Clinical Integration Report: Ms. Melody's Peritonitis Care and Nursing

This clinical integration report focuses on the case of Ms. Melody, who suffered from peritonitis following a ruptured appendix. The report meticulously applies the clinical reasoning cycle to analyze the patient's condition, including the collection and processing of information, identification of nursing problems such as pain, infection, and deficient fluid volume, and the establishment of nursing goals. The report then details the nursing interventions implemented to address these problems, including pain management, infection control, and fluid volume restoration. Furthermore, the report evaluates the effectiveness of the care provided, highlighting improvements in the patient's condition and the adoption of a patient-centered approach. The conclusion reflects on the learning gained from this experience, emphasizing the importance of strategic interventions and the role of teamwork in challenging situations. The report references several sources to support the analysis and recommendations.

Running head: CLINICAL INTEGRATION
Clinical Integration
Name of the student
Name of University
Author’s note

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Table of Contents
Introduction:....................................................................................................................................2
Reflection based on clinical reasoning cycle:..................................................................................2
Identification of 3 nursing problems based on the health evaluation data-.....................................4
Nursing goals or key care priorities.................................................................................................5
Discussion on nursing care..............................................................................................................6
Evaluation of care............................................................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

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Introduction:
The clinical reasoning cycle is the process by which the nurse collects cues,
process information, analyze the nursing situation, construct plan. Develop
interventions and then evaluate the effects and reflect on the learning. This report
analyses the case of Ms Melody, who is having Peritonitis followed by ruptured
appendix. The reflection on the patient-care approach used for the patient is
provided here by the application of clinical reasoning cycle (Adams, Maben &
Robert, 2014). The phase or process used in clinical reasoning cycle is also
described here for Ms. Melody to determine appropriate interventions and outcome
for her.
Reflection based on clinical reasoning cycle:
Description of person’s conditions, collection of information, process and
presentation of the information
This will be reflecting on the condition of Ms Melody who is suffering from
peritonitis followed by ruptured appendix. It is found out that she was presented in
the Emergency department with 2-3 days of severe left lower quadrant abdominal
pain. She needed emergency laparoscopic surgery on removal of the ruptured
appendix. The following is the current information that was collected about
Melody. Then it can be reviewed that her information on past medical history

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which showed that she had asthma, depression. The present medical cues were
followed on the medicaments like ventolin, seretide, straline. It is also observed her
current observations which included blood pressure 95/45 mm Hg, heart rate of
120, temperature 38.3 Celcius, RR of 22/ min and shallow, spO2 of 95% on room
air. It is also noted that she complained of increasing nausea, abdominal pain
which was found to be 7-8 on a scale of 0to10. Her physical evaluation reflected
on distended abdomen and generalized abdominal guarding. Then it was found that
she had her raised white blood cells (WBC ) count and CRP.
After all the possible cues and the situations of Ms Melody, following
information can be processed. On the basis of information, it could be interpreted
that she has low blood pressure. She is also facing higher heart rate than the
optimal. Her body temperature is moderately increased it was about 100.94
Fahrenheit. Her respiratory rate is within the normal range but she is having
tachypnea because of shallow breath . Her SPO2 reading suggests that her oxygen
level in the blood is almost normal. While processing her complaints it could be
said that she is facing acute Peritonitis. She is suffering from abdominal pain
which is high in the scale of 0-10. The abdominal pain mainly presented her
situation of peritonitis (Grace, 2017). The nausea that she is having is also due to her
present condition.

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Pathophysiological conditions of peritonitis – The clinical issues faced by
patient has mainly occurred because of the diagnosis of peritonitis. The
pathophysiological explanation of the condition of peritonitis states that it is
mainly caused by the inflammation of peritoneum and the tissues which line the
inner walls of the abdomen. They are mainly caused by the bacterial and fungal
infection (Burkhardt & Nathaniel, 2013). The basic pathophysiology behind the
conditions is due to immunological response. The initiator effector cells which
localize the peritoneum such as the mast cells, macrophages and lymphocytes,
increase the secretion of chemokines and influx of neutrophils, monocytes. These
lead to inflammation and clinical symptoms of peritonitis. Thus the key points in
pathophysiology will include the leakage of contents of abdominal cavity,
proliferation, edema, invasion of the blood cells and the immediate response of the
intestinal tract (Cherry & Jacob, 2016).
Identification of 3 nursing problems based on the health evaluation data-
While making the person centered care, the nurses can prioritize on the 3
nursing issues on which it will be developing the nursing interventions. The three
nursing problems are related to:

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1. Pain- The patient is suffering from acute pain. Thus the nurses need to
manage the pain problem which will be an important step in my nursing
interventions. This will help me manage her condition
2. Infections- The inflammation in the peritoneum will be causing fungal
and bacterial infection (Feo et al, 2017). The infection is occurring due to her
distended abdomen and the generalized abdominal guarding. This is another cue
which the nurses need to handle.
3- The deficient fluid volume which was detected from her low BP and high pulse
rate (Gee et al, 2015). This section also requires high care and management by my
nursing interventions.
Nursing goals or key care priorities
1. Pain- The nursing goal will focus on controlling the acute pain as it was almost
7-8 in a scale of 0-10. The nursing interventions will be planned in such a way that
it will provide relaxation skills and methods that will promote comfort from this.
2. Infections- The goal here is to achieve timely healing, free of erythema,
verbalize the goals according to the individual causative risk factors (Holloway &
Galvin, 2016). Here the nurses must set up the goal according to situation of Melody
who can face infections due to ruptured

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3. Deficient fluid volume- The nurse will try to improve the fluid balance which
will be evident with the adequate urinary output with normal specific gravity,
stability in vital organs, moist mucous membranes, good skin turgor, capillary
refill will be prompt and the weight within the acceptable range. This will also
follow with the goal to maintain the blood pressures and heart rate of the patient
(Griffith & Tengnah, 2017).
Discussion on nursing care
1. Pain: To manage pain of patient, the nurse gave the following nursing
interventions to patient. The nurse investigated the pain report of Ms
Melody. In this section, the nurses noted the duration and intensity of pain.
She had pain level of 7-8 in 0-10 scale. The pain tends to be constant and it
diffuse over the entire abdomen when the inflammation process will
accelerate (Hunter & Arthur, 2016). The nurses will maintain the semi-fowler’s
position. This will facilitate the fluid and wound drainage by gravity
reducing the abdominal irritation and reducing pain (Johnstone, 2015). The
nurses moved the patient slowly and deliberately, splinting the painful area.
This will reduce the muscle tension and guarding and minimize the pain
(Mikkonen, Kyngäs & Kääriäinen, 2015).

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The nurses also provided comfort measures like massage, back rubs that helped in
patient’s relaxation.
2. Infections- The nursing interventions I took are listed below,
The nurses noted the risk factors that are due to ruptured appendicitis. This will
influence the choice of intervention. The nurse will access and evaluate the vital
signs like decreased blood pressure, tachycardia, fever and tachypnea. This will
help to evaluate any complications in patient and promote early action (Ignatavicius
et al, 2015).They have to strictly monitor the urine output because oliguria can
develop due to bacterial infections. They will have to maintain aseptic conditions
while handling the open wounds, dressings. This will minimize the infecting
organisms or cross contaminations. They will have to observe the drainage of
wounds and provide the status of infection (Li et al, 2016).
3. Deficient fluid volume- Looking at the signs and symptoms of Melody, the
nurses took some of the nursing interventions to manage this condition,
They monitored the vital signs that are the blood pressure, tachycardia, tachypnea.
They also measured the central venous pressure. This has aided in assessing the
fluid deficit and the effectiveness of the fluid replacement.The nurses will maintain
accurate I and O and will be co relating the weights every day. They will evaluate
the overall hydration status.

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They measured the urine specific gravity that will also reflect upon the hydration
status and the renal function. They will observe if the patient had dry mucous
membrane. This will reflect on the conditions of hypovolemia (Doenges et al, 2014).
They will change the positions frequently and provide skin care that may arise to
deficiency in fluid. The edematous tissues are compromised in circulation and are
prone to breakdown (Parahoo, 2014). If necessary, they will be administering fluid,
electrolytes and diuretics. This will be helpful to replenish the circulating fluid and
electrolyte volume (Sommers et al, 2014).
Evaluation of care
After nursing care interventions were adopted on the patient for managing
pain condition, the patient showed a little improvement with the relief in pain.
With proper evaluation of the infection level and maintaining the aseptic
conditions, the infections decreased in case of Melody. The evaluation results in
deficiency of fluid showed that her vital signs improved a lot. These interventions
taken for curing and relieving the issues in peritonitis is effective. The nursing
process that should be followed also reflected patient-centred care approach as
major focus was on identify immediate care needs of patient and taking patient’s
preference before initiating any nursing actions. This action is also in relevance
with the ethical and legal code of conduct for nursing practice because this code

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emphasizes on maintaining autonomy of patient during care process (Sidani & Fox,
2014).
Conclusion
The last part of the reasoning cycle describes the contemplating the issues
that the nurses will learn. Hence, my reflection from this activity or experience is
that the nurse learnt to identify the specific issues and take patient centered caring
process for peritonitis. The nursing interventions taken after accessing and
processing the overall conditions of the patient helped in recovery of patient. This
form of patient-care approach will help me in the future to implement strategic
interventions and identify specific rationales too. It can also reflect team of nurses
and other professional act as great means of support when we require guidance in
relation to nursing actions required for challenging situations.

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References
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based co-design (EBCD): an evaluation of the sustainability and spread of EBCD
in a cancer centre. King’s College London.
Burkhardt, M., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Nelson
Education.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for
individualizing client care across the life span. FA Davis.
Feo, R., Conroy, T., Marshall, R. J., Rasmussen, P., Wiechula, R., & Kitson, A. L. (2017). Using
holistic interpretive synthesis to create practice‐relevant guidance for person‐
centred fundamental care delivered by nurses. Nursing inquiry, 24(2).
Gee, T., Dalton, L., & Levitt-Jones, T. (2015). Using Clinical Reasoning and Simulation based
education to flip the enrolled nursing curriculum. In Sustainable Healthcare
Transformation: International Conference on Health System Innovation
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones &
Bartlett Learning
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& Sons.
Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:
Clinical educators' perceptions. Nurse education in practice, 18, 73-79.

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Ignatavicius, D. D., & Workman, M. L. (2015). Medical-Surgical Nursing-E-Book: Patient-
Centered Collaborative Care. Elsevier Health Sciences.
Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.
Li, P. K. T., Szeto, C. C., Piraino, B., de Arteaga, J., Fan, S., Figueiredo, A. E., ... & Struijk, D.
G. (2016). ISPD peritonitis recommendations: 2016 update on prevention and
treatment. Peritoneal Dialysis International, 36(5), 481-508.
Mikkonen, K., Kyngäs, H., & Kääriäinen, M. (2015). Nursing students’ experiences of the
empathy of their teachers: a qualitative study. Advances in Health Sciences
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