Nursing Case Study: Hartmann's Procedure for Mr. Kahil's Deterioration

This case study focuses on Mr. Kahil, a patient who has undergone a Hartmann's procedure, a surgical intervention for left colonic complications. The assignment delves into the definition, indications, and potential complications of the procedure, including colostomy care. It then analyzes Mr. Ka...Read More

Case study

Table of Contents
Question 1........................................................................................................................................3
Question 2........................................................................................................................................4
Question 3........................................................................................................................................5
Question 4........................................................................................................................................6
Question 5........................................................................................................................................7
Question 6........................................................................................................................................8
REFERENCES................................................................................................................................9

Question 1
Describe the Hartmann’s Procedure including definition, indications, and complications. Ensure
you apply this discussion to Mr Kahil.
Hartmann's Procedure defined as the surgical procedure where unhealthy part of colon
get cut from colon and there is connection of colon of one end with the bag outside. This surgery
can be done by using two different procedure that is by using the small incision and large
incision. This procedure refers to the standard live saving operations which is there for the left
colonic complications. This is said as the temporary procedure that can be intent for reversing it
after some period of time. This procedure is the one in which some part of patients colon get
unhealthy that is due to having some infectious process. There can also due to cause of cancer in
patient. Hartmann's procedure here helps to avoid the spreading of tumour or infection to the
healthy part of the colon. Mr. Kahil has had this operation in which there is formation of
colostomy there in body (Concha‐Miranda and et. al., (2020)).
There is the indication which includes some range of resulting of pathologies in
perforation or obstruction of left colon which includes the diverticulitis, volvulus, ischemia or
trauma. Mr. Kahil has the operation of Hartmann's in which there is colostomy in his body. This
operation is done when there is temporary emergency procedure is there. It is said that is this
operation is safe and faster operation which is there in the adverse general status along with local
abdominal conditions.
There are different complication which are there due to having the Hartmann's procedure
that are like wound infection, Fistula form rectal stump to bowel, paratomal hernia, paralytic
ileus, retraction to the colostomy etc. There can easily be seen that there is colostomy as the
complication is there in the Mr. Kahil. Colostomy refers to the surgical procedure which bring
out one end of the large intestine that is in the body through the wall of abdominal. In this
procedure colon get diverted in incision that is there to create stoma in the abdominal wall of Mr.
Kahil. There are some of the side effect that can be experienced by Mr. Kahil due to colostomy.
Some of the side effects are like tummy cramps, a swollen stoma, vomiting or nausea or both,
swelling in tummy, passing watery poos etc. (Chohno, (2018)).

Question 2
Review the above vital signs of Mr Kahil. Using your knowledge of the common causes of
clinical deterioration in the postoperative patient; state which likely reversible cause (one of the
4H’s & 4T’s) Mr Kahil is experiencing and describe its pathophysiological cause resulting in Mr
Kahil’s deterioration.
Drowsy- This is the one in which there is falling asleep anytime which is there is causing
of falling asleep anytime with getting tired. This can be general but can leads to forgetfulness or
getting sleep anytime which can be an inappropriate times. This is said to be the excessive
sleepiness. There are different cause for this in which some of them are like depression, certain
medication or medical condition that can affect the brain along with body which can be there in
Mr. Kahil (Frank, (2020)).
Due to low temperature there can be chances of Hypothermia which is there in the body
of Mr. Kahil which is caused due to low temperature. This condition comes when body
temperature get below 35 C. in this condition body is able to loose its heat faster that the body
can produce heat within. This can be common due to having old age. There is also chances of
infection in body that is able to cause the low body temperature.
Pulse- This is the increased heart rate which is very fast in nature called tachycardia. This
occurs when heart rate is over than 100 beats per minutes. There is the pathology of the
tachycardia in which there is electrical impulses which reaches to ventricles muscles and there is
contraction which causes pumping of blood that can be either to body or only to lungs. There
there is disruption in the complex system, then it can cause heart beat too fast or too slow or any
irregular rhythm (Holmer, (2017)).
Blood pressure- Mr. Kahil is patient of hypertension and there can be observed that there
is hypotension to him which says that there is chance of getting complication. In this, when there
is systolic pressure is less than 90mmHg and diastolic pressure get less than 60mmHg is there
which can cause reduction in the blood flow along with flow of oxygen delivery to tissues and
organs.
Respiration- Mr. Kahil have the normal respiration rate which is there in old age. In this,
there is no need to worry about the respiration rate.
SpO2- This is the one in which there is oxygen saturations are there common and there is
no need to worry about on context of Mr. Kahil health. This percentage can be drop during sleep

and there is the condition that during taking to the ward there is noticed that Mr. Kahil was
getting sleep there was the condition of Drowsy. In this, during walking there can be oxygen
percentage be more than 94% but during rest there can be fall in the percentage and can lead to
less than 88%. This means that it is normal condition for the Mr. Kahil (Siddiqui & Young,
(2020)).
Pain- There is no change in the pain observation which is there normal for the patient and
there are some of the characteristics which are related with dull, aching, stress, inflammation,
peptic ulcer, cancer etc.
There are different causes which are there in the reversible causes in 4H's and 4T's that
are Hypoxia, Hypovolemia, Hyperkalemia, Hypothermia and Thrombosis, Tension
pneumothorax, Tamponade, Toxins etc. respectively. Mr. Kahil is suffering form the Hypoxia in
which there is low level of oxygen in the body. There is need for better treatment that can help to
get better health to Mr. Kahil. There can be seen the blood pressure in which there is less supply
of oxygen which leads to cause Hypotension which should be treated well (Tschann, (2021)).
These are some of the cause through which Mr. Kahil is getting deterioration in his
health.
Question 3
Discuss three specific nursing assessments that would be prioritised for Mr Kahil’s
deterioration.
There are mainly four of the nursing assessments which are there like initial assessment,
focused assessment, time-lapsed assessment and emergency assessment. To determine the
diagnosis along with treatment there is need to learn these amassment that is there necessary of
the nursing staff. This is the part of the nursing education along with for the health care industry.
This one refers to the group of routine procedures and different process which is involved with
patients care and their assessment. There is discussion about the three type of assessment which
is there related with the health of Mr. Kahil (Wright, (2017)).
Initial assessment- This one is refers to the first stage of assessment and also known as
triage. This helps to find out the nature of problem. This also helps to make the way to ensuing
different assessment stages. This assessment is highly used by the nursing staff. In this, there is
need to find out the nature of the different problems that is there with Mr. Kahil. In this, there is
need to use the medical history by using the physical exam. There can also the use of vital signs.

Mr. Kahil will get fully checked up and his medical history will taken for the references that can
help to get better treatment. There is high need for the initial assessment that is there in relation
to finding out the problem which is there in the Mr. Kahil's health. This one is important to get
the problem in relation to find out the solution for Mr. Kahil's better health (Ha & Ko, (2018)).
Focused Assessment- in this stage there is information about the problems and how to
treat. In this, there is need to monitor Mr. Kahil and his each and every assessment parts which is
regarding the treatment of pain and long term treatment. This includes different tests like X-rays
etc. In this, main focus is on to diagnose and its treatment. There is need to find out the
stabilisation of Mr. Kahil in which there is need to focus on his health by the nursing staff or
professionals. This is important to monitor that has any positive change in health of Mr. Kahil.
Time-Lapsed assessment- This is the assessment in which there is need to conduct to get
ensure about Mr. Kahil is getting recovery form his health issues that is there causing the
deterioration of his health. This is done to be ensure that condition of Mr. Kahil should be
stabilised. This assessment can take place form 2 hours to couple of months. In this, there is
comparison between the condition of Mr. Kahil's health before and after the treatment or
assessment. In this assessment there is also use of different lab work and different diagnostic
medical tests. This is important for Mr. Kahil to get better treatment which is there can help to
get better treatment and help the nursing staff to give their best (Ruiz-Millo, (2017)).
Question 4
Discuss three specific nursing interventions that you as a Registered Nurse could initiate to
manage Mr Kahil’s deterioration.
There are many intervention which are there related with nursing staff in which some of
the intervention is discussed further.
Sleep pattern control- This is the one intervention which is there to control the pattern
of sleep. In this, there is need to control the sleep of Mr. Kahil that is regarding not to get sleep
during inappropriate time. This is not the right way and time to sleep in which there are not the
right time and way to sleep. Nursing staff should keep in mind that there is need to use different
diagnostic test or treatment that could help Mr. Kahil to get over through this problem. There is
also need to take care about the taking of medicine on right time. Along with this, there is need
to ensure about the meal of Mr. Kahil should be on proper time with proper quantity (Hackett,

(2018)). This is important because there is need for better sleep but due to getting sleep in
inappropriate time, there can cause different complication in Mr. Kahil's health.
Infection control- This is an important intervention which is there needed to take care by
the nursing staff. In relation to this, there are different nursing staff and they have the duty and
responsibility to take care of Mr. Kahil's infection which is there due to in the form of tumour.
This is the one which is getting spread over the time and there is high need to stop or finish this
spreading tumour in Mr. Kahil's body. This is highly need to control over the infection which is
there in the patients. This one plays an important role in controlling over the other medical
complications which are there due to having different infection in all over the body part (Thomas
and et. al., (2020)).
Evaluating outcomes- This is the one which is there high needed in relation to find the
outcomes of the nursing practice. This is the one which is there to get and ensure about the Mr.
Kahil health either he is getting recover or not and in what proportion. In this, nursing staff is
able to find out the outcome of the patients treatment and its effect which can be seen in the Mr.
Kahil's health. This is important to get that is there any improvement in health of Mr. Kahil or
not. This can help to get that either there is need to change the medication or treatment or not.
There is need to use the studies, values and preferences which are there for better decision
making process for the nursing staff regarding health of Mr. Kahil (Kochenderfer, (2017)).
These are three intervention which are there to help the nursing staff to create positive
impact on health of Mr. Kahil.
Question 5
Mr Kahil is prescribed a bolus of intravenous isotonic crystalloid fluids. Describe the
indication for and physiological effect of administration of bolus fluids.
Isotonic crystalloid fluid refers to the composition of isotonic sodium chloride solution
(normal saline) along with Lactated Ringer (LR). They are used to expand the intravascular
along with interstitial fluid spaces. There are some of the side effect of normal saline are like
severe irritation, warmth, redness and pain and many more. Bolus of fluid refers to the
administration of defined volume of fluid that is given to the patient in definite period of time.
There are different choice of resuscitation fluid which are there for the intravenous isotonic
crystalloid fluids (Zhen, (2020)). Crystalline solution is the required in Mr. Kahil for
intravascular volume where replenishment are typically isotonic. There are only 10% of isotonic

fluid remains in the space of intravascular. There are many causes of getting complications in
the health of Mr. Kahil in which there is due to having 20 packs per day smoking also cause the
adverse effect on the health of Mr. Kahil. There is need for the isotonic solution in relation to
increase the intravascular volume there in the body that can help to control over the blood
pressure of Mr. Kahil. There is metabolic acidosis in the body which is there to create and give
rise in the acidity in the body. This intravascular fluid may assist in controlling over the high
blood pressure which is there high in the Mr. Kahil's body. This one can help to get better health
and nursing staff can get the condition which is there in better state and can evaluate the
outcomes. There can be seen that due to different complication and having different health
problem of Mr. Kahil there can easily seen the effect of physiological impact that are affecting
the health of Mr. Kahil (Rogers, (2017)).
Question 6
According to the assessment and intervention there are some of the evaluation that is
there in the related with different complication in the health of Mr. Kahil.
Form above assessment and intervention, it is evaluated that for the proper care and better
health of Mr. Kahil. There is need to have the better health. There is need to control the sleep
which is there is getting inappropriate time. There is need to provide better treatment and also
there is need to use the proper medication within right dose within right time (Helmich, (2020)).
There is also an evaluation that there is need to control over the infection which is able to
create medical condition in Mr. Kahil. In this, there is need to control the infection which is there
need to control the spread of the infection which can lead to increase the health issues in Mr.
Kahil.
There is also an evaluation that there is need to focus on the outcome of the assessment
and intervention which is there related with different health issues and the improvement in the
health of Mr. Kahil (Raje and et. al., (2019)).

REFERENCES
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