent supervision, Postoperative ileus
(Zhang & Xu, 2017) can be monitored. When evaluating the dietary routine and quantity,
the type of fluid intake needs to be measured for adequate fiber intake and the roughage
creates a bulk of the fluid, and the consistency of the stool should be determined.
Disrupted incidence or absence of effluent combined with auscultated intestinal sounds is
sometimes observed. Lag time may indicate persistent ileus or stoma obstruction that
may occur postoperatively due to oedema, which is improperly suited to the pouch.
Answer 4:
Another drug that can be used to treat postoperative ileus is methylnaltrexone, which is
branded as Relistor (Schwenk et al., 2017). When shown in the case report, Ted recovers from
pain and constipation, this medication could be recommended for the management of opioid-

7CLINICAL ASSESSMENT: CASE STUDY
induced constipation (OIC) in patients with advanced disease who are seeking palliative care
where the reaction to laxative therapy has been insufficient (Janku et al., 2016). The use of
opioids allows gastrointestinal motility and movement to slow down. The adverse effects might
include making the patient feel dizzy and nauseatic. In extreme cases abdominal pain and
flatulence is also observed in the patient.
Metoclopramide is commonly employed as an antiemetic and as a way of promoting the
nasoduodenal feeding tube. Metoclopramide works by promoting gastric emptying and by
inducing gastric, pyloric and small-bowl muscle motions that have little to no impact on the
colon (Acosta & Camilleri, 2015). It is considered as a prokinetic agent (Agah et al., 2015) that
can potentially be used to control POIs. A longitudinal, randomized study of metoclopramide
tested in 100 patients who underwent elective abdominal colorectal surgery to shorten the length
of ileus during colorectal surgery (Thiele et al., 2015). The drug was administered through via
intravenous pathway every 8 hours from the conclusion of the procedure until and unless
a proper diet was regimed. Metoclopramide has been shown not to dramatically alter the POI
path (Liu & Abell, 2017). Double-blind, monitored 60-patient study found that metoclopramide
had an adverse impact on POI resolution. It should be borne in mind that metoclopramide can
induce intubation, symptoms of motor agitation and other autonomic dysfunction reactions.

8CLINICAL ASSESSMENT: CASE STUDY
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