Clinical Integration

This article discusses the nursing care goals and interventions for peritonitis patients in the emergency department of laparoscopic surgery. It covers the procedural involved in the technique to handle the pharmacology, culture, physiology, pathology and ethical measures of a registered nurse in the surgical department. The paper shows the establishment of goals, logical sequence, legal-ethical, evidence-based and quality person-centered care approach.

Running head: CLINICAL INTEGRATION 1
Clinical Incorporation
Student’s name
Professor’s name
Institution Affiliation
Date

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Introduction
Cultivating the sensitivity of health care to Patients' requirements and demands is quite
challenging in healthcare situation like in Melody’s case. Therefore, the expectations and
experiences of the patient in health care are progressively explored using the survey among
patients, focus group meetings, interviews and the outcomes of which are applied to motivate
change in care delivery. Nurses are liable to provide the patients with high-quality care. For
instance, Ms. Melody is suffering from Peritonitis which requires keen attention of the nurse. If
the nurse does not give keen attention to her, the conditions may worsen. They are faced with
some ethical tasks in their professional practice, so they need to be acquainted with ethical codes
of conduct and the basics of ethical decision making. The nurses' ethical, legal, profession code
of conduct as it pertains to their work, nursing problems, as well as relevant and realistic goals
and set objectives towards patients' care, will be evaluated, analyzed and discussed in the easy.
The clear overview and description in this easy is demonstrated based on the clinical reasoning
cycle.
(a). consideration of the patient's situation.
According to Melody's emergency situation, it is quite important to quantitatively
measure, evaluate and elaborate via physical and some chemical examination the main cause of
the pain. The information recorded was blood pressure, respiratory rate, temperature pulse rate
information, skin color, moisture, white blood cells count and also the investigation of the status
of the peritoneal membrane (Yu, Hamill, Liley & Hill, 2013).
(b). Data collection

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Ms. Melody's presented complains after she was admitted to the emergency department;
severe abdominal pain in the right lower quadrant, which called for laparoscopic surgery to
remove the appendix. Her current complains about the prescribed medication that included
Seretide, sertraline, and Ventolin. She also reported centralized abdominal pain that read 7- 8
from the medical scale of 0- 10. Ms. Melody's history of medication were asthma and depression
complications. After the physical assessment, it was observed that she had a swollen abdomen
and general abdominal guarding. Other observations from her body changes included; HR 120,
38.3 degrees Celsius, SpO2 95% at the room air, BP 95/45mmHg and shallow RR22/min. It was
realized that she had increased white blood cells count from further treatment examination
(Binda et al., 2012). All the information was recorded and used to investigate the type of
treatment that was required after the laparoscopic surgery.
(c). Processing the information gathered
After the proper interpretation and analysis of the current patient's symptoms, complaint's
information, the assessment observations and according to her history, the pathologist deduced
that Ms. Melody suffered from Peritonitis due to the ruptured appendix. Peritonitis is a chronic
or acute swelling of the peritoneum membrane which covers the abdominal cavity and other
splanchnic (Dahabreh, Steele, Shah & Trikalinos, 2015). The disease is known to decrease the
intestinal mortality and result to distention of intestine with gas. When the intestinal mortality
reaches 10% can result in death due to bowel obstruction. Nursing care necessary for a peritonitis
patient is frequent monitoring and measures to avoid the spread of the disease or further
complications. The six nursing care plans for peritonitis that a registered nurse has to prioritize
on includes; handling the acute pain, fear and anxiety, risk of infection, dangers of the
unbalanced diet, adequate fluid volume and sufficient knowledge. Some of the infection risks

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include immunosuppression, insufficient primary defense, and invasive procedures. According to
the history of diagnosis of peritonitis the patient's signs and symptoms in rare cases are
unpredictable and the most appropriate recommended way of preventing the disease is through
nursing interventions (Bansal et al., 2014).
(d). The problem
The experimentation and examination of the obtained specimen from the wound culture,
serial blood and urine to monitor the cause of the infection were carried out. The experiment was
to determine and identify the causative agent of the disease and help in assessing the
effectiveness of the antimicrobial regimen. Registered nursing handling the peritonitis patient has
to maintain a sterile technic when providing catheter care and always ensure cleaning of perineal
on a daily basis to prevent bacterial growth in the urinary path (Warady et al., 2012). A nurse has
to control visitors including the staff and family members in an appropriate way to reduce the
exposure risk or secondary infection to the immunocompromised patient. The microbial agent
identified to be the cause of the problem are clindamycin, amikacin, and gentamicin through
peritoneal membrane.
The therapy through the data and information collected showed that the gram-negative
bacteria called bacilli which is aerobic was necessary for the disease. The lavage process is
useful in removing the necrotic debris and to treat the inflammation of poorly diffused peritoneal
membrane (Gill, Switzer, Driedger, Shi, Vizhul, Sharma & Karmali, 2012). Some of the cause of
pain to the patient is due to the postoperative laparotomy surgery. The patient requires proper
nursing interventions because of the hyperglycemia condition that may result from the lack of
knowledge on the disease and poor diet.

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(e). The nursing goals
The first nursing goals is to reduce the level of pain for the patient. Ms. Melody king has
lower abdominal pain which requires attention of the nurse to relieve the pain and the nurse can
do this by administering antibiotics intravenously, but they can also be infused straight into the
peritoneum and it could be much helpful. Secondly, the nurse needs to restore fluid and
electrolyte balance for the patient. The nurse closely monitors and administers fluids to ensure
that they are as desired. Thirdly the nursing goal for a peritonitis patient is to prevent
complications that may occur as a result of the infection and finally, the nurse is required to
restore normal gastrointestinal (GI) functions for the patient to ensure that it was operating as it
should. Some of the nursing issues that arose during nursing management to the patient included
how to balance between the electrolyte and the fluid. Assessment in response to the
gastrointestinal functioning and controlling the increased pain in the patient were other major
issues. Another prominent issue was the risk for shock and secondary infections in relation to
hypovolemia or septicemia. Controlling the visitors’ movement to the patient was not an easy
exercise to a nurse as the family members were a bit radical to convince about the situation.
(Schultz et al., 2015).
(f). The nursing interventions for the target goals
Nursing interventions centered on the following measures. Pain management where
administration of antibiotics, analgesics and body positioning can help to reduce pain. The nurse
is supposed to ensure the patient maintains a strict aseptic method in caring for abdominal drains.
Cleanse with the appropriate solution. Monitor urine output and fluid the patient is taking.
Accurate recording of all intake and output could help in the assessment of fluid replacement
(Worni et al., 2012). This will ensure that the fluid balance in the body is maintained at the

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desired levels. The nurse administers and carefully monitors fluids. Drainage monitoring, the
nurse should monitor and record the character of the drainage postoperatively. The nurse should
perform and show the patient proper hand washing technique to minimize the risk of cross-
contamination and the spread of infection. Monitoring the patient's blood pressure levels. The
blood pressure for the patient is to be monitored by arterial line if the shock is present to avoid
any further complication and any other complication as indicated in her diagnosis history should
be thoroughly checked (Johnston, Arora, King, Bouras, Almoudaris, Davis & Darzi, 2015).
(g). Evaluation and Reflection.
By considering the individual common risk factors such as peritoneal dialysis, acute
appendicitis, and abdominal trauma can help to increase the effectiveness of the treatment for the
patient. Application of quality and efficient nursing ethics and experience in sterilizing the
process of the patient medication is the best choice in such an emergency situation. Regular
monitoring and taking measures on the vital changes in the signs and symptoms of the patient are
very influential (Wigg, McCormick, Wundke & Woodman, 2013). Noting and recording the
hypotension progression, fever, tachycardia, tachypnea and decreased pulse pressure are
essential signs of imminent septic shock. To improve the insufficient volume of the body fluid
intervention on the endotoxins circulation that produces vasodilation which promotes low output
state by ensuring the airways are operational (Ignatavicius, & Workman, 2015).
It is crucial to note the changes in the patient's mental status like stupor,
discombobulation and cognitive sense. Hypotension, acidosis, and hypoxemia are the significant
changes to check on for they are responsible for impairing psychological condition. Monitoring

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the urine output can assist in oliguria prevention that results from decreased perfusion in the
renal, toxins circulation and as the consequences of antibiotics (Nygren, Thacker, Carli, Fearon,
Norderval, Lobo & Ramirez, 2013).
Conclusion
The easy elaborate how to apply quality and efficient nursing care goals both at prior and
postoperative interventions in the emergency department of laparoscopic surgery during the
treatment a peritonitis infection. The easy illustrate the procedural involved in the technique to
handle the pharmacology, culture, physiology, pathology and ethical measures of a registered
nurse in the surgical department. The paper shows the establishment of goals, logical sequence,
legal-ethical, evidence-based and quality person-centered care approach.
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