Nursing the Surgical Patient: Analysis of Potential Clinical Issues and Relevant Nursing Care

This report analyzes nursing priorities, pathophysiology, and nursing interventions for a patient after hemicolectomy for a poorly differentiated adenocarcinoma. It also includes discharge planning involving medication, self-care, diet, activities, incision and drain care, wound care, and when to seek immediate care.

Nursing the Surgical
Patient

Table of Contents
INTRODUCTION...........................................................................................................................3
Part A: Analyse the case to identify potential clinical issues and relevant nursing care ................3
Nursing priorities ...................................................................................................................3
Pathophysiology ....................................................................................................................4
Nursing intervention ..............................................................................................................5
Part B: Discharge planning .............................................................................................................7
CONCLUSION ...........................................................................................................................10
REFERENCES ............................................................................................................................11

INTRODUCTION
In the health care system after the laparotomy, care of a surgical patient is consider as the
post surgical care. Which involves the evidence based interventions in context to the post
surgical nursing issues, as nursing priorities (Nascimento & Jesus, (2020)). Patient after the
hemicolectomy for a poorly differentiated adenocarcinoma, face huge health issues and
complications, such as the acute patient, berating issues, frequent urination etc. In this report
identification of the potential clinical issues is done in context to the post surgical situation,
which should be relevant for the nursing care. Identification of the nursing priorities,
pathophysiology and the nursing interventions for the patient post surgical issues is done, along
with evidence of intervention rationales.
Part A: Analyse the case to identify potential clinical issues and relevant
nursing care
Nursing priorities
Patient is 64-year-old female with the medical history of hypertension, and
hypercholesterolemia, Myocardial infarction, Obstructive sleep apnoea (OSA), hypertension and
asthma. Due to the three month history of the abdominal pain and diarrhoea she had diagnosed
with the CT scan and revealed the tumour in the ascending colon. In context to that analysed
chronic issues, she re-saintly retuned from the open right hemicolectomy. registered nurse key
priorities in context to this patient is analysed for which the selected interventions are planned.
Below is the explanation of three nursing priorities (Holle & Lopez, (2019)).
post-operative pain
One of the most common issues which is faced by the patient after the surgery and have to
manage by the nurse is acute pain. This pain is related to the surgical incision and reflex muscle
spasm. These complaints are proved by the registered or documented complains of restlessness,
irritability, moaning, guarded body posture. So the registered nurse key priority is can be
management of the acute pain with relevant intervention (Campbell & Scott, (2021)).
Ineffective breathing pattern
Another nursing priority related to the patient health issue is ineffective breathing pattern.
This is basically involves the respiratory irritation, airway obstruction, increased secretions. This

nursing issue is evidences by dyspnoea, crowing, low oxygen saturation. As the patient is having
the history of asthma this become more important to manage the berating pattern of the patient
with educate interventions.
Hemorrhage
Patient is having the history of myocardial infarction, hypertension and after the surgery,
this increases the chances of hemorrhage due to the ineffective vascular closure or alterations in
coagulation. This is another key priority of the nursing care practices during the post surgical
care (Rohatinsky, & Hellsten, (2020)).
Pathophysiology
Patient primary condition was associated to her medical history Hypercholesterolemia, as
it has been identified that increase serum cholesterol level have be reported positively associated
with the risk of the colon, rectal, prostatic cancer (Ehrenfeld & Gonzalo, (2019)).
Hypercholesterolemia is further associated with the risk of asthma, as the patient of given case
study has already faced in her medical history. High blood pressure and high cholesterol is also
linked, because due to the high cholesterol plaque and calcium arteries become hardened and
narrowed, due to which hart strain much harder to pump blood, as result of which blood pressure
become high. Obstructive sleep apnoea is phased by the patient due her excessive weight. risk
of premature atherosclerotic disease is associated with the hypercholesterolemia, as identified in
the patient case. The current medication of the patient, such as Simvastatin 40mg nocte is
associated with the health risk like headache, nausea, stomach pain, constipation and muscles
damage. Aspirin 100 mg mane was the medication which is possibly the causative of the patient
adenocarcinoma. Because this is proved that Aspirin cause gastrointestinal ulcerations and
abdominal pain, which lead to the adenocarcinoma (Akuji & Thomas, (2019)). Ventolin prn
medication is associated with the risk of chest pain, fast heart beet seizure etc. laparotomy is
further associated with some clinical issues like post-operative pain, Ineffective breathing
pattern, haemorrhage as this has been identified from the current observation 0800, that patient
Pulse is 110, which is the dedicator of irregular breathing. Pain score 6 on a scale of 0-10 and
estimated blood loss (EBL) in OT 600ml. The key assessment data sources which is used to
collect the information for the development of effective care plain, are pre-operative clinical
data and post operative clinical data (Ladwig, & Makic, (2019)).

Nursing intervention
Nursing interventions are the action which takes place by the nursing departments to
implement patient care plan, this is involving the treatments, patient education, patient support
and comfort. Below are the some selective evidence based interventions in context to the
identified nursing priorities, along with the Rationales.
post-operative pain
Nursing outcomes Nursing interventions Rationales
Pain control, this can be done
with the help of analgesic
recommendation, non-
analgesic relief measures. By
reporting changes in the pain
symptoms.
Pain management intervention
is can be, comprehensive
assessment of the pain.
Optimal pain relief, with the
prescribe analgesics to relive
acute pain.
Patient education related to the
pharmacological techniques
such as music therapy,
massage, guided imagery,
along with the measures
pain relief (Molloy &
O'Dwyer, (2021)).
Encouragement of the patient
to use the adequate analgesics
along with the other pain
control measures.
This is impotent because this
helps in the further
improvement of the care plan
for effective outcomes .
This is important intervention
or relevant for the patient
because this helps to prevent
pain and manage the situation
at the absence of nurses.
Because pain control helps the
patient to recover fast and its
also prevents the further
complication.
Ineffective breathing pattern
Nursing outcomes Nursing interventions Rationales
Normal respiratory rate
Normal Respiratory rhythm
Depth of inspiration
Monitoring the rhythm, depth
and efforts of respiratory
needs(Hickey & Taylor,
This is important because this
help in the identification and
management of the patient

Manage the ability of patient
for clear secretions (National
Academies of Sciences,
Engineering, and Medicine
(2020)).
(2018)).
 Monitoring the patient
crowing or snoring.
Monitoring of the patient
ability to chough effectively.
Positioning of the patient in a
lateral recovery position .
repository support needs.
Because this helps in the
identification of air way
abstraction.
This is important because it
helps in removal of secretions.
This is important in order to
prevent the aspiration.
Hemorrhage
Nursing outcomes
 For the nursing priority
like the Haemorrhage
one of the key goal is
monitoring of the
operative site for the
signs of haemorrhage
in order to immediately
manage the situation .
 Another outcome is
reporting of the
deviation from the
acceptable parameters.
 Registered nurse goal
is to carry out the
appropriate medical
Nursing interventions
 nurses have to observe
the surgical site and
conduct the regular
dressing.
 Monitoring vital signs
regular between the
q15min to q2-4h.
 Reporting of the health
abnormalities like rapid
pulse, decreasing blood
pressure, clammy skin.
 Monitoring of the
changes in mental
status, such as
indicators of the
Rationales
This is important intervention
because this helps to detect the
sings of the bleeding.
This intervention is important
because this helps in the
detection of hypovolemia
signs .
This is important in order to to
intervene in a timely manner.

and nursing
intervention for the
management of patient
clinical issue.
inadequate cerebral
perfusion, restlessness
and sense of doom.
 Monitoring of the
blood haemoglobin
levels.
 Control
Coagulopathies by the
Monitor platelet levels
and coagulation
studies.
This intervention is important
because that is the indicator of
inadequate cerebral perfusion.
Essential in order to keep
preventing or managing the
haemorrhage.
This intervention is important
because this indicate
coagulopathies (Segal &
Goren, (2020)).
Part B: Discharge planning
For the patient after the post surgical care discharge planing is involving the various steps
and aspects of care along with the education of self care (Du, & Naik, (2021)). First step is the
development of the appropriate post discharge plan with the essential information of the home
nursing care practices, medication, infection control measures and patient self care interventions.

Next step is the reconcile of the medication, schedule follow up visits. Discharge plan is
involving the over all aspects of care and amassment related to the physiological and
psychosocial care and management. Below is the illustration of patient discharge plan .
Discharge instruction which should be teach to the patient
Medicines
Antibiotics are important medication, its helps in the prevention of infection caused by the
bacteria.
Pain medication- Is can be use by the patient according to the given prescription to reduce the
pain, patient should not wait until the sever pain.
Take the medication as directed- patient should contact to the health care providers if she is not
clear about the right prescription timing to take medication and if medication are not helping in
pain and infection control. Patient should always keep the list of the medication, vitamins and
herb's they take.
Follow up with the health care provider
Patient may need the go to the health care settings to have their stitches or bandage removed.
During that period patient have to go with their list of their questions related to care.
Self-care
 Patient have to take appropriate rest and engage in some activities.
 Prevent the constipation by managing the healthy diet, with high fiber foods, extra
liquids, regular exercise.
 Patient lave to take liquids as directed, such as they have to drink the prescribed amount
of the liquids each day, as this helps to prevent constipation.
Diet
 Patient have to follow the health care provider diet instruction and start with the liquid
and then add the solid foods to the diet.
 Add laxative or stool softener.
 Drink plenty of fluids.
Activities
 patient should take rest as much as needed.
 patient should take bath on the basis of instructions and take helps of some one if needed.
 Take the help of some with chores and errands.

 Do some strenuous activities for 3 to 6 weeks.
 Avoid lifting over the 9 pounds.
 Walk as often patient feel able to.
 Patient have to do coughing and breathing exercise on regular basis.
Incision and drain care
 Keep it clean and dray.
 Do not sit at the bathtub, pool, or hot tub until the incision is closed.
 Do not use oils,or creams on your incision.
 Change the incision dressing after the 48 hours.
 In the case of drain, record the amount of drainage daily. Patient also have to empty the
drain and clean the attached tubing daily
Contact immediately to the health care provider if
 Having the fever more of 100.4°f (38°c).
 Feeling acute pain,swelling, bleeding,drainage at the incision site.
 Contact to the heath acre provider at the situation of Nausea,Diarrhoea and vomiting.
Seek care immediately
Seek care immediately if the incision comes apart, blood soaks through bandage,short of breath
and chest pain.
Wound care
 Patient have to follow their health care providers instructions, such as they have to keep
their bandage on their incision for 1 to 2 days, after the follow up visit patient need to
change the their bandage 1 to 2 time in a day.
 Washing hand is one of the important task, which should be done by the use of soap and
warm water, patient have to do this before and after the care of wound, as this help to
prevent the chances of infection.
 Patient have to remove their bandage gently, by using the warm water on the bandage to
lift it off. Edges should be lift towards the centre of wound, then carefully clean around
the wounds. Dry the area and use the new bandage to cover the wounds (Du & Naik,
(2021))(Vela & Coburn, (2019)).

CONCLUSION
From the above study is has been concluded that in the health care system in context to
the patient of the adenocarcinoma, after the surgery or laparotomy, the key responsibility of the
nursing department is post surgical care. For which the identification of clinical issues is very
important in-order to develop the care plain with the evidence based interventions. It has been
identified that health issues, medication and the possibility of further health risk is most of time
interrelated to each other. Such as in the case of given case study patient Hypercholesterolemia
is associated with the overall health complications faced by the patina through out her medical
history and present. Medication are also having some side effects and they can cause the health
issues. The key identified clinical issues of the patient was post-operative pain, Hemorrhage,
Ineffective, breathing pattern in context to which the the evidence based interventions are used to
manage the health condition and quality of patient living.

REFERENCES
Books and Journals
Nascimento, A., & Jesus, É. (2020). Nursing work environment and patient outcomes in a
hospital context: A scoping review. JONA: The Journal of Nursing Administration,
50(5), 261-266.
Holle, C. L., Sundean, L. J., Dellefield, M. E., Wong, J., & Lopez, R. P. (2019). Examining the
beliefs of skilled nursing facility directors of nursing regarding BSN completion and the
impact of nurse leader education on patient outcomes. JONA: The Journal of Nursing
Administration, 49(2), 57-60.
Campbell, A. R., Kennerly, S., Swanson, M., Forbes, T., & Scott, E. S. (2021). MANAGER'S
INFLUENCE ON THE REGISTERED NURSE AND NURSING ASSISTANT
RELATIONAL QUALITY AND PATIENT SAFETY CULTURE. Journal of Nursing
Management.
Rohatinsky, N., Risling, T., Kumaran, M., & Hellsten, L. A. (2020). N24 Prioritised adolescent
healthcare transition readiness factors by Canadian inflammatory bowel disease nurses.
Journal of Crohn's and Colitis, 14(Supplement_1), S668-S668.
Ehrenfeld, J. M., & Gonzalo, J. D. (2019). Health Systems Science Review E-Book. Elsevier
Health Sciences.
Akuji, M. A., Martin, F., Chambers, D., & Thomas, E. (2019). CRQs for the Final FRCA.
Cambridge University Press.
Ladwig, G. B., Ackley, B. J., & Makic, M. B. (2019). Mosby's Guide to Nursing Diagnosis E-
Book. Elsevier Health Sciences.
Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M., ... & Naik, A.
D. (2021). Implementation and feasibility of the re-engineered discharge for surgery
(RED-S) intervention: a pilot study. The Journal for Healthcare Quality (JHQ), 43(2),
92-100.
Molloy, R. G., MacKay, G. J., Dorrance, H. R., & O'Dwyer, P. J. (Eds.). (2021). Colorectal
Surgery. Oxford University Press.
Hickey, T., & Taylor, A. (2018). The Effect of Continuous Bilateral Transversus Abdominis
Plane Block on Opioid Consumption After Laparoscopic Colorectal Surgery. Webster
University.
National Academies of Sciences, Engineering, and Medicine. (2020). Framing opioid prescribing
guidelines for acute pain: developing the evidence.
Segal, G., Tirosh, A., & Goren, I. (2020). Assessment and Treatment of Sarcopenia and Frailty in
the Setting of Personalized Internal Medicine. Cambridge Scholars Publishing.
Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M., ... & Naik, A.
D. (2021). Implementation and feasibility of the re-engineered discharge for surgery
(RED-S) intervention: a pilot study. The Journal for Healthcare Quality (JHQ), 43(2),
92-100.

Vela, N., Bubis, L. D., Davis, L. E., Mahar, A. L., Kennedy, E., & Coburn, N. G. (2019).
Comparison of patient-reported outcomes in laparoscopic and open right
hemicolectomy: a retrospective cohort study. Diseases of the Colon & Rectum, 62(12),
1439-1447.