Nursing the Surgical Patient: Clinical Issues, Interventions, Discharge Plan and Post-Operative Education

This report discusses the clinical issues of severe pain, haemorrhage and wound infection, nursing interventions for these issues, a discharge plan and post-operative education for a surgical patient. The report includes a case study and references.

NURSING: THE SURGICAL
PATIENT
A CASE REPORT

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY ..................................................................................................................................3
TASK 1 ...........................................................................................................................................3
Three priority clinical issue....................................................................................................3
Nursing intervention for these clinical issue..........................................................................4
Rationale of each intervention................................................................................................5
TASK 2 ...........................................................................................................................................5
Plan and priorities discharge advice.......................................................................................5
Post-operative education .......................................................................................................6
Suggestion related with discharge plan .................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Surgery is defined as the medical or the dental speciality that is used in operative manual
and instrumental techniques which are associated with the person to investigate or treat the
condition which is related with the pathological situation, that includes disease or injury which
help to improve the bodily function. This is useful for the patient to repair unwanted ruptured
areas. In this report, the discussion is based on the various segmentation in which it helps to
evaluate the priorities which are based on clinical issues and nursing intervention which is
related to these clinical issues. Moreover, the rationale is also mentioned with a proper discharge
plan (Althoff and et. al., 2021).
MAIN BODY
TASK 1
Three priority clinical issue
Risk of severe pain:
This analyses that the condition is predominantly associated with severe pain after the
condition of post-operative surgical procedure. This, Wendy dealing with this clinical issue
which is associated with the unbearable pain which is retrieved due to post-operative factors. As
per this, in the context with Wendy who is gone in the condition of laparotomy. After the
successful surgery, Wendy Green inspected for the twenty-four hours of post-operative factor. In
this, the risk of severe pain is associated with Wendy. The severe pain after the surgical
procedure which is act as a major factor which used to get dissatisfaction, delayed recovery,
immobility and prolong hospital stay in the post-operative period and it is usually associated with
the complex situation of pain which is chronic (Ashry and et. al., 2020).
Haemorrhage:
The condition of haemorrhage is well associated with the patient who is taking surgery
and they are inspected for a longer period to monitor the situation of excessive bleeding from the
site of surgery. A haemorrhage is defined as bleeding from any particular site which is suffered
from any surgical matters (Discharge Planning, 2020). In the context of the case study, this
situation is may be associated with Wendy after the surgical procedure of laparotomy. In this,
rapid blood loss from the site of surgery is occurring. For example, this is taken in the case of
laparotomy because it is usually observed as per the clinical issue which can lead to the cause of

shock. Moreover, the treatment of the rapid blood loss may further include some of the factors
which may create the situation more critical such as intravenous fluid or blood plasma which
turns into a loss. In this, blood transfusion is also analyse after the condition of post-operative
factor, however, due to the condition of haemorrhage other surgery are taken with the patient to
control the bleeding.
Wound infection:
This is also associated with the post-operative factor as a clinical issue where the risk of
infection is related to the wound (Care Transitions from Hospital to Home: IDEAL Discharge
Planning, 2019). When bacteria enter the site of surgery, infection is being taken as a result. In
this, an infection can show a delayed response to healing. The risk usually with this is that the
wound infection is spread nearby tissue and organ. After a time while when precaution does not
take for this then it spread in the bloodstream (Macones and et. al., 2019).
Nursing intervention for these clinical issues
Intervention to control the risk of severe pain:
To reduce the complication and severe pain which is associated with post-operative
factors after the surgery is provide medication for instant use. As per this, there are some of the
drugs which are mentioned in the case study which help to control the pain which is faced by
Wendy. In this, the prescribed drug which refers for the Wendy to control the pain is Aspirin 100
mg mane which is useful to control pain related with the body and Fentanyl PCA 20 mcg is a
useful drug to control the pain which is usually prescribed by hospital and GP to their patient
which is facing the difficulties of severe pain after surgery. In this, Wendy used to take a long
deep breath to feel good and relax. In this, Tramadol is also provided to Wendy for control of
moderate and moderator severe pain (Miller and et. al., 2018).
Method to control haemorrhage:
After the post-operative surgery, the major clinical issue associated with the patient is the
risk of excessive bleeding. If this condition occurs then, the step which is used to control the
haemorrhage is by using a bandage on the injured site. In this, try to do not to remove the large
or deeply embedded object which does not probe the wound or make an attempt to clean. Try to
control bleeding by using a sterile bandage or clean cloth on the wound. Press the bandage
smoothly with the palm to control the bleeding and apply the same pressure until the bleed stop.
Whereas, in the case of Wendy Green during the surgery, the chance of excessive blood loss

occurs so, the electrode which acts to balance the loss of blood with help of Sodium Chloride
0.9% which is normal saline and provide 80ml/hours to Wendy for temporary fluid restoration.
Prevention of wound infection:
This is a common risk that is associated with a patient who is taking surgery. In context
with this Wendy, the healthcare professional provide some medication that is accessible in such a
way that help to control the infection. As per this, the medication includes Cefoxitin 2gms TDS
which is act as an anti-bacterial which help to prevent infection and with a proper time frame
dressing will be taken such as changing of bandage and all help to resist the infection nearby
wound (Miskovic and et. al., 2017).
The rationale of each intervention
The rationale of the intervention is used to take such as taking the measure of spirometry
which make to allow as a term which is given to the basic lung function which helps to measure
the air that is expired and inspired. The weekly exercise is used conduct twice a day which helps
to maintain the factors which are responsible in a way to improve the chance of infection and
boost the healing factor due to exercise which helps to trigger the receptor to heal the wound.
Moreover, deep breath and other associated factor which is compatible for the recovery and
getting the change which is related with the expansion of lungs and other organ become well
worked and smooth for the better pathophysiology of the body (After Surgery: Discomforts and
Complications, 2021).
TASK 2
Plan and priorities discharge advice
While taking the aspect of discharge advice for Wendy, they must focus on health and
their outcome. In this, the plan and priorities are being taken and discuss among the healthcare
professional which is helpful to overcome the complication which arises due to the local factor
which may be associated with an issue that is based on clinical aspect and self-management. Any
kind of discharge instruction is being taken in review with the patient in this case study the
context of the patient is undertaken with Wendy. The discharge advice is usually a set of written
forms which is associated with the patient to take home. In this, Wendy Green must focus on the
specific, written in terms of the patient to make legible understanding. Moreover, make sure that

the family member is used to notify for the pending core of discharge which is based on
transportation and others (Snyder and et. al., 2021).
Physical consideration: Physical intervention which is required for the inpatient help to show
the activity which specifically includes direct physical care to the Wendy due to the health
complication which may arise due to post-operative factor.
Patient and family teaching: In this, the patient and family teaching the vital role in discharge
planning which is planned before the patient is going to discharge from the clinics. A nurse will
help to show the major role in patient teaching.
Topic included for the pre-discharge teaching: In this, discharge advice we strictly focus on the
various scope of medication and drugs, diet, wound care and using equipment which is helpful to
reduce the complication which may be associated with the Wendy after their post-operative
factors. In this, some of the main aspects which are followed by Wendy to take care of
themselves by following some of the activities which are based on a regular pattern such taking
of medication on the regular basis, use to do exercise programs, physical therapy, changing
dressing/bandage, injection or the respiratory treatment, any home healthcare and more of the
factor which is responsible in such a way which is useful for Wendy for the future are to follow
up the doctor (Steffens and et. al., 2018).
Documentation of discharge: In this, they are used to follow a chart of the date and time of
discharge. In this, special instruction is also followed or given to the patient to reduce
unnecessary complications. While making discharge it is an important aspect where the
responsibility is to be drive by taking the personal belonging which is sent with the patient
(Vittinghoff and et. al., 2018).
Types of discharge:
Planned: Planned discharge is defined as the scope for the patient to make their own
decision for discharge. In this, they used to focus on the various aspect as per taking the context
with Wendy. Moreover, Wendy used to take some precautions after the post-operative factor
after reducing of clinical issue then the planned discharge is placed (Postoperative Care, 2018).
Transfer: In this, when the condition has become dichotomous which is based on patient
compliance or complication (Legallois and Sabatier 2019).
Post-operative education
Some of the post-operative factor which is associated with the Wendy include:

 In this Wendy must have an adult who used to take responsibility for driving from home
the facility.
 After the post-operative factor, Wendy needs to stay with the adults and with nurses.
When Wendy used to discharge from the office they must require everything ready on the
home before surgery (Buikstra and Clay-Williams 2020).
 The effect of the general or local anaesthesia is persist with the patient for 24 hours and
more. Excessive exercise creates consequences that are based on harmful to others.
 In this, Wendy must focus on the small exercise when he is feel better after the issue and
then they follow the dose and medication regularly with the routine check-ups.
 After the post-operative aspect some time due to the allergy to the drug is experienced by
Wendy which is characterised by itching, rash, wheezing or tightness in the throat, stop
taking all medication which is associated with the office immediately. This is the core
sign of drug allergy (Egan, Laliberté-Rudman, Rutkowski, and Donnelly 2020).
Suggestion related to the discharge plan
The postoperative patient must focus on their clinical issue and used to follow the
prescription and instructions which is provided by the doctor and nursing staff. Moreover, the
essential approach which is associated with this post-operative patient and their factor is
monitoring and nursing care. The main aim related to the discharge plan is to conduct an
appropriate approach which is based on the nursing intervention such as follow medication
routine, follow up the instruction of doctor and so on after the discharge which may be helpful to
improve the situation of Wendy (Riley and Hardinge2021).
CONCLUSION
As per the above discussion, it is well analysed that the post-operative factor some the clinical
issue are arises as per the 24 hours of surgery. In this, intervention is used which is based on
nursing care and after that, the plan is usually initiated for the patient for their compliance.

REFERENCES
Books and Journals
Althoff and et. al., 2021. Effects of night surgery on postoperative mortality and morbidity: a
multicentre cohort study. BMJ Quality & Safety, 30(8), pp.678-688.
Ashry and et. al., 2020. Doctor-patient distancing: an early experience of telemedicine for
postoperative neurosurgical care in the time of COVID-19. The Egyptian Journal of
Neurology, Psychiatry and Neurosurgery, 56(1), pp.1-8.
Macones and et. al., 2019. Guidelines for postoperative care in cesarean delivery: Enhanced
Recovery After Surgery (ERAS) Society recommendations (part 3). American journal
of obstetrics and gynaecology, 221(3), pp.247-e1.
Miller and et. al., 2018. Intravenous versus inhalational maintenance of anaesthesia for
postoperative cognitive outcomes in elderly people undergoing non‐cardiac
surgery. Cochrane Database of Systematic Reviews, (8).
Miskovic and et. al., 2017. Postoperative pulmonary complications. BJA: British Journal of
Anaesthesia, 118(3), pp.317-334.
Snyder and et. al., 2021. Routine postoperative fluid restriction to prevent syndrome of
inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary
adenoma. Journal of Neurosurgery, 1(aop), pp.1-8.
Steffens and et. al., 2018. Preoperative exercise halves the postoperative complication rate in
patients with lung cancer: a systematic review of the effect of exercise on
complications, length of stay and quality of life in patients with cancer. British journal
of sports medicine, 52(5), pp.344-344.
Vittinghoff and et. al., 2018. Postoperative pain management in children: Guidance from the pain
committee of the European Society for Paediatric Anaesthesiology (ESPA Pain
Management Ladder Initiative). Pediatric Anesthesia, 28(6), pp.493-506.
Legallois, D., Chaufourier, L., Blanchart, K., Parienti, J.J., Belin, A., Milliez, P. and Sabatier, R.,
2019. Improving the quality of care in patients with decompensated acute heart failure
using a discharge checklist. Archives of cardiovascular diseases, 112(8-9), pp.494-501.
Buikstra, E., Strivens, E. and Clay-Williams, R., 2020. Understanding variability in discharge
planning processes for the older person. Safety Science, 121, pp.137-146.
Riley, J., Swindale, C., Edmans, N., Robinson, A., Ovington, A., Kearley, K. and Hardinge, M.,
2021. P148 Reducing 30-day readmissions through the establishment of a Post
Discharge Virtual ward for patients admitted with an exacerbation of COPD.
Egan, M.Y., Laliberté-Rudman, D., Rutkowski, N., Lanoix, M., Meyer, M., McEwen, S.,
Collver, M., Linkewich, E., Montgomery, P., Quant, S. and Donnelly, B., 2020. The
implications of the Canadian Stroke Best Practice Recommendations for design and
allocation of rehabilitation after hospital discharge: a problematization. Disability and
Rehabilitation, 42(23), pp.3403-3415.
Online
Discharge Planning, 2020 [Online] Available through;
<https://www.sciencedirect.com/science/article/pii/S1873959812000695>
Care Transitions from Hospital to Home: IDEAL Discharge Planning, 2019 [Online] Available
through; <https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/
hospital/engagingfamilies/strategy4/Strat4_Implement_Hndbook_508_v2.pdf>

After Surgery: Discomforts and Complications, 2021 [Online] Available through;
<https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-
discomforts-and-complications>
Postoperative Care, 2018 [Online] Available through;
<https://www.healthline.com/health/postoperative-care>