Nursing Assignment: Developing a Care Plan for Post-Operative Patients

This nursing assignment presents a comprehensive analysis of post-operative complications, focusing on a case study of a patient who underwent a thoracotomy and right upper lobe lobectomy for early-stage non-small cell lung cancer. The assignment delves into the patient's medical histor...Read More

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the University
Author note

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Table of Contents
Introduction......................................................................................................................................2
Discussion........................................................................................................................................2
Background..................................................................................................................................2
The risk factor of the patient........................................................................................................3
One potential post-operative complication of the patient............................................................4
The care plan................................................................................................................................5
Role of physiotherapy after operation.........................................................................................7
The education that the patient requires........................................................................................7
Conclusion.......................................................................................................................................8
Reference.........................................................................................................................................9

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Introduction
The postoperative complications are the discomforts that a patient suffers after the
surgery is over. The extent of the difficulties vary according to the operations and from persons
to persons. The complications may include nausea and vomiting due to the anaesthesia done
before surgery. The patient any suffers from sore throat because of the tube placed in the
windpipe. Another significant discomfort is restlessness and sleeplessness. Not only these side
effects, but the patient may also develop certain complications like bleeding, shock, wound
infection, deep vein thrombosis, and pulmonary embolism, problems of lungs, urinary retention
and reactions to anaesthesia. Post-operative care is the care that the patients receive after the
surgical procedure is over. During the postoperative period, the nurses have to conduct the
assessments of patients, implement specific nursing interventions to meet the needs of the
patients and preventing the patients from suffering from complications. They also help in
providing the necessary education required by the patient (Bowyer & Royse, 2016). This
assignment is going to deal with a case study for examining the potential significant
postoperative complications of a person. The job also deals with how a nurse can apply her
knowledge in developing a care plan for preventing the patient from suffering the postoperative
complications.
Discussion
Background
The case study is about a 66-year-old gentleman, Mr Joseph Bailey, who was admitted to
the surgical ward after undergoing a thoracotomy and right upper lobe lobectomy. The operation
was done for an early-stage non-small cell cancer (NSCLC). His medical history showed that he

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suffered from osteoarthritis and bronchitis. He only lived with his wife in an only two-story
building. His height is 160 cm, and weight is 45 kilogram. At the time of returning to the ward
from the theatre, the blood pressure was 108/56. His body temperature was 37.2° Celsius, the
respiratory rate was 18 breaths/minutes, the concentration of oxygen was 96%, and the score of
pain was 5/10. He was already using a catheter and had already trained 100 ml of urine since the
time he had returned to the ward. He was administered 0.9% saline in the left hand at the rate of
100 ml/hr. Oxygen was delivered at the rate of 21/ minutes through nasal prangs. The result of
the GCS was found to be 14.
The risk factor of the patient
The patient of the case study suffered from an early-stage non-small cell lung cancer and
had undergone thoracotomy and lobectomy in the upper lobe of the right side. The staging of
lung cancer is done based on the location of cancer and whether cancer has spread to other
organs or lymph nodes or not. Tumours can grow within the lung for an extended period before
they are found as the size of the lungs are large. Almost 85%of the lung cancer are the non-small
cell lung cancer. Among them adenocarcinoma is the most common type of lung cancer, 25% of
the lung cancers are the squamous cell carcinoma, and the large cell carcinoma counts for 10%
of NSCLC (Gazdar, Bunn & Minna, 2017). At stage I, the cancer is located within the lungs, and
it does not spread to any other regions. At phase II, cancer spreads to the lymph nodes, and in
phase III, the tumour can be found in the lymph nodes in the middle region of the chest. Stage IV
is the final stage of cancer, in which cancer had spread to both the lungs and also to other parts of
the body, like liver or another organ (Antonia et al., 2019). In the given case study, the patient
had to undergo thoracotomy and upper lobe lobectomy on the right side. The non-small cell lung
cancer of stage I and stage II can be cured by surgery, and because of this, surgery was done to

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the patient of the case study. For doing the medicine, the doctor had to perform lobectomy for
removing the right upper lobe. The risk associated with lobectomy is infection, collapsing of the
lung at the time of breathing, the leaking of air or fluid into the chest and formation of pus in the
space between the lungs and the walls of the chest. The risk factors associated with thoracotomy
are obesity, chronic obstructive pulmonary disease and fluid imbalance on postoperative day 1
(Jamal-Hanjani et al., 2017).
One potential post-operative complication of the patient.
The most important post-operative complication of lobectomy is pneumonia or mucus
plugging. Patients after the thoracic surgery are at increased risk of decreased pulmonary
hygiene, which can lead to the development of atelectasis and progression to mucous plugging.
The patient of the given case study had been suffering from chronic bronchitis. He was already
suffering from cough, production of mucus, shortness of breath, fatigue and feeling of discomfort
at his chest. The nasal congestion or the stuffy nose happens when the nasal passage gets
irritated, swollen, inflamed, making breathing a challenge to the patient (Zhou-Suckow et al.,
2017). The irritated nasal passages may lead to the production of excess mucus secretion. The
congestion of sinus occurs when the mucous membrane gets irritated, infected or start secreting
more mucus than usual and thus lead to the filling of the areas with thick mucus. Anything which
irritates the mucous membrane causes the production of excess mucus. The health condition
which causes the production of excess mucus is a bacterial infection, viral infections like flu or
cold, allergies like hay fever and asthma. The other causes are when an object gets lodged inside
the nose, infection of sinus, head injury and other use of nasal spray (Mall, 2016). The patient
had already been suffering from chronic bronchitis, so he had breathing problems for a long
time. The patient might have followed specific preventive measures since the beginning to avoid

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mucus plugging. He should have undergone chest physiotherapy involving percussion and
coughing and incentive spirometry as the post-operative prophylaxis against the retention of
sputum. The narcotic pain medications may improve the sufferings from pain after the operation.
Epidural analgesia, intercostal nerve blocks and the patient controlled intravascular analgesia are
the most commonly used methods to reduce pain. Another most important way to prevent the
secretion of sputum is smoking cessation (Dunican et al., 2018). Smoking cessation before the
operation is required to decrease the flow of sputum. However, if the prevention strategies are
not followed, specific treatment policies need to be undertaken. Broad-spectrum antibiotics can
be applied to cure the mucus plugging, and before the application of medicines, the blood and
sputum cultures need to be tested. If the infection is very severe, then the patient can be
administered with respiratory support like the ventilator for recovering the conditions of the lung
(Omokawa et al., 2018).
The care plan
The ADL refers to the activities of daily living, which is a term used in healthcare for
covering the daily care activities of people. The health professionals commonly use a person’s
ability to perform the ADLs as a unit of measurement of the functional status, preferably about
the health conditions after surgery, persons with disabilities and the elderly persons. The basic
ADLs include preserving a safe environment, communication, breathing, eating and drinking,
personal cleaning and dressing, eliminating, controlling the body temperature, playing and
working, mobilizing, expressing the sexuality, sleeping and dying. The four complications re-
described below;
 Complication 1- The first post-operative complication is atelectasis. The first nursing
assessment associated with it is the measuring the concentration of oxygen and nursing

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intervention associated with it is providing oxygen therapy to the patient. The rationale
behind this is because of the accumulation of mucous, the patient might suffer from
breathlessness (Suzuki et al., 2015). The second nursing intervention is managing the
pain of the patient and the intervention is referring a physiotherapist who can cure the
patient from pain. The rationale behind this is decrease in the expansion of lung may lead
to discomfort. The third nursing assessment is educating the patient about nutrition and
the intervention behind this is providing the patient with nutrition. The reason behind this
is the patient need high calorie to fight against the infection (Restrepo & Braverman,
2015).
 Complication 2- Secondly, the patient may suffer from post-operative complication
pneumonia. The first assessment of pneumonia is a full respiratory assessment. The
intervention in relation to this is regularly checking the vital signs and reporting the
doctor regarding the changes. The rationale behind this is that it enables the doctors to
treat the patient easily (Dhawan, et al., 2015). The next nursing assessment is the fluid
balance and the intervention behind this is that optimizing the fluid balance by providing
IV fluids. The rationale behind this is that because of pneumonia the patient may suffer
from dehydration and the oral consumption of fluid is not adequate to treat the
dehydration (Hendriks et al., 2017). Another nursing assessment is pain management.
The intervention is providing the patient with medicines to manage pain and the rationale
behind this is that the patient may suffer from chest pain because of pneumonia.
 Complication 3- The next post-operative complication is wound infection. The first
nursing assessment associated with it is pain management. The intervention is that the
patient must be provided with medicine to control pain. The reason behind this that the

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patient may suffer from severe pain after the operation (Greatrex‐White & Moxey, 2015).
The next nursing assessment is preventing the spread of infection to the nearby areas. The
intervention behind this is that the nurses must follow the infection control mechanisms
to prevent the spread of infections. The rationale behind this is that if the wound are left
untreated, microbial infection may happen and can spread to other areas. The next
nursing assessment is providing proper nutrition of the patient. For this the nurses can
teach the patient about the needs to take proper nutrition and also informing the patients
about the required foods that he should take. The reason behind this is that the patient
need proper nutrition for quick recovery (Shang et al., 2015).
 Complication 4- The next post-operative complication bronchial asthma. The first
nursing assessment is assessing the vital signs of the patient. The nurses must check the
vital signs regularly and report about this to the doctors. The rationale behind this is that
increased blood pressure or respirator rate may lead to respiratory failure. The next
nursing assessment is to find whether there are any signs of dyspnoea not (Mohammed &
Muhbes, 2015). The intervention is that the nurses must check the signs of dyspnoea. The
reason behind this is that it becomes difficult for the patient to breath in and out as the
pattern of respiration changes. The next assessment is checking the oxygen saturation
level and the intervention behind this is that the regularly checking the concentration of
oxygen saturation as reduce oxygen saturation increases the breathlessness of the patient
(Mohammad, 2015).
Role of physiotherapy after the operation
The physiotherapists perform an essential function concerning health and well-being. The
purpose of the physiotherapy is helping the patient to achieve the maximum physical

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features. The physiotherapy involves treatment of any acute or chronic injury. After surgery,
the bones, muscles and the other soft tissues undergo an age of healing. If the patient fails to
use the joint, then the healing process will not occur effectively. This can decrease the range
of motion, flexibility, and functions of the joints and overall outcome of the surgery. Because
this the physiotherapy after surgery is essential (Khalid et al., 2015).
The education that the patient requires
The patient of this case study requires specialized training to maintaining health. The
patient needs to know in details about the disease (non-small cell cancer) that he was
suffering. The nurse should have taught the patient about inevitable consequences of if the
patient fails to keep his health in good condition. Usually patients overlook the chances of the
post-surgery complications, so they need proper education about the specific disease that
they are suffering from and also about the particular operation that they had undergone The
patient had undergone thoracotomy and lobectomy, so he must be aware of the severe
complication like mucus plugging, The patient must be concerned about the diet plan and
should know which foods he should take and those foods which should be avoided. Fruits
with antioxidants like pomegranates and grapes should be taken, vegetables, nuts, fish, meat
and eggs should be taken to speed up the surgical recovery (Reeves, 2016).
Conclusion
The patients are admitted to the hospital with the expectation of receiving a
comprehensive treatment starting from the identification of the disease until the post-
operative treatments. During the post-operative stages, the patient may suffer from certain
complications because of the surgery that he had undergone. The nurses had responsibilities
to provide necessary care to the patient for reducing the sufferings of post-surgery

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complications. They should prepare a separate care plan for the postoperative complications
so that nothing of the health issues of the patient does get unnoticed.

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