Postoperative Care Question Answer 2022

Running head: POST-OPERATIVE CARE 1
Postoperative Care
Students Name
Institutional Affiliation

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Question one
Edward Williams, an 82-year-old male, has a temporary colostomy after a bowel
resection was done. He had previously had a biopsy and colonoscopy, which revealed a
malignant mass. He has a distended abdomen with abdominal pain that worsens on palpation. He
currently has a colonoscopy and urinary catheter in situ. Surgical outcomes or complications
appear to have a substantial effect on patient's biopsychosocial, spiritual, and cultural issues
(Klaseem, Ouden, & Schuurmans, 2015). The client may experience different challenges due to
complications that result in long term disability that might affect activities of daily living such as
communication, elimination, breathing, mobilization, and dressing.
Loss of control over the elimination of feces may result in embarrassment and social
isolation. The client might experience psychological symptoms such as depression and anxiety,
which might result in suicidal ideation (Jayarajah & Semarasekera, 2016). Body image is a vital
psychosocial issue since it changes functioning and appearance. The client may have problems in
dressing, working, and playing. The appearance changes may induce feelings of lack of
masculinity, disfigurement, inferiority, feeling angry at one, and also feeling alienated from the
body (Kyung, Young, & Kwang, 2017). Loss of bodily functions changes an individual's self-
worth. In addition to interfering with the perception of body image, it might result in thoughts of
no longer being a human and fear of not able to live a healthy life. Cultural background plays a
significant role in the patient's beliefs, whether personal or religious (Liao & Qin, 2015). Ostomy
surgery changes an individual perception of God. The individual might avoid going to church or
mosque due to loss of control over elimination and disturbed body image. The patient might get
angry at God, asking God why they had to go through the problem.
Question two

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Ted had previously had a biopsy and colonoscopy that revealed a malignant mass. He has
a history of heart failure, gout, type 2 diabetes, and obesity. His vital signs at 10am were as
follows: T 38.1; HR 98 reg; BP 135/85; RR 26; SpO2 94% on 3L NP. On assessment, he had a
moist productive cough with right-sided inspiratory coarse crackles. He had a distended
abdomen with an abdominal pain that worsened on palpation. His current medication include
metformin 500mg, captopril 12.5mg, allopurinol 100mg, and paracetamol 1g. Ted might be
having colon cancer since the colonoscopy and biopsy revealed a malign mass. Obesity, as seen
by the client, has been associated with increased risk for colorectal cancer. BMI plays a major
role; increased body size may affect colorectal carcinogenesis. Cancer begins when the body
cells start to go out of control. Polyps start to grow on the inner lining of the rectum or colon.
The polyp usually starts in the innermost layer and grows outwards towards all other layers. The
cancer cells can also grow in the lymph or blood vessels.
Bowel resection surgery was done to remove part of the bowel with the malignant tumor.
During bowel resection, the surgeon removes the diseased part, and the two remaining ends of
the colon are joined using stitches or staples, also called anastomosis. For Ted, anastomosis was
not done; both ends of the colon were attached to an opening on the abdomen. This procedure is
known as colostomy. Four days postoperative Ted had a fever of 38.1, rapid heart rate of 98, and
an increased respiratory rate of 26 breaths per minute and blood pressure of 135/85, which might
be an indication of postoperative sepsis. The specific commodity that increased the risk of Ted
getting postoperative sepsis is diabetes. Individuals with diabetes have a reduced response to
bacteria, causing infections. High blood glucose levels create a suitable environment for the
bacteria to thrive. When blood sugar levels are high, it increases inflammation of body cells and

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prevents oxygen and nutrients from energizing the cells. Delayed wound healing increases the
risk of sepsis.
Problems
Ineffective breathing pattern related to pulmonary edema as evidenced by right-sided
inspiratory coarse crackles, tachypnea (26 breaths per minute) and a moist productive cough. Ted
has a history of heart failure. Systolic and diastolic dysfunction results in reduced cardiac output,
which activates the renin-angiotensin system and sympathetic nervous system. The net effect
produces an arterial vasoconstriction, which helps regulate arterial pressure and increase blood
volume, thus enhancing the stroke volume. This causes the heart to work harder to pump blood,
causing ventricular hypertrophy (Long, Mordi, & Sagar, 2018). Pulmonary congestion takes
place when the left ventricle is not able to pump blood to the rest of the body. Blood volume and
pressure increases in the left atrium hence reducing blood flow to the lungs. Pulmonary blood
volume rises, forcing fluid out of the capillary into the alveoli impairing gaseous exchange
causing pulmonary crackles, cough, and tachypnea.
Pain related to bowel resection surgery as evidenced by patient verbalization of pain 4-
5/10 that worsens on palapation to 7/10, nausea and vomiting, increased heart rate and blood
pressure. The activity of the SA node increases when the sympathetic is more active during pain.
Hyperactivity of the SA node increases the heart rate. The feeling of nausea and vomiting is a
common side effect of pain. Studies show that patients experienced both pain and nausea after a
surgical procedure. Vomiting is usually mediated by the sympathetic, motor, and
parasympathetic (Thienhaus, 2018). Pain activates the motor system causing reverse peristalsis.
Contents in the middle of the small intestines are brought up to the stomach. Contraction of
abdominal musculature and inspiration against closed glottis results in vomiting.