Principles of Nursing-Surgical: Ted's Post-Op Case Study Analysis

This case study analyzes the post-operative care of an 82-year-old male, Ted, who underwent a bowel resection and colostomy. The student applies the clinical reasoning cycle to address Ted's holistic health needs. The analysis begins by considering the patient's biopsychosocial, spiritual, and cultural impacts, using the ROPER LOGAN TIENERY model. The study then processes the provided data, identifying problems related to Ted's health, including fever, abnormal respiratory rate, and abdominal pain, linking these to pathophysiology. The student then proposes five justified nursing care interventions to address these issues. Finally, the study details two classes of medications, including angiotensin-converting enzyme inhibitors, ibuprofen, and baclofen and acetaminophen, fentanyl, antihistamines, and metformin, to manage Ted's post-operative condition, emphasizing the importance of clinical reasoning in patient care.

Running head: PRINCIPLES OF NURSING-SURGICAL
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Principles of Nursing-Surgical
Student’s Name
Institutional Affiliation

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Principles of Nursing-Surgical
The case study issues concern Ted's holistic health care needs and subsequent
interventions. Moreover, in this write up, the clinical reasoning cycle has been applied to
practice. The answers for the four questions are as follows;
Question one
Presentation of the patient's case to the health expert for the consideration step of clinical
reasoning, the cultural, spiritual, and the biopsychosocial impacts of the patient's surgery was
identified (Daly 2018). It was noted from the case study about Ted’s health history that he was
suffering from several illnesses. These illnesses include type II diabetes mellitus, obesity, and
gout, as well as heart failure. From the surgery that Ted had, some cultural factors that seemed to
affect in and his family were noted. As for Ted, the operational activity has denied him to engage
in some chaos he used to do before (Gurung 2019). For instance, that Ted cannot participate in
simple work until he completes heals from the surgical aftermath.
Psychologists have concluded that spirituality is what makes up good health results of an
individual. Moreover, spirituality is that aspect of a person that shows them the purpose to live
(Reiner and Koenig 2013). From the case study, it has been indicated that Ted moved to a
retirement area as a result of the death of his wife as well as his deteriorating health. This action
shows that he is undergoing a spiritual breakdown. On the other hand, scientists have argued that
biopsychosocial impacts are usually made up of biological, psychological as well as
environmental factors. Biopsychosocial factors may be well explained by mood change and
familial aspects (Bika, 2017). From the surgical practice, it is right to say that these two factors
have affected Ted's health care routine.

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Question 2
Considering the provision of results by the clinical reasoning cycle step two, this question
combines both step three and step four. Stage three of the clinical reasoning cycle involves data
processing, while stage four requires identification of problems a patient is faced with (Gruppen
2017). Under data processing of the patient, according to current health data Ted is having a
body temperature of 38.1 degrees Celsius, a blood pressure of 153/85, respiratory rate of 26
breaths per minute, 94% SpO2 on 3L NP and HR98reg. It has also been noted that Ted is
struggling with inspiratory coarse crackles that are right-sided. Moreover, he is also experiencing
a moist productive cough. It is as a result of surgical operation that Ted is enduring an abdominal
pain that is at a scale of 4-5/10, which gets goes up to 7/10 on palpation. In Ted's health case
study, it has also be recorded that the colostomy bag is well in its position in that the stoma can
be observed through the colostomy bag. It is as a result of the surgical operation that the patient
is struggling sluggish sounds and no flatus passed. The abdominal laparotomy contains a
transparent dressing, and less oozing was also indicated. Lastly, it is from Ted’s medical case
study that we learn that he is having a redivac drain that consists of 30mls haemoserous fluid as
well as a urine amount of 60-70 per hour.
During information processing and identification of the problems that Ted is facing, the
pathophysiological tactic was employed. The pathophysiological tactic involves the combination
of physical as well as biological illness disorders (Scott et al. 2015). Some of Ted’s biological
disordered mentioned in his health history case study tends to be continuous all through his life.
On the physical side of his medical history, it has been noted that his wife died, and it is normal
how people take a period to recover from that kind of loss. From his previous medical report, it
has been recorded that he has a body temperature of 38.1 degrees Celsius. Health experts argue

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that if a person records any value higher than 38 degrees Celsius, the individual is termed as a
victim of high fever (Houdas and Ring 2013). In our case, it is right to say that Ted is suffering
from high fever. Biologists have also argued that the body temperature of a healthy individual is
37 degrees Celsius.
Under the respiratory rate, the standard respiratory rate of a healthy adult is usually 12 to
20 breaths in a minute. This is to imply that respiratory rate below 12 and above 25 is not healthy
(Sierra and Telfort 2014). However, Ted has a respiratory rate of 26; this shows an abnormality
in his respiratory rate. On the other hand, standard blood oxygen saturation is usually between
94% and 99%. From the comparison of Ted’s medical report and the above fact, Ted is at the
health range of blood oxygen saturation. On Ted’s blood pressure, health experts have said that
the standard blood pressure for aged people is usually 150/80 (Sprint Research Group 2015). Ted
has a blood pressure of 135/85, which is very high and may cause more harm to Ted, considering
he is struggling with heart failure.
Question 3
This question focuses its argument basing on the fifth step of the clinical reasoning cycle.
In this step, the treatment schedules are established. This question requires five well-justified
nursing care interventions. From the earlier discussed medical report for Ted, it was clear he had
a fever of 38.1 degrees Celsius. Health personnel should include the following interventions in
their treatment schedule to help stabilize Ted's body temperature. Nurses can use their role to
ensure Ted takes fluids in his body. These fluids may include water. Water prevents dehydration
of the patient's body; by preventing dehydration, this strategy could lead to standardizing body
temperature (Nakamura 2011). Nurses should also assess Ted’s body to eliminate all factors that

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may be leading to a rise in temperature, for example, wounds. It is also advisable that nurses use
drugs that are capable of lowering fever to help Ted stabilize their body temperature.
In the case of standardizing blood pressure, nurses should advise Ted on the right diet
that he should consume to help his body fight high blood pressure. High blood pressure is not
treated, but it can be lowered (American Heart Association, 2017). Nurses are well known in
educating patients on the benefits of a good lifestyle in an individual's health; they should
employ this strategy to figure out which lifestyle should Ted adopt to enable him to stabilize his
blood pressure. It has been put into our notice that Ted is enduring abdominal pain since the
surgical operation was done. Nurses should issue him with the right painkillers that can help
minimize that pain. However, nurses should come with a proper sitting posture that will help in
reducing pain in the operated area.
It is from the medical report that we notice Ted is experiencing an abnormal respiratory
rate. Biologically, high body temperature may result in an elevated respiratory rate (Ray et al.
2011). This means that if the strategies laid out for the treatment of body temperature are keenly
applied, they will, in some way, help in reducing and stabilizing Ted’s respiratory rate. However,
most are the times when the respiratory rate raises due to the wrong posture individuals assume.
Therefore, nurses should help to design the right posture that will help Ted in standardizing his
respiratory rate. Nurses should inspect Ted on respiratory infections. This is because some
respiratory infections tend to increase the breathing rate of an individual. If Ted is found with
any of these respiratory infections, treatment should be done with immediate effect.

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QUESTION 4
Every surgical operation will be followed by prescribed medication that will help the
patient recover as fast as possible. In the case of Ted, two classes of drugs that will help him
manage his post-operative condition were listed down below. The first class of medications
includes Angiotensin-converting enzyme inhibitors, ibuprofen, and baclofen. The angiotensin-
converting-enzyme is used to lower high blood pressure. These medicines will help Ted stabilize
his blood pressure since they work by relaxing veins as well as arteries and thus reducing
patients' blood pressure. These drugs, however, can cause dizziness (Vegter et al. 2013).
Ibuprofen is used in lowering high body temperature and also helps reduce the breathing rate of
an individual. However, ibuprofen causes rapid weight gain. Baclofen will help in reducing pain.
This will be the best drug to help Ted reduce his abdominal pain.
The second class of drugs will include acetaminophen, fentanyl, antihistamines, and
metformin. Metformin helps regulate blood sugar in the body. This will help Ted since he is
struggling with type II diabetes. Antihistamine helps treat fever in a patient. However, it can
cause sneezing and a runny nose. Fentanyl is used to reduce severe pain. Most used after surgical
operations. This will be the best for Ted as he is experiencing a sharp pain that was a result of
abdominal surgery. However, this drug has its side effects that include constipation and
sweating. Acetaminophen can be used temporarily to reduce fever (Young et al. 2015). However,
it causes the patient to use them to have dark urine and clay-colored stool.
To conclude, the strategies discussed above will help nurses keep Ted in good condition,
considering he just had a surgical operation. The drugs that have been listed above will also help
him stabilize his health as he fully recovers. However, nurses in health care centers should

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always stick by using clinical reasoning cycles in their work to avoid errors that could cost the
lives of patients.

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