Surgical Nursing Question Answer 2022

Running head: SURGICAL NURSING
SURGICAL NURSING
Name of Student
Name of University
Author note

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Response to question 1
Ted Williams is 82 years old male who had a bowel resection surgery just about 4
weeks back. The subject was being treated for a malignant mass that was revealed through
colostomy and biopsy. As per the present situation of the subject, the patient is on
medications such captopril for normalizing the blood pressure, metformin for type 2 diabetes
mellitus and Frusemide for congestive heart failure. In the post-surgical condition, the subject
did not intake anything for 48 hours then a liquid diet was given. His oxygen saturation is a
bit low and he is having nausea, abdominal pain and shortness of breathing. As for
biopsychosoical impact, the biological effect of the surgery on comorbid conditions of
diabetes mellitus type 2, congestive heart failure, gout and obesity will occur. As the subject
is old and very aged that is 82 years, he is bound to have mental anxiety and stress caused by
the experience of the surgery. As the subject lives alone, with his wife died about three years
ago and his son and daughter lives with their respective families abroad and in the city
respectively, the lack of social support can impact the effect of surgery on the subject, very
adversely, leading to social isolation and depression. There is a partner though, who is 78
years old. Given his age, spiritual state can be distorted due to the post-surgical
biopsychosoical crisis and a culturally competent spiritual, humanistic nursing can aid the
post-surgical situation of the subject, in a very effective manner. If the assessment, diagnosis,
intervention and evaluation is only culturally competent, then the post-surgical geriatric care
can be affected very much.
Response to question 2
Processing the information
The subject has mild fever as the body temperature of the patient is 38.1 degrees. The
heart rate of the subject is normal but is on the higher side. The normal range of heart rate is

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60-100 post which the subject is said to be tachycardia and lesser than 60 beats per minute is
considered as bradycardia (McLeod et al. 2018). The heart rate of the subject is almost 98,
which although normal but should be considered high and risky, given the age of the subject
and the severe respiratory distress. The respiratory rate of the patient is 26 breaths per minute
and referring to the normal range is 12-20 breaths per minute – it can considered that the
subject is having shortness of breath and respiratory distress because of which the heart rate
of the patient has also increased. As the subject had a history of congestive heart failure and
is being given frusemide, the increase in heart rate can be a problem (Ohr, Jeong & Saul
2017). The subject has moist productive cough and fever as well, it is critical that color of the
cough is noted to see if there is any infection that has occurred, that can then be correlated
with the presenting fever. The environmental conditions such as the room temperature,
dysregulation of body temperature, shock, anxiety, fear can also cause the increase in body
temperature of the patient and given the age of the patient and lack of family support
throughout the experience of the surgery, can easily attribute the aforementioned
pathophysiology of fever in the patient (Healy, Davis & Pei 2018). The subject has been
reported to have crackles on inspiration which means the respiratory distress in the subject is
due to a restrictive issue or inhalation, inspiratory problem and acute respiratory distress
syndrome can be considered for a further assessment and diagnosis was well. The condition
can be caused by post-surgical infections or hospital acquired infections as well and as the
subject is 82 years old, the subject is prone to get affected by these infections than any other
age groups. At the surgical site, due to the surgical trauma and also due to the bowel issues as
the subject has sluggish bowel sounds and has not passed flatus, there can be an abdominal
distension leading to causation of the severe abdominal pain. On the scale, the readings were
taken as 7 upon 10 and this high intensity of pain can decrease the pace of recovery of the
patient. The current blood pressure of the patient is about 135/85 which is almost border high

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but under control – as because the subject is under the effect of the medications. The normal
oxygen saturation of the subject is ninety five to hundred percent and in this case, the subject
is having 94 percent of oxygen saturation which is low and this can be attributed to the
shortness of breathing, inspiratory problems.
Identify the problems
At first, the respiratory distress with decreased oxygen saturation is the major nursing
problem that has to be treated. Respiratory distress due to shortness of breath and coughing
can lead to the causation of cyanosis which can be life-threatening to the patient of 82 years
of age. Respiratory failure can be the other severe complication.
Secondly, the second priority problem is severe pain in the subject and as the subject
has a reading of 7 upon 10 on the pain scale, the same has to address by the nurse. Post -
surgical pain is common but can be very complicating in a geriatric patient (Bloomer et al.
2019).
The third priority problem bowel problems which has been sluggish and the subject
has not passed flatus, when accumulated can lead to abdominal distention.
Response to question 3
The first nursing goal is to improve and normalize the breathing issue of the subject.
The nursing interventions include pharmacological management and non- pharmacological
management (Witt et al. 2017). The pharmacological nursing management will include the
muscle relaxants, sedatives and nebulization to help the subject breath efficiently with
effective bronchodilation. As the oxygen saturation of the subject is low, the oxygen therapy
can also be started to aid the breathing issue and help normalize the ventilation-perfusion
ratio of the subject. The decongestants can be administered on a timely basis by the nurse in
order to break the congestion in the lungs and to release the respiratory distress due to airway

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restriction, on inhalation. The arterial blood gas analysis should be requested by the nurse to
assess the partial pressure of carbon dioxide with respect to partial pressure of oxygen in the
body and a capnography monitoring in the post-surgical phase will be very helpful to the
subject to understand and eliminate any chances of the cyanosis if present under the
circumstances (Caranci et al. 2017). As for the non-pharmacological management of the
subject, the breathing exercises such as diaphragmatic breathing, pursed lip breathing and
thoracic expansion exercise plus clearing of chest filling with percussion and chest
mobilization exercises are very critical as well (Steele & Bolognesi 2020). In addition,
promoting generation relaxation in the patient is also a critical and crucial element of the
breathing intervention and here, the nurse can modify the surroundings of the subject to
decrease any noise, bright light or any objects in the near environment of the subject that is
causing irritation to the subject. In addition, the modifying the color of the room, lighting,
bringing in a fan and adding culturally relevant landscapes can also heal the stress and
anxiety of the patient, thus relaxing him down and helping him sleep that would, naturally
normalize breathing pattern and rhythm of the breathing (Carlson et al., 2018). It is critical
that as a part of this intervention and goal, the nurse monitors the breathing patterns for
apneusis, ataxic patterns, Biot’s breathing patterns, Cheyne-Stokes breathing, Eupnoea, apnea
to prevent complications.
The second goal of the nursing care is to improve the pain intensity of the subject that
is currently 7/10 and severe. The goal is to eliminate the pain completely. The post-surgical
bleeding, pain and infections are the common symptoms and it is critical that the nurse
undertakes the right intervention to manage the pain of the patient. The administration of
sedatives and analgesics should be done (Willingham et al. 2020). The chances of
neurological depression as the subject is on morphine - is high and the monitoring can be
done with capnography. The non-medication management will involve progressive muscle

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relaxation, guided and visual imagery. Proper wound care, checking for the integrity of the
dressings and the pressure on the abdominal area, should be assessed regularly, the nurse.
The third goal is to improve the bowel function of patient. Collaborating with a
dietician to improve the bowel function and controlling fluid intake can help the situation.
The fourth goal is to improve the fever of the subject which can be due to infections
or dysfunctional thermo-regulation of the patient due to neuropsychological issues (Chen et
al. 2018). Administering the antipyretic medication by the nurse is important. Requesting for
a cough analysis and blood report, to check if there is any presence of underlying infection in
the body of Ted, is vital. If present, then the antibiotic therapy can be then started by the
nurse (Marmelo, Rocha & Moreira-Gonçalves 2018). Loose, relaxed clothing and controlling
the environmental temperature is important to help the subject sweat and normalize the body
temperature.
The fifth goal is to improve the overall biopsychosoical condition of the patient. The
nurse should socially and culturally support the subject. Providing talk therapy, cognitive
behavioral therapy in collaboration with a psychologist and providing activities of daily life
training to improve the functional independence of the subject, in collaboration with physical
therapist is critical to address the biological and psychosocial parameters of the subject.
Response to question 4
For the post-operative management of pain, morphine can be used. Morphine blocks
the signaling of the nociception and it binds to the opioid receptors, in order to block the pain
signal transmission. It acts on the pain gate at the spinal cord level and blocks the dorsal horn
sensory neurons. The action of morphine starts from within 6-30 minutes after getting
administered (Ball et al. 2018). However, overdose of morphine can cause neurological
depression with increase in the partial pressure of carbon dioxide which is to be checked

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continuously with the help of capnography monitoring. Morphine should be used by the
nurse, in this case to address the severe pain in the patient but at any cost, the dosage should
not be miscalculated that in turn, provides the opportunity of adverse medication event. It can
lead to addiction, abuse and withdrawal symptoms in the patient as well which means again,
the overdose of the strong pain killing medication has to be checked more so often in order to
prevent any chances of medication incidents in the clinical scenario (Tabacco et al. 2019).
Nausea, euphoria, respiratory depression, neurological depression, increased intracranial
tension, pain suppression, miosis and sedation are the various symptoms and rather the side
effects of morphine that are to be addressed by the nurse. The other medication that is very
important is paracetamol that can be used to decrease the fever and pain in the subject but as
the subject already has symptoms of nausea, or rather severe nausea, and dosage of
paracetamol should be calculated properly in order to address the side effect. The mechanism
of action of these drugs is that it blocks the cyclooxygenase pathways that have a role to play
in prostaglandin synthesis.

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