Clinical Assessment: Case Study

Purpose: This is a summative written assignment based on a surgical case study requiring appraisal of an individual’s holistic health care needs and subsequent interventions and management to assist with the application of theory into practice. Length : 1800 words +/- 10% References: articles should be only current peer-review. Between 2015-2020. And references should be on APA 6th edition. Amount of references: atleast 10 references are needed I have attached the questions, case study and marking rubric down below.

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

1CLINICAL ASSESSMENT: CASE STUDY
Answer 1:
The layout of the therapeutic learning approach (Hunter & Arthur, 2016) includes the
determination of the individual's status. Edward (Ted) Williams 82 is postoperative and has an
abnormal colostomy that may impact different facets of his life. The RLT therapeutic strategy
reflects on the daily activities (ADLs) and strategies to increase patient health and quality of life
(Roper, Logan & Tierney 2009). The RLT nursing model (Williams, 2017) explains the potential
of patients within their age, their risk factor and the key factors in the design of the care system.
Physiological and psychological challenges Ted can suffer poor self-esteem, fear, pessimistic
attitude, or feeling vulnerable to stoma. Relationship problems and depression are expected to
escalate (Jayarajah & Samarasekera, 2017). He may have sexual insecurity and depression. It is
more likely that having a stoma would encourage Ted to seek personalized care, stoma treatment,
and thus become more relaxed and dependent on his ADLs (Williams, 2017). Even though, Ted
has a girlfriend who's just a couple years younger than him, so he still seems to be sad.
Psychological and social change could restrict its social network and leisure time, because Ted
would also be unable to make sense of the lack of mental well-being. The case study reveals that
Ted has a wife named Gwen who stays in the same retirement facility. He may be worried about
keeping him in this environment. The therapeutic impact of developing a stoma is seen
significantly in various societies. The other considerations may have an impact on the realization
that Ted was a widow and that he would miss his wife and children.

2CLINICAL ASSESSMENT: CASE STUDY
Answer 2:
The research conducted on the cases study indicates that Ted has never received
operations following abdominal resection and partial colostomy. In addition, it has traditionally
been found to contain a malignant mass following colonoscopy and biopsy, extreme cardiac
failure, type II diabetes mellitus, obesity and gout. Throughout this step of the CRC, nurses
should closely analyze Ted's previous medical background, illness meaning, new recovery
strategy, outcomes of tests, and vital signs. Analyzing the case study, it was found that Ted had
signs of disease when he was given his diabetes meds on the fourth day of his surgery. The case
report also offers proof that Ted was said to have vomited frequently and felt nauseated.
Exceptionally high vital signs suggest the presence of a form of infection. Therefore, the nurse
should note the perioperative control of fluids and electrolytes. It is also necessary to provide
sufficient preloading of the heart to improve pulmonary contractility and cardiac efficiency, also
referred to as Plasma Volume Control (EDWARDS & GROCOTT, 2015). Appropriate
intravascular volume is also required for the highest possible supply of oxygen to the tissue.
Even though Ted was postoperative, there was no difference after surgery. It is also
established that gastrointestinal motility dysfunction may have arisen, most likely due to
intestinal resection surgery, and can also be referred to as postoperative ileus (Venara et al.,
2016). Nurses recognizes, as described above, some of the problems that Ted is most likely to
recover from. It's a disorder that differs with gastrointestinal and abdominal swelling and absence
of digestive sounds. Ted has a distensive back, as well as slow abdominal effects. Postoperative
ileus is often marked by aggregation of gas in the GI tract, which results in decreased absorption
and flattened activity, as with Ted. Medications are mainly used to alleviate discomfort, but can
often reduce the likelihood of post-operative ileus. In terms of pathophysiology, the medical

3CLINICAL ASSESSMENT: CASE STUDY
operation activates the afferent nerves prior to the incision. Diarrhoea and diarrhea (Doenges,
Moorhouse & Murr, 2016) are among the primary symptoms of the disorder. Surgical
stimulation of macrophages contributes to the entrance of infectious agents such as neutrophils
and monocytes into the body. Degeneration of sympathetic / parasympathetic nerves in the
gastrointestinal tract contributes to a corresponding extended period of inflammation. The next
crucial concern that Ted can face relates to his motivating crackles and persistent cough. There is
a broad variety of factors that may contribute to the development of positive, coarse crackles.
Nevertheless, it is important to note that Ted has a history of cardiac disease and is still on
Captopril treatment, also used for Congestive Heart Disease. It has been shown that symptoms
can improve in patients with CHF following major surgery, such as intestinal resection. CHF
may also induce pulmonary oedema, which indicates that fluid has collected in alveolar space.
This adds to painful cough, shortness of breath, and inspiring crackles, some of which are
apparent in Ted's situation, like hypertension. As for pathophysiology, this also happens because
the heart cannot work properly, so the blood rises up through the veins that bring the blood into
the lungs. Pulmonary oedema (Purvey & Allen, 2017) is the main cause of extreme cracking in
the individual. If blood pressure is elevated, the fluid can be squeezed into alveolar volume,
causing pulmonary oedema. It can also be due to influenza, but Ted still has a prior record of
heart failure, which is assumed to be the key cause in his condition.
Answer 3:
Although Ted discusses problems in removing stools, his intestines would not have been
bloated to op as he was already on opioids. Nurses must establish goals for the provision of
necessary therapies to Ted in conjunction with the next step of the CRC. The aim of palliative

4CLINICAL ASSESSMENT: CASE STUDY
treatment is to take control of his postoperative ileus and pulmonary edema. Regulation and
planning of health facilities (Ambe et al., 2018) for persons with ileostomy or colostomy
includes: helping individuals and/or families during adjustment, preventing injuries, encouraging
self-care, exchanging information of procedures / prognosis, medical conditions and potential
issues.
 When measuring the dietary regimen and volume, the amount of fluid consumption needs
to be assessed for sufficient fiber intake and the roughage produces a bulk of the fluid and
the quality of the stool needs to be calculated. The condition Postoperative ileus (Zhang
& Xu, 2017) can be tracked in most situations with regular assistance and constant
monitoring. Destabilized occurrence or lack of effluent especially in combination with
auscultated intestinal sounds has often been witnessed. Lag time may suggest chronic
ileus or stoma obstruction that may arise postoperatively due to oedema that is poorly
fitted to the pouch.
 Nursing workers can very well urge and motivate Ted to sit upright with a raised head to
prevent repeated sitting (Doenges, Moorhouse and Murr, 2016). This will aid to facilitate
the discharge of perineal wounds/drains and raise the chance of pooling. Repeated
treatments have been shown to cause perineal discomfort, reduce wound bleeding and
enhance sluggish healing.
 Postoperative Ileus is the biggest issue that Ted is experiencing. The therapies are aimed
at restoring gastrointestinal function to normal. They involve nasogastric suction.
Nasogastric suction (Stakenborg, Gomez-Pinilla & Boeckxstaens, 2016) applies to
squeezing rid of some intestinal obstruction and has also been seen to be effective in
postoperative ileus. It can be used by physicians in conjunction with other medical

5CLINICAL ASSESSMENT: CASE STUDY
strategies. This involves intraveinous hydration. Because the individual cannot handle a
fluid diet or a light diet, nutrition and hydration must be given intravenously. Therefore,
Ted has to be issued intravenous medication so that he can receive his correct nutrients.
 The disorder can also contribute to lengthy hospital stays and increased expenses that can
add pain to the individual. Nurses are vitally important at all rates to motivate and sustain
them through their treatment. Nurses are often called to remind him of his postoperative
status. Motivating Ted to articulate his thoughts about ostomy, as well as to understand
the rationality of feelings of despair and sorrow, will be assured. It makes it easier for a
person to understand that emotions are not uncommon and that it is not important or
beneficial to feel bad about them. Because the incorporation of the stoma (Arvelos
Mendes et al., 2018) into the external picture may take months or even years, gazing at
the stoma and making findings (made in a natural, objective manner) may assist the
patient with this recognition.
 Training and awareness are the primary nursing resources provided here. The patient has
recently endured a big operation, and they are suffering from postoperative complications
that can cause him pain. It is incredibly important at this point that the nurses encourage
and support him throughout the care. Nurses must also teach him about his postoperative
state. This would make it possible for him to feel more in charge and may will his
tension. This is critical to every patient who has undergone surgery (Arvelos Mendes et
al., 2018). Postoperative ileus also triggers prolonged hospitalizations and increasing
costs, and can be distressing for the individual. Ted's extended hospital stay could be a
source of tension. The nurses must then be compassionate and provide Ted with

6CLINICAL ASSESSMENT: CASE STUDY
motivation. In terms of patient care, it must be clarified what protocols are being
practiced and why they are required.
Answer 4:
Opioid antagonists (Nair, 2019) operate on one or more opioid receptors to inhibit the
influence of opioids. Opioids cannot also have an effect on the environment. Naloxone is a
potential treatment that may be used on Ted to control his postoperative ileus. The drug will be
given intravenously to Ted, because it is typically unable to keep it together unless consumed
orally. Because this drug decreases the impact of drugs, it improves the risk of postoperative
morphine-induced ileus (Schwenk et al., 2017). It would make it easier for Ted to be handled.
This is used to counteract the dose of medication so that the influence of drugs that Ted has
already received reduces. This has a small risk of hurting a consumer, and it may be a good
medication to use. Peripherally specific opioid antagonists, such as methylnaltrexone and
alvimopan, can also be used. However, alvimopan is also correlated with an elevated likelihood
of heart disease, and because Ted has a history of cardiac problems, this drug should be
prevented (Zhang & Xu, 2017).
Metoclopramide is widely employed as an antiemetic and as a way of supporting the
nasoduodenal feeding tube. ). This is known to be a prokinetic agent (Agah et al., 2015) and may
theoretically be used to monitor POIs. A retrospective, randomized analysis of metoclopramide
studied in 100 patients undergoing elective abdominal colorectal surgery to reduce the duration
of the ileus during colorectal surgery (Thiele et al., 2015). The medication was delivered by an
intravenous route every 8 hours from the completion of the treatment before and until a healthy
diet was prescribed. Metoclopramide has been shown not to substantially change the POI system

7CLINICAL ASSESSMENT: CASE STUDY
(Liu & Abell, 2017). This should be taken into consideration that metoclopramide may induce
intubation, signs of motor disturbance and other autonomic impairment reactions.

8CLINICAL ASSESSMENT: CASE STUDY
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