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(PDF) Routine postoperative nursing management

   

Added on  2021-04-24

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Running head: CASE STUDYCase studyName of the student:Name of the University:Author’s note

1CASE STUDYThe essay gives an insight into the nursing management of post-operative complications in patients by the analysis of the case scenario of Susan Summers, a 40 year old female who has undergone laparascopic right adrenalectomy. She had to undergo the surgery due to the presence of benign tumour on her right adrenal gland and diagnosis of Cushing’s syndrome. The essay gives an understanding about the cause of Cushing’s syndrome by discussion on the etiology andpathophysiology of the condition. In response to the vital signs observation of Susan 2 hours postsurgery, a discussion on the pathophysiology behind different clinical deteriorations is provided. The essay also provides detail about care priorities for patient 2 hours post op and the role of other health care team for the recovery of Susan in the hospital. The case study is about Susan Summers, who is a patient with type 2 diabetes patient and recently been admitted to the hospital due to Cushing’s syndrome. It is a disease caused by the excess secretion of cortisol hormone from the adrenal gland, leading to symptoms of stretch marks, abdominal obesity, fatty tissue deposits between the shoulder and thin fragile skin (Lacroix et al., 2015). Susan also experienced such kind of changes in her appearance and the Cushing’s syndrome was caused by a benign tumour of her right adrenal gland. Hence, it can be said that tumor in the pituitary gland was the main cause of the disease. These tumors release adrenocorticotropic hormone (ACTH), which causes the adrenal gland to produce excess amountof cortisol. ACTH is released in diurnal patterns and its level decreases throughout the day. The release of ACTH is controlled by means of negative feedback at the pituitary levels (Raff & Carroll, 2015). Apart from pituitary tumor, Cushing’s syndrome is also caused by primary adrenal neuplasm’s and ectopic ACTH secreting tumors (Lacroix et al., 2015). From this explanation, the etiology and pathophysiology behind Susan’s presenting condition is understood.

2CASE STUDYFollowing changes in Susan’s appearance due to Cushing’s syndrome, she was admitted to the hospital for a laparscopic right adrenalectomy under general anaesthesia. However, post-operatively, observation of his vital signs gave indication about deterioration in his clinical condition. For example, Susan respiratory rate was 30 breaths per minute, however the normal breathing rate is 12-20 breaths per minute. Her pulse rate was 128 beats/ minute although pulse rate is 100 beats/ minute (my.clevelandclinic.org, 2018). Such kind of respiratory complications post surgery occurs because of the effect of anesthesia and surgery. Karcz & Papadakos, (2013)has explained that in case of normal patient, general anesthesia and mechanical ventilation impairs pulmonary function and leads to respiratory complication post surgery. This kind of issues increases morbidity of the disease. However, such kind of complication also depends on patient variables too. In case of Susan, this kind of complication was also seen because of obesity and this contributed to the etiology of post-operative respiratory complications. Susan was obese at 90 kgwith a BMI of 36. According to World Health Organization recommendation, a person with BMIabove 30kg/m2 is regarded as obese (Kioko, Williams & Newhouse, 2016). Obesity has great impact on physiology of breathing because of the impact of heavy weight on thoracic cage and abdomen. It changes respiratory compliance and alters respiratory muscle function (Brazzale, Pretto & Schachter, 2015). For this reason, airway resistance and increased work of breathing is seen in obese patients. Hodgson, Murphy & Hart, (2015) suggest that respiratory system compliance decreases by 35% in obese patients and fat distribution create high pleural pressure, thus leading to low overall compliance. Hence, in case of Susan, respiratory complication of highbreathing is seen due to obesity.

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