University Hospital Acute Care Report: Eleanor's Post-Op Care Plan

This report presents an acute care plan for Eleanor, focusing on her post-surgery care following a bowel surgery. It begins with an assessment of her condition in the first 24 hours, detailing potential problems like hypotension and respiratory distress, along with corresponding nursing interventions and rationales. Part B identifies potential clinical issues associated with Eleanor's co-morbidities, particularly her history of smoking and cardiac heart disease, discussing complications such as increased blood pressure and blood in urine. Relevant assessments and interventions, including medication and hemodynamic monitoring, are also discussed. Part C outlines Eleanor's discharge plan, emphasizing post-operative education, medication management, and follow-up care. The report highlights the importance of evidence-based nursing practices and strategic patient management to ensure a smooth recovery and transition to home care, and provides insights into the patient's recovery process.

Acute Care

TABLE OF CONTENTS
Table of Contents.............................................................................................................................2
INTRODUCTION...........................................................................................................................1
Part A: Plan of care..........................................................................................................................1
PART B: Identify potential clinical issues.......................................................................................2
(a): Discussion about Eleanor’s co-morbidities.....................................................................2
(b): Two potential clinical complication associated with the co-morbidities.........................3
(c): Discussion of relevant assessment and intervention the nurse would initiate during the
time.........................................................................................................................................3
(d): Analysis of the case.........................................................................................................4
PART C............................................................................................................................................5
Discharge plan........................................................................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................8

INTRODUCTION
Acute care is said to be the specific branch of secondary health care that consists of
health system elements, or care delivery stage used to treat sudden illness and major injuries. It
may be need a stay in a hospital emergency ward, ambulatory surgery centre, along with the
assistance of diagnostic services in the community. This project is categories into three parts,
first one is related with the place of care chart, second one is associated with the overall analysis
of the potential clinical issues and last one is based on the patient discharge plan (Anderson and
et. al., 2014).
Part A: Plan of care
First 24 hours’ post-surgery report of Eleanor
Assessment Potential problems /
issues
Interventions Rationales
(Subjective assessment
criteria):
Extra strain on the patient heart
and circulatory system.
A little bit of discomfort goes a
long way in terms of individual
development.
The scale rating of respiratory
distress is lies under 12-15.
Because of lower urine output
count which is 15-20 ml/hr,
Eleanor was not been able to
remove additional waste from
the body.
Pressure risk assessment scale in
conjunction with a
comprehensive visual assessment
is to analyse the Eleanor risk of
pressure injury.
 Hypotension
 Respiratory
distress (RR 12)
 Lower urine
output (15-20
ml/hr)
 Presser injury
risk
Monitoring and control:
Monitor vital signs in every
4 hours at the first 24 hours,
then every 8-12 hour,
decrease in respiratory rate
below to 14-16 breaths per
minute as well as increase
pulse rate more than 100
beats per minute.
The case of respiratory
distress, nurse need to give
corticosteroids and
antibiotics in order to
balance the respiratory rate.
The nurses need to focused
on optimal use of indwelling
catheters in the acute and
long term care. Identification
is done one the basis of
electronic database and
antiseptic solution in
drainage bag.
A powered, air filled surface
Allows time for
poorly ventilated
lung areas to
adjust to new
alveolar gas level.
Response to the
position change
can vary greatly.
Assessment
provides baseline
and ongoing
database for
monitoring
changes and
evaluating
intervention. It
demonstrates no
any rapid weight
changes.
The current
guidelines
rationalise the
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that is filed redistributes
through cyclic inflation and
deflation of air cells. Keep
the skin dry and report on
regular basis.
methods used by
nurse to stabilised
the pressure risk
injury to the
Eleanor.
PART B: Identify potential clinical issues
(a): Discussion about Eleanor’s co-morbidities
As mentioned under the case study of the Eleanor’s that she was works as a volunteer at
the local St Vincent De Paul centre in almost three time in a week. She is having a record of 40
years’ history of smoking 2 cigarette a day. Postoperative period, she has been chain smoker by
the doctors. Because, there was left coronary artery stenting in the heart. Similarly, cardiac heart
disease is basically usual cause in build-up of plaque (Marschall and et. al., 2014). This will
directly attack the coronary arteries to narrow, restricting blood flow to the heart. The
consequence can be more high to a patient as it will result in death. It can be change through
proper chance in the lifestyle, medication and surgery.
The general anaesthesia is basically given before operating the patient, but the doctors
must check that all the other problems must also be taken into account (Health systems and
services, 2018). The doctors need to discontinue all the antihypertensive drugs those are
previously taken by Eleanor. Blood pressure loss of response to stimulation and 5-15 minutes
after intubation were significantly lower than body. It is major concern for the doctors to take
close look on the last issues which are present with the Eleanor. During the induction of general
anaesthesia, patient with hypertension can exhibit important increase in heart rate and blood
pressure, though the agent used for this often cause hypotension. Nurses need to review blood
pressure before and during induction of anaesthesia in Eleanor during or after the surgery (Jacob
and et. al., 2013).
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(Source: Colonoscopy results, 2017)
(b): Two potential clinical complication associated with the co-morbidities
In medicine, comorbidity is said to be presence of one or more additional disease or
disorders as a primary disease within a patient. In case of multiple chronic condition which is
more commonly increase the level of complexity in managing the condition of Eleanor. The two
basic clinical complication associated with the co-morbidities found in the patient after the 24
hours of period are stated below:
Increase in BP: After the surgery of Eleanor issues, the major thing which is going to
impacts is the Blood pressure. Because she is already being facing the problem of left coronary
artery stenting which would increase the blood level faster from its normal level. During the
observation of PACU Eleanor’s, it has been seen that BP rate is 90/54. The cause of high blood
pressure is clearly examining from the past record of the patient as she was having heart issues
and tension of her daughter.
Blood along with the urine: Another major issues which is seen after the completion of
the surgery is associated with the blood flow with the urine. As she also having certain issues
regarding the output of urine which was recorded earlier as 15 – 20 mls / hrs for the last three
months. For this purpose, doctors have recommended a medical therapy that consists of
indwelling catheter on hourly Urine measure. But after the surgery, it was found that certain
counts of bloods are coming out with the urine. The nurse must take acute care regarding this
particular issues so that it can be overcome quickly.
(c): Discussion of relevant assessment and intervention the nurse would initiate during the time
In the integrative analysis, the nurse would have aimed to summarise and examine the
condition of the patient in the ward. This seems to be utmost essential aspects or critical phase
for the Eleanor which will indicate that is any changes is occurred in the health condition. For the
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assessment of the patient, nurse used to record the 24 hours’ detail of BP, HH and RR sedation
rate of the Eleanor (Centers for Medicare and Medicaid Services (CMS), 2015).
After the surgery, it has been found that BP rate is more fluctuating with 140/90 in 6
hours and then it comes closure to the normal BP rate of 118/75. In order to balance this, she
given Angiotensin II receptor blockers and Hydralazine medication to balance the BP of the
patient (Antihypertensive Drugs, 2017).
The another assessment is associated with the urine implication which specific concern
with the Eleanor. Cardiac output which consists of peripheral perfusion, urine outputs and body
temperature under the assessment. Removal of vacuum which are included as indwelling catheter
for remove the unwanted water from the body indicate certain portion of blood particles. In order
to balance the blood flow proper medication and injunction is being given to Eleanor to balance
the condition of the patient. Haemodynamic status which consists of systolic and diastolic blood
pressure monitory is being to record any movement of change in patient.
(d): Analysis of the case
According to the mentioned case of Eleanor, there are various interventions which are
used to overcome the condition of Eleanor. As she was suffering from different kind of problem
after having a transfusion of 2 bags of whole blood. She has a midline incision with an occlusive
dressing. It cannot be removed until reviewing the colorectal surgeon. Eleanor was recovered in
PACU unit before being transferred to the common surgical ward. Postoperative period of
surgery has collected various specific information about the Eleanor. Such as high blood
pressure, heart rate fluctuation and Urine evacuation. Healthcare research is continuously process
wide amount of outcome and revised method of treatment and care to the patient. Evidence based
nursing systematically search a large range of global healthcare which is applying strict criteria
for collecting relevance to appropriate nursing practices. The objective of the scoping analysis is
to locate the international aspects associated with the nursing sensitive indicators. This was an
exploratory process of analysing the condition of the patient which was suffering from various
issues. Such as hypertension, high blood pressure and so on (Vetrano and et. al., 2014).
The results indicate that EBP protocol used to create a well-structured method to clinical
patient management for the nursing activities. Through the strategic observation of the patient
assessment, toileting and hemodynamic status evaluation is being done accordingly. Proper
medications such as Indwelling catheter, Patient Controlled Analgesia, Intravenous infusion is
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delivery to the patient as prioritise intervention during the time of observations. The BP rate and
flow of urine get normal after 24 hours of the critical guidance. This will clearly prove that all
the intervention is effectively helpful for the better health of the Eleanor.
PART C
Discharge plan
Medicare states that overall discharge planning is an essential process to decide Eleanor
needs for a balance move from one level or care to another. Only the doctors have the right a
patient to release from the hospital but it can be passes by social workers, nurse, case manager
and other person.
Post-operative education for Eleanor
A case of Eleanor who is a 78yr old lady admitted in the hospital for the surgery of bowel.
After the proper intervention of 24 hours the doctors has decided to discharge her. Cultural
resources management is one of the effective areas which provide historic preservation and other
discipline to that patient for the purpose of compliance with NHPA and other state-mandated
law. This NHPA also work for control the cancer patient as her father was associated with
cancer. Thus it would help them to recovery from them faster with the proper rules (The National
Health Priority Areas initiative, 2017).
Subjective: The overall state of the Eleanor shows that she is getting recover more quickly
so the doctors have prescribed discharge her and suggested 3-4 week of bed rest.
Discussion: Under this stage, doctors used to talk with the patient or their representatives
to provide all sorts of medical remedies at the mentioned time period.
Planning: In this particular process, a well organise plan is being made for homecoming or
transfer to another care treatment to the patient. For the purpose of normal check-up, she need to
come here on a regular interval.
Determination: It is considered as one of the caregiver training or other essential support
needed to Eleanor.
Referrals: All the prescribed medication and diet chart which is been recommended by the
doctors to the Eleanor has to be prepared under this stage.
Arranging: In this particular procedure, gathering of proper follow-up test and
prescription and medical tablets can be delivered to them.
Education around medication:
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 Fludrocortisone (Rx)
 Aspirin 100mg daily
 Lipitor 20mg daily
 PRN Ondansetron and Metoclopramide
 Hydralazine injection as in case of high blood pressure
The above mentioned medication, must be taken on as per the prescribed time and day. This
will assist in faster recovery of the Eleanor.
Prevention of complications:
Epidemiological data is associated with BP and kidney disease which should be provide
maximum attention so that chances of high BP cannot be arises. Smoking is highly prohibited
because it can directly make impacts of heart. Prolonged exposure to sedentary lifestyle and
consumption of calories in excess of emerges must be avoided so that stress cannot be occurring
to the patient (Discharge Planning, 2017).
Psychosocial issues:
All the back psychosocial problems which are related with her daughter has not be put in
front of the Eleanor. This can again increase the chance of anxiety, depression and eating
disorder in the patient.
Lifestyle modification:
This seems to be utmost important change which is needed to be included under the
discharge plan. Eleanor must have to follow specific routine of daily lifestyle such as morning
walk, health diet and regular meditation. This will assist her to increase the overall condition and
increase energy among them to do any kind of work.
It is essential for the relative of Eleanor to deliver better acute care to her so that any kind of
hypertension or high blood pressure and other diseases can be arising. All the above discussed
information about the Eleanor, it has been noticed that she need to proper attention and care for
the home member. Because one of the basic reason is stress which is increasing the impacts on
the Eleanor. To get more valuable results in near past, Eleanor need to follow specific diet and
medication chart which will assist her to recover more quickly from the surgery.
CONCLUSION
From the above project report, it has been concluded that acute care is utmost important
ways to take care for the patient. It will assist them to recover from any kind of disease or
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medical implication. This particular section would be concentrate on first 24 hours’ post-surgery
observation is analysed effectively. Proper analysis regarding the case to examine potential
clinical issues related to Eleanor is being done accordingly. A well structure discharge plan is
being prepared to overlook the condition of Eleanor after the surgery.
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