NRSG370 - Clinical Integration - Assignment

NRSG370 - The current essay contemplates the collection of data, considerations for the patient, and the evaluation of the information collected. Further, the essay sets down the priorities in the nursing plan along with interpreting the outcomes of the action plan for the execution of the nursing priorities. The current project involves the application of the clinical reasoning model for the assessment of clinical nursing needs and priorities for Ms. Melody King, for whom postoperative laparoscopic surgery nursing intervention was undertaken.

Nursing Assignment 1
Nursing Assignment
Student's Name:
Instructor's Name:
Date:

Nursing Assignment 2
Case study clinical reasoning
Introduction:
The profession of nursing comprises of several elements of practice, experience,
and technical and professional expertise (Levett-Jones, 2013). The practice of
clinical reasoning is one of the most crucial elements in nursing clinical practice. The
primary reason for this is that the duties of the nurse are greatly dependent on the
logical reasoning cycle that is adapted by nurses in order to prioritise the critical
nursing goals, establish appropriate nursing goals, design a plan of action, and
evaluate the patient outcomes and the results achieved out of the action plan
(Nackaerts, Heremans, & Vervoort, 2016). Nurses are essentially required to apply
reasoning and logical prioritization to establish the needs of the patient and plan
nursing interventions to address the specific concerns of the patient.
The current project involves the application of the clinical reasoning model for the
assessment of clinical nursing needs and priorities for Ms. Melody King, for whom
post-operative laparoscopic surgery nursing intervention was undertaken. The
current essay contemplates the collection of data, considerations for the patient, and
the evaluation of the information collected (Levett-Jones, 2013). Further, the essay
sets down the priorities in the nursing plan along with interpreting the outcomes of
the action plan for execution of the nursing priorities.
1. Considerations for the patient:
The patient, Melody King, is a 36-year-old female patient admitted for peritonitis
following appendix rupture. She presented with severe pain in the lower left quadrant
of the abdomen to the emergency department, as she had been experiencing the

Nursing Assignment 3
pain for about 3 days’ time. She underwent emergency laparoscopic surgery for the
removal of the appendix which was ruptured.
Melody is currently in the post-operative unit and her medical observations, physical
examination, and medical history have to be considered. Patient information has to
be retrieved from the concerned physician and surgeon.
2. Collection of information and cues from patient history and
presentations:
The patient information indicates that Melody presents with a history of depression
and chronic asthma and respiratory disorders. She is currently taking compliant
medications including Ventolin and Seretide for asthma and sertraline for the
treatment of depression.
The physical examination details for Melody indicate a low blood pressure value of
95/45 mmHg; increased heart rate of 120 beats per minute; elevated body
temperature of 38.3 degree Celsius; slightly elevated or borderline respiratory rate of
22 breaths per minute; near-normal SpO2rate of 95%, since Melody has asthma, the
value can be considered normal.
Melody additionally complains of nausea and a pain in the central abdominal region
of an approximate rating of 7 or 8 on a scale of 10. Records of physical examination
indicate distension in abdominal region. The lab reports of histology and pathology of
the patient indicate elevated levels of white blood cells (WBC) and c-reactive protein
(CRP).
3. Analysis and processing of the obtained information:

Nursing Assignment 4
Melody presented with lower left abdominal pain of a severe range to the emergency
department. She has undergone laparoscopic removal of ruptured appendix.
Additionally, she has a considerably strong history of depression and asthma and is
undergoing treatment for them. Post-laparoscopic surgical nursing involves the
monitoring and treatment of subsequent pain, monitoring adverse effects due to the
chronic medications and the current post-surgical situation of the patient, keeping a
check on the physical examination and pathological reports, and monitoring and
treatment for elevated CRP and WBC levels. The patient complains of centralised
pain in the abdomen. Additionally, the distension in the abdomen presents higher
complication.
In the current scenario, it is important to monitor the effects of Ventolin, Seretide, and
sertraline on the current abdominal pain, WBC, and CRP levels (Monticone et al.,
2015). The patient has undergone laparoscopic surgery and may have sepsis or
septic shock. The primary intervention that is required includes fluid resuscitation
(Kojovic et al., 2012). The levels of CRP act as a biomarker, useful for the indication
of the patient condition and health status in terms of inflammation present in the
body. Elevated levels of CRP indicate the possible conditions such as trauma,
infections, inflammation, cardiovascular risk etc. (Cross, Warner, Young, & Weiand,
2012). In the case of Melody, there may be the presence of inflammation at the site
of surgery or a septic shock due to which, there is an increase in the levels of CRP
produced in the liver. There is a likelihood of trauma in the surgical site and the
elevated levels of WBCs in the blood also indicate an immune reaction to trauma or
injury at the site of surgery (Ridker, Kastelein, Genest, & Koenig, 2013). The
increase in the levels of WBC is known as the condition of leucocytosis and is a
result of trauma or the presence margination of neutrophils or the condition of

Nursing Assignment 5
neutrophilia. The amount of increase in the WBC count indicates the severity of
injury to the organ (Bonacina, Baragetti, Catapano, & Norata, 2013). The condition of
leucocytosis is short in duration and typically lasts somewhere between a few
minutes to hours.
4. Identification of specific problems:
The case of Melody is complicated due to the various associated problems in the
patient. The nursing intervention must address the important concerns adequately.
The primary problems or concerns in the patient include:
a. Centralised abdominal pain and elevated levels of CRP and WBCs, indicating
trauma, injury, or sepsis in the surgical site
b. Nausea, low BP, and elevated respiratory rate, pulse, and temperature
c. Side effects of Ventolin, Seretide, and Sertraline in the increase of the
symptoms of abdominal pain and dysfunction
The patient has several complications due to the presence of ongoing compliant
medication and likelihood of trauma or injury at the site of surgery (Brenner, & Kautz,
2015). The nursing concerns include the elimination and treatment of the injury and
monitoring regular medication and associated adverse events.
5. Establishment of nursing goals:
The increased level of WBC and CRP increase the suspicion of blunt trauma or an
occult injury at the site of operation (Tabatabaie, Maleki, & Talebpour, 2017). The
priorities of nursing care for Melody therefore constitute the main goals of:
a. Assessment of injury or trauma and execute the treatment plan for the trauma
and leukocytosis

Nursing Assignment 6
b. Provide adequate care for abdominal pain, nausea, BP, raised temperature
and pulse
c. Monitor the side effects of Ventolin, Seretide, and Sertraline.
The three primary nursing goals have almost the same degree of importance. All the
three priorities are equally crucial. However, the highest priority is given to the
determination of trauma as indicated by the CRP and WBC biomarkers.
6. Action and execution:
The nursing intervention needs to focus on the post-operative care for the patient.
These interventions include resuscitation and disinfection to microbial infections.
a. Directing the patient to the concerned physician for the examination or
radiology to determine the presence of trauma or injury and subsequently
follow the treatment prescribed by the physician for the treatment of the
trauma
b. Providing continuous fluid resuscitation to the patient and maintaining sterility
and provision of prophylactic interventions to the patient experiencing
complications related to the surgery and related trauma or injuries.
c. Monitoring abnormalities in the physical examination observations including
heart rate, pulse, blood pressure, and body temperatures (Philips et al.,
2013).
d. Monitoring the effects of Ventolin, Seretide, and Sertraline.
The intervention primarily focuses on the post-operative care for the patient along
with providing ample support and resuscitation. The elimination of trauma and
related pain along with immune reactions such as increased pulse, body

Nursing Assignment 7
temperature, and reduced blood pressure are of critical importance (Sista et al.,
2013).
Ventolin and Seretide can cause nausea and increase in body temperature.
Sertraline can lead to pain sensation in most situations. Therefore, the doses and the
particular reactions to these drugs have to be constantly monitored.
7. Outcomes of the action and evaluation:
The observations in the patient records indicate the following outcomes of the
intervention:
a. Leukocytosis has reduced and the WBC count is within the normal range. The
trauma was detected and treated according to the instructions of the
concerned physician
b. The physical examination values of blood pressure, BP, pulse, and respiratory
rate are borderline-normal. The complaints of nausea and pain are mostly in
control upon continuous monitoring with the intake of compliant medications
such as Ventolin, Seretide, and Sertraline.
8. Reflections of the nursing experience:
The current experience in the case of Melody was particularly challenging due to the
number of complications and associated medical concerns. This case has served as
the perfect example for the importance of the clinical reasoning model. The case
seemed exasperating at first due to the high number of complications and the
presence of leukocytosis and increased CRP. However, the clinical reasoning model
made it possible to enumerate the specific patient concerns and allot the priorities
according to the urgent concerns. The clinical reasoning model and logical analysis
of the concerns of the patient, the trauma or the injury, and the related concerns

Nursing Assignment 8
enabled timely treatment for the patient. Nursing care includes sound technical
knowledge and reasoning for the appropriate identification of nursing priorities.
Conclusion:
The concept of clinical reasoning is one of the crucial elements of nursing care.
Interventions for the care of post-operative laparoscopic patients require technical
knowledge and abilities to assess the physical examination and surgical reports of
the patient. In cases of continual chronic medications for a particular patient, the
drug interactions and adverse effects have to be monitored and prevented. The
concept of clinical reasoning provides a holistic ground for the analysis and
identification of patient concerns along with enabling the appropriate course of action
for the nurse.

Nursing Assignment 9
References
Bonacina, F., Baragetti, A., Catapano, A.L. & Norata, G.D. (2013). Long pentraxin 3:
experimental and clinical relevance in cardiovascular diseases. Mediators of
Inflammation, 2013, 1-10
Brenner, P. & Kautz, D.D. (2015). Postoperative care of patients undergoing same-
day laparoscopic cholecystectomy. AORN, 102, 16-29
Cross, M.B., Warner, K., Young, K., Weiand, A.J. (2012). Peripheral sympathectomy
as a novel treatment option for distal digital necrosis following parenteral
administration of promethazine. HSS J., 8(3), 309-312.
Kojovic, M., Bologna, M., & Kassavetis, P. et al., (2012). Functional reorganization
of sensorimotor cortex in early Parkinson disease. Neurology, 78(18), 1441–
1448
Levett-Jones, T. (Ed.), (2013). Clinical reasoning: learning to think like a nurse.
Sydney, Australia: Pearson
Miller, C. A. & Hunter, S. (Ed.), (2012). Nursing for wellness in older adults. Sydney,
NSW: Lippincott Williams & Wilkins
Monticone, M., Ambrosini, E., Laurini, A., Rocca, B., & Foti, C. (2015). In-patient
multidisciplinary rehabilitation for Parkinson’s disease: a randomized
controlled trial. Movement Disorders, 30(8), 1050–1058
Nackaerts, E., Heremans, G. Vervoort et al., (2016). Relearning of writing skills in
Parkinson’s disease after intensive amplitude training. Movement Disorders

Nursing Assignment
10
Phillips, N.M., Street, M., Kent, B., Haesler, E., & Cadeddu, M. (2013).
Postanaesthetic discharge scoring criteria: key findings from a systematic
review. Int J Evid Based Healthc., 11(4), 275-284.
Ridker, P.M., Kastelein, J.J.P., Genest, J. & Koenig, W. (2013). C-reactive protein
and cholesterol are equally strong predictors of cardiovascular risk and both
are important for quality clinical care. European Heart Journal, 34, 1258–1261
Sadati, L., Pazouki, A., Mehizadeh, A., Shoar, S., Tamannaie, Z., & Chaichian, S.
(2013). Effect of preoperative nursing visit on preoperative anxiety and
postoperative complications in candidates for laparoscopic cholecystectomy:
a randomized clinical trial. Scand JCaring Sci., 27(40), 994-998.
Sista, F., Schietroma, M., Santis, G.D., Mattei, A., Cecilia, E.M., Piccione, F., Leardi,
S., Carlei, F., & Amicucci, G. (2013). Systemic inflammation and immune
response after laparotomy vs laparoscopy in patients with acute cholecystitis,
complicated by peritonitis. World J Gastrointest Surg, 5(4), 73-82
Tabatabaie, O., Maleki, S., & Talebpour, M. (2017). Leukocytosis and neutrophilia
after laparoscopic gastric placation. Acta Chirurgica Belgica, 117(2), 99-103
Ting, L.H., Chiel, H.J., Trumbower, R.D. et al., (2015). Neuromechanical principles
underlying movement modularity and their implications for rehabilitation.
Neuron, 86(1), 38–54