Nursing Care of the Surgical Patient | Assignment

Nursing care of the surgical patient
Introduction
Nursing care of the post-operative patient with the support of the clinical reasoning cycle aids
in making an accurate nursing diagnosis and care plan. It also improves patient outcome and
prevents postoperative complications. This assessment implements steps of clinical reasoning
cycle to critically analyse which includes consideration of the situation, collection of
information, processing gathered information, identification of a problem, the establishment
of goals, implementation of nursing intervention including two pharmacological
interventions.
Question 1
Consideration of patient situation is the primary step of the clinical reasoning cycle which
provides information about the present condition. In the case study, Ted is an elderly person
who had recently undergone bowel resection and the formation of temporary colostomy. His
personal history confirms that the patient is a widower, living alone in a retirement village.
His two children are grown up and live apart in the city. Ted has a partner Gwen 78 years old
lives in the same retirement village. Ted was suffering from various chronic diseases like
heart failure, diabetes mellitus, obesity and gout. Comprehensive discussion of the bio-
psychosocial, spiritual and cultural factors aids in understanding the bio-psychosocial needs
of the patient.
Ted is living alone in the retirement village which confirms that the patient is lacking the
family unit. Family supports the members to overcome the physical and mental issues.
Elderly people significantly need family support during hospitalisation. Ted is a retired
person. Retirement impacts the social position and contacts of an individual. Widowhood
makes the ageing painful. Men who lost his wife would suffer a loss of moral support and
nutrition supplement. In the case of Ted, retirement and widowhood affected the physical,

psychological and social health. Loss of income affects the liberty which may shrink the
social activities of the person. The retirement village that accommodates Ted is away from
the city which had prohibited him to drive to the city where his children live. It may also
affect the socialization, taking part in a family gathering and meeting friends.
Question 2
Collection of information is the vital step of the clinical reasoning cycle. Collection of family
history, past medical history present medical history and personal history, helps the nurse in
making a unique care plan for the patient. In the case study, Ted is an 82-year-old widower,
who had bowel resection and formation of temporary colostomy. He is a known case of heart
failure, diabetes failure, obesity and gout. Biopsy has confirmed the malignant mass. Ted was
on Nil per oral for 48 hours and gradually started with a light diet. After breakfast, Ted had
two episodes of vomiting and feeling nauseated.
On assessment, his vital signs were slightly elevated (Temp 38.1, HR 98/mt, RR 26/mt, BP
135/85mmhg) and reduced saturation with the 3L oxygen therapy through NP (SpO2 94%).
On auscultation, the patient has coarse crackles on the right side during inspiration. He has a
productive cough. Ted has complaints of abdominal pain which scores 4-5/10 which worsens
on palpation to 7/10. He has abdominal distension and the colostomy bag is intact. The stoma
is slightly elevated above the skin which had no output after the surgery. Has no output since
surgery and has slothful bowel sounds. He has slight ooze from the surgical site. He has a
medivac drain with 30mls of haemoserous fluid. His urine output is moderate.
Critical analysis of the Pathophysiology of the disease and cause for the present situation
helps the nurse in locating the diagnosis and establishing goals. The patient had a malignant
mass which was removed through the surgery called bowel resection. Colorectal rectal cancer
is the complicated disease which is associated with the genetic modification of the structure
and function. Chain of modification causes molecular and genetic actions to lead to

alterations in the adenomatous polyps to the malignant mass in the colon. The disease
originates from the outer layer of the colon which ends up in mutation.
Ted had undergone bowel resection surgery. On the fourth day of post-opp, he was started
with a normal diet. But he vomited twice after food intake and was feeling nauseated. Signs
and symptoms show that the patient is suffering from the post-operative complications that
commonly occur after bowel resection. Critical analysis of the signs and symptoms helps in
identifying the cause for the present situation. Loss of part of the bowel can impact the
balanced mechanism in the stomach. The condition is stated as small bowel syndrome which
can increase the bacterial growth, gastric acid and malabsorption of the gastric hormones
(Tappenden, 2014). Imbalance of gastric hormone induces the continuous secretion which
may cause the gut to be filled with gastric hormones. This condition may present with the
symptoms of bloating stomach, vomiting, nausea, increased flatulence, weakness and
heartburn.
Various other complications of bowel resection surgery are infection and bowel obstruction
(Johnson et al. 2016). The signs and symptoms of the patient show that the patient had
developed an infection. The colostomy stoma is slightly elevated. An increased vital sign
indicates the post-operative infection. Nausea and vomiting are the indications of bowel
obstruction which is one of the postoperative complications (Moon, 2014). On auscultation,
the patient has coarse crackles on the right side during inspiration and productive cough
which is the indication of postoperative pneumonia. Chronic conditions of the Ted including
heart failure, diabetes, obesity and gout also contributed to the present situation.
Question 3
Establishment of goals is the fifth step of the clinical reasoning cycle. It helps the nurse to
draft goal-oriented nursing interventions. Time oriented goals motivate the nurse to work
efficiently to reach the goals (Dalton, Gee, & Levett-Jones, 2015). The primary problem of