Case Study: Post-Operative Nursing Care of Edward Williams

This case study examines the post-operative care of Edward Williams, an 82-year-old male who underwent bowel resection and colostomy. It analyzes his medical history, current condition, and complications, including pneumonia and postoperative ileus. The case study details the application of the clinical reasoning cycle, including the collection of cues, information processing, goal setting, nursing interventions, and medication management. It discusses the importance of assessing vital signs, monitoring for signs of infection, and implementing strategies to address both pneumonia and ileus. The nursing interventions include hydration, nasogastric suction, monitoring breathing, and early mobility practices. The study also suggests pharmacological treatments such as glycopeptide antibiotics for pneumonia and epidural blockade for postoperative ileus. This case study highlights the comprehensive approach needed for effective post-operative care, considering the patient's overall health and potential complications.

Running head: PRINCIPLE OF NURSING
PRINCIPLE OF NURSING
Name of the Student:
Name of the University:
Author’s Note:

1PRINCIPLE OF NURSING
QUESTION 1
According to the information presented in the case study, Edward Ted William was an
82 years old man who was operated due to bowel resection and formation of colostomy. He
was a widower and had a previous history of a number of conditions. Earlier, he used to live
alone as his children, Christopher and Janice had left him. Currently, he was residing in the
retirement village near to his previous location in the city. He has a partner whose name was
Gwen, 78 years old women who lived in the same village. From the biopsychological
assessment, Ted was suffering from pain that had an impact on his behaviour, attitude and
feelings. It was found that he had a positive outlook to the operation as after the evaluation
and proposal of surgery was given to him, he agreed to it and since he was his family thus,
the impact on this aspect on his family was negligible in nature. From the spiritual aspect,
the procedure of the surgery did not have an implication; as a result, Ted had happily
accepted to the all procedure and process that had been administered to him without any
hindrance because his health was more important to him than any other factors. From this, it
can be stated that he had an education qualification that helps him in quantifying between the
spiritual aspects and health factor where the weightage was given to health. Another aspect
that needs to be evaluated is the cultural aspect that would be related to cultural belief,
attitude, family and society (Indra, 2018). From the evaluation, it was found that his family
had left him a long time ago and he lives in a retirement village; thus, the cultural hindrance
or barrier, in this case, was found to be minimum as he can do whatever he wants to without
any limitation or restriction. Therefore, he had chosen the option of choosing surgery over
other factors.
QUESTION 2

2PRINCIPLE OF NURSING
From the evaluation of stage two of the Clinical Reasoning Cycle that includes the
collection of cues and information which was clearly presented in the case study. The details
of the fourth day of the operation were stated in a vivid manner. It was found that there was
no diet in the first two days and on the third day; he was given a liquid diet in the morning
and light diet in the evening, which he was able to digest. After the assessment of his vital
signs, it was found that it was normal except his temperature, which was 38.1℉ and the
blood pressure (BP) was elevated that was 135/85. On further investigation, it was found that
he had a right-sided inspiratory coarse crackle and moist and productive cough. In the study
conducted by Lu et al. (2020), it was stated that coarse crackle are loud, low pitched and low
lasting in nature and they demonstrate that an excess of fluid was present in the lungs. This is
the reason because of which, the condition such as pulmonary edema, the aspiration that was
observed in this case and pneumonia can occur. Another symptom that is moist and
productive cough indicates that there is the presence of mucous or sputum due to during the
chest was congested (Michaudet & Malaty, 2017). This may be an indication that the patient,
Ted, was suffering from pneumonia or similar condition. He had compliant that there was an
abdominal pain that can be described in a scale as 4 or 5; however, during palpitation, the
pain worsened and increased to 7. Besides this, on visual observation, it was found that the
abdomen was distended in nature. The pathophysiology of pneumonia include infection from
the virus, bacteria or fungi that cause inflammation in the alveoli in the lungs. There is a
consolidation of the lungs due to the infection as a result of inhalation of foreign particle or
irradiation. The air sacs of Mr Ted was inflamed and filled with mucous which do not allow
him to take by oxygen in an adequate amount thus, causing difficult. According to
Bhattacharya et al. (2016), the enlargement in the abdominal was because of swelling that
had occurred due to an increase in fluid concentration and thus, offering such appearance.
The colostomy bag that was used for the collection of waste had been attached after the

3PRINCIPLE OF NURSING
surgery was found to be intact and there was a presence of stoma that can be seen through the
surface of the bag. This is a positive indication in the body and is a common feature after
surgery. As per the opinion of the nurse, the stoma was moist, warm, and pink in colour and
was slighted elevated above the skin. This will be reduced with time and is an indication that
surgery had occurred in the body. However, the factor that may be concerning for the doctor
in case of Mr Ted was there was no output in the bag even after four days of the surgery and
there was inactive bowel sound and there was the presence of flatus. From the review of Lee
et al. (2016), it was found that in some cases in the surgery, there is a temporary of delay in
the mobility of the gastrointestinal content or bowel movement which is known as
postoperative ileus. The most potential explanation of this condition is there is a disruption in
either sympathetic or parasympathetic pathway of the gastrointestinal tract after the operation
that had led to inflammatory changes in the body. This change had been the reason, which
can be mediated due to a number of process in the body or usage of medications that help in
the management of pain as observed in the case study, that Ted was given PCA morphine in
situ that was used for pain regulation after the surgery. Another condition that can be a
probable reason for the distress faced by Ted was pneumonia. The disorder is a contagion that
is caused due to inflammation of the air sacs present in the lining of the lungs. Due to the
infection, the sacs are filled with fluid and causes coughing, pain in the abdominal, fever and
the patient has a problem in proper breathing.
QUESTION 3
After the processing of information and identification of the condition, the next step in the
Clinical Reasoning Cycle is to establish goals for the patient that will help in the mitigation of
the health issues suffered by him. From the evaluation and processing of the due, it can be
stated that Ted was suffering from pneumonia as well as postoperative ileus that if not
treated, would have serious complications on the health and wellbeing. Moreover, it was

4PRINCIPLE OF NURSING
known from his past medical history that he had type II diabetes, heart failure, obesity and
gout; thus, the present conditions may have a negative impact on these issues as well. Since
Ted lives alone in the retirement village, thus, it would be difficult for him to manage the
condition after the surgery on his own. It is needless to say that it is critical to formulating
nursing care strategies that would focus on mitigating any complication after the surgery as
well as treating the health conditions identified. Nursing care strategies for Ted include:
 The assessment of the status of hydration in the body by a registered nurse from time
to time. The obstruction in the airways is due to the insufficient hydration level and
this may even cause mucus deposition in the respiratory tract (Vargas & da Cruz,
2018). Thus, it is critical for monitoring the hydration and maintenance by the
administration of 3000 ml of fluid per day and it would be optimal if the liquid is
warm. Fu et al. (2019) opined that this would help in the maintenance of the hydration
and thus, increase the action of ciliary, which is used for elimination of any secretion
in the tract.
 The use of nasogastric suction can be used that help in draining the contents of the
stomach using a tube. Chan et al. (2019) opined that the process is usually conducted
among the patients that are enabled to removes its gastrointestinal content and air due
to the obstruction in the system. The nurse needs to be experienced as the tube need to
be inserted through the nose and slowly moved into the stomach without any damage.
This is a critical step in the nursing intervention and thus, the procedure needs to be
conducted by an experienced nurse or a doctor. The professional need to administer
saline or water through the tube for the maintenance of suction and protecting the
patient from an imbalance of electrolytes that usually occur after the removal of fluid
from the stomach.

5PRINCIPLE OF NURSING
 To monitor the rate and depth of the breathing as well as its rhythm. This will be
useful in understanding the condition or the productiveness of the coughing (Wang et
al., 2016). The compensatory response may indicate airway obstruction and thus, the
nurse needs to change the breathing strategy where the use of accessory muscle need
to be included.
 Due to the issue of postoperative ileus, one of the nursing intervention that would help
in early mitigation of the problem is early mobility practice. The stable position of the
patient for a prolonged period may cause an obstruction in the passing of gas and have
an impact on the gastrointestinal system. Therefore, the nurse needs to try to motivate
the patient to move or walk for a short period of time.
 The examination of sputum with respect to its colour, viscosity and odour needs to be
done that will indicate the presence of any infection in the body. Further infection
may complicate Ted’s situation and lead to the severe implication that constant
monitoring needs to be done
QUESTION 4
For mitigating the issue, along with nursing intervention, medications need to be
administered. For pneumonia, thew class of drug that can be given to Ted was glycopeptide
antibiotics. According to Blaskovich et al. (2018), glycopeptide antibiotics are a group of
drug that has a microbial origin and are comprised of glycosylated cyclic or polycyclic
nonribosomal peptides that inhibits the formation or synthesis of cell walls among microbes.
This is done by inhibiting the synthesis of peptidoglycan. The drug can be administered
orally to Ted and will particularly focus on reducing the infection in the body. For treating
postoperative ileus, the class of drug that can be administered to Ted was epidural blockade
with local anaesthetics. This has the ability to improve the condition by blocking the
inhibiting reflexes and the efferent sympathetic pathway that was blocked in this condition

6PRINCIPLE OF NURSING
(Kulinska et al., 2019). As per the studies, the combination of thoracic epidurals that include
bupivacaine or a combination of opioid with this helps in treating postoperative ileus. This
can be given orally to Ted.

7PRINCIPLE OF NURSING
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