Nsrg258: Principles of Nursing Surgical | Q&A

Running head: NRSG258: PRINCIPLES OF NURSING SURGICAL 1
Nsrg258: Principles of Nursing Surgical
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Institutional of Affiliation

NRSG 258: PRINCIPLES OF NURSING SURGICAL 2
First question
Mr. Ted is an 82-year-old patient who a surgery in the bowel resection after being
admitted to the hospital for several chronic illnesses. This was after which he was diagnosed
with an unhealthy dangerous mass in his bowel after an examination conducted to him. His
wife died three years ago for she was ailing from pneumonia and he is living solely in his
home after he retired. This is because his two grown-up children were already married and
for that particular reason, they lived far away from each other. He has spent in the hospital for
4 days after the surgery was carried out and for the first 2 days after that, he did eat any food.
He began eating for the first time after 3 days and the food was that which is not heavy but
composed of drinks and other light food (Justiniano et al., 2019).
He must have been lonely and have had felt being socially isolated. It is seen that Mr.
Ted has had chronic illnesses including hypertension, gout and diabetes type 2. For that
reason, he is on medication. It is shown that he uses these medicines daily to help him
manage the conditions he is having. Being that Mr. Ted is very old, he must be needing
someone just to help him do some work such as those of reminding him of when to take
drugs. For Mr. Ted, the loss of the functions of organs together with its cognitive decline has
been shown to accompany senescence processes. This might have led to him forgetting to
take his drugs which cumulatively affects his health drastically and negatively. The cultures
surrounding Mr. Ted must have affected him greatly. These factors have increased his
stressed status including other factors from where his children leaving him alone. The
detection of the mass in his bowel was somehow detected late. Some effects are affecting him
and the family at large following the scheduled surgery (Höhn et al., 2017).

NRSG 258: PRINCIPLES OF NURSING SURGICAL 3
Second question
To resolve the problem of malignancy which Mr. Ted is having, surgery on bowel
resection has to be carried out along the colon extending to the sigmoid. This patient vomited
twice after the four days of carrying out the surgery since he was feeling nauseated. This
patient had a higher respiratory rate than the normal known rate and this characteristic is
evident in patients who have had cases of diabetes and hypertension before. These
occurrences might have taken place due to the effects brought about by the surgery. Even
though oxygen saturation in blood was at the normal expected range, Mr. Ted had a high
blood pressure, a condition evidenced in patients who had suffered from diabetes and cardiac
arrest before (Chen et al., 2020).
The contents which are eaten are forced to be vomited out since the intestines have
collapsed as a result of the pressure which obstructs them. Due to the obstruction of the lower
bowel, there was the swelling of the stoma seen in the patient. The use of morphine also
inhibits or slows down the movement of the intestinal contents which hence obstructs the
lower bowel. This patient was therefore, undergoing severe abdominal pains which resulted
due to the administration of morphine in-situ to deal with pain-relieving. The nurse who is
attending to him should therefore, stop giving him any food or drinks since he is vomiting
from the time, he had surgery. They can also be advised to be taking note of the kind of food
Mr. Ted is given before carrying out the surgery. This will enhance the follow-ups and
determination of where the problem lies (Koning et al., 2017).
Mr. Ted had difficulties in breathing therefore, he was also diagnosed with respiratory
crackles. He was still complaining of abdominal pains even after being put once more in an
in-situ administration of morphine. He has had no output since the surgery was carried out
and it must have been due to the blockage of the lower bowel. Distention cases that were seen

NRSG 258: PRINCIPLES OF NURSING SURGICAL 4
in the patient was as a result of the bowel blockage. The blockage could have also caused the
noises in the bowel and vomiting instances. This instance of bowel blockage was mainly
caused by the accumulation of fluids and foods he was being given. Disorientation of the
processes of the digestive system such as peristalsis can be caused by the bowel blockage
hence causing the forcing of the food contents in the gastrointestinal tract near the mouth to
be pushed up. In addition to the pressure created by this process, abdominal distention and
pains are therefore, caused and this was evident in Mr. Ted (Li et al., 2019).
Due to vomiting, Mr. Ted’s urine output was low as compared to the normal range
known. This caused a lot of dehydration as a result of the loss of water in the body.
Assessment of his past medical history must therefore, be carried out by the nurses carefully.
This includes inquiries whether he had suffered from any complications which are evident
from previous surgeries. This will help the nurses to come up with appropriate ways of
coming up with proper treatment options and management choices suitable for the current
condition of this particular patient. Due to the missing information about the health records of
some of his children, the family's medical history should be carefully be assessed to have a
better plan of handling this particular case. Administration of metformin pills to this patient
should be regular to enhance a constant normal blood sugar together with preventing issues of
neuropathies and kidney disease (Khilnani & Joshi, 2013).
A pouch with a bigger opening should be reinstalled into this patient and the one in
the swollen stoma be taken out immediately. The nurses should as well take keen note of the
many medical complications which Mr. Ted has had before and is still having while
delivering any kind of medication whatsoever. His blood pressure needs to be closely
monitored since surgery causes the loss of a lot of blood. He has minimal oozing from his
incision which is normal after surgery, the excess would have indicated errors made during
surgery and this calls for immediate treatment. Mr. Ted also complained of having a