University Nursing Report: Melody King Post-Operative Care Reflection

This report reflects on the case study of Melody King, a patient admitted with acute abdominal pain and a ruptured appendix, who underwent laparoscopic surgery. The study examines post-operative complications such as increased nausea, abdominal pain, elevated WBC count, and potential causes. It discusses the importance of holistic nursing care, including pain management, monitoring for complications like peritonitis, and addressing abdominal distension. The report emphasizes nursing goals to reduce pain, nausea, and infection risk, along with nursing interventions like patient assessment, vital sign monitoring, pain relief strategies, and early ambulation. It also considers the patient's medical history of asthma and depression, highlighting the need for a comprehensive approach. The reflection concludes that proper nursing protocols, early detection, and evidence-based practices are crucial for improving patient outcomes and preventing complications after an appendectomy, with references to relevant research.

Running head: REFLECTION ON THE CASE STUDY ON M.S MELODY KING
REFLECTION ON THE CASE STUDY ON M.S MELODY KING
Name of the Student
Name of the university
Author’s note

1REFLECTION ON THE CASE STUDY ON M.S MELODY KING
Introduction
This case study deals with a patient named Melody King, who had been admitted into the
emergency department of the hospital with acute abdominal pain. He had undergone a
laparoscopic surgery for the removal of the ruptured appendix. It has been reported that Melody
is having post operative complications like increasing nausea, centralized abdominal pain and the
assessment report shows that she is having an elevated WBC count and CRP. This study aims to
discuss about the possible causes and the complications of the clinical conditions and nursing
interventions that has to be taken up during the post operative period of the surgery. This study
focuses on how to provide a holistic care of approach to the patient as a registered nurse.
Discussion
A ruptured appendix can be a life threatening condition. When an appendix becomes
obstructed or infected, the bacteria residing inside the organ will reproduce and multiply. Due to
this the appendix may become filled with puss tissue cells, white blood cells (Biard et al., 2017).
This will create pressure on the walls of the appendix as a result the amount of blood flowing in
to the organ will reduce. Eventually the tissue of the appendix will die, causing breaking open of
the muscular walls of the appendix. According to the case study provided such a condition will
cause pain in the lower abdomen (Biard et al., 2017).
Past medical history:
Past records of Asthma and medical history can be found.

2REFLECTION ON THE CASE STUDY ON M.S MELODY KING
Present medications:
Current prescribed medications include -Ventolin, Seretide, Sertraline.
Ms. Melody kings observations:
 Her blood pressure is 95/45mmHg, which is quite low.
 Heart rate – 120, which is high than the standard.
 Temperature- 38.3°Celcius. The body temperature is normal.
 RR 22/min and shallow
 SpO2 95% on room air
Her report indicates that she has got a high WBC count. Normally appendicitis can be
diagnosed with elevated level of WBC. But it should get normalized after the application of the
antibiotics. An elevated WBC indicates that the infection still persists, which has to be treated
(Hussein, Bickel & Fischer, 2016).
The abdominal distension might have been caused due to the accumulation of gas in to
the abdomen. Although, appendix has a very little physiological role in human body,
inflammation in any organ is bound to create disturbance in the body. Abdominal guarding is the
tensing of the muscles of the abdominal walls in order to the guard the inflamed organ. Since
Ms. Melody had been suffering from Appendix infection, therefore it is normal that she will be
faced with abdominal guarding (Flum, 2015).
Prioritization of the nursing issues
To manage the post operative pain-

3REFLECTION ON THE CASE STUDY ON M.S MELODY KING
 Abdominal pain after the removal of appendix is quite normal, but if the pain is
intense and is centralized then proper and special care has to be taken. It has been
reported that the post operative pain generally decreases with time.
 To look for the complications-
Sometimes appendectomy is followed by complications that require immediate attention.
Red skin along with drainage can come out through the incision point. The complication is
known as Peritonitis. Things will worsen and will become life threatening if the infection enters
the blood stream. Fever, vomiting, abdominal tenderness, abdominal guarding may indicate
peritonitis (Giesen et al., 2017). The following case study gives information about the symptoms
of then patient which may indicate peritonitis. Improper assessment of the patient, improper
dressing of the wound, improper setting up of the nurse’s protocol, inefficient nursing
interventions can pose threat to the life of the patient by bringing about the complications
(Bjerrum et al., 2017).
 To look for the abdominal distension after the surgery
It is normal to face abdominal distension and bloating after an appendectomy, although it
goes away with time. Proper medications should be administered to decrease the formation of
gas in the stomach.
Nursing goals related to the case
The case provides with the information the Ms. Melody was suffering from some post
operative complications like increased level of nausea, abdominal pain. She was having a
centralized pain of about 7-8 on a scale of 10, which indicates that she was in quite a distress and
the surgery has not been able to remove her from the pain that she was in with the appendix

4REFLECTION ON THE CASE STUDY ON M.S MELODY KING
rupture (McAteer et al., 2015). The following can be the nursing goals to provide care to M.s
Melody-
 To reduce the post operative pain
 To reduce the level of the nausea
 To reduce bloating
 To lower the rate of wound infection
 To prevent comfort
 To prevent complications
 To reduce the risk of deficient fluid volume.
 To assist in proper breathing.
 To impart proper knowledge to the patient and her family (Ms. Melody and her family)
 To chalk out an appropriate discharge plan catering to the need of the patient.
Post operative nursing care approach
The post operative nursing care approach involves (Jaschinski et al., 2014)-
o The pain and the location should be assessed properly, as in this case the pain is
centralized. A complete physical assessment of the patient. Monitoring the vital signs of
the patient; in this case the patient is suffering from increased nausea and abdominal pain.
The patient should be kept in the semi fowler position in order to lessen the pain, as the
inflammatory exudates localizes into the pelvis due to the gravity which gives relief from
the pain. Holding a pillow against the stomach during or coughing or getting up can
decrease the pain with these activities.

5REFLECTION ON THE CASE STUDY ON M.S MELODY KING
o Early ambulation has to be given in order to promote normalization of the function of the
organs and to prevent complications. Ice bags should be kept on the abdomen during the
initial 24-48 hours. The patients’ laboratory results should be well addressed. Patent IVF
should be maintained properly. Proper antibiotics and analgesics should be administered
on time after consulting with the doctor.
The dressings of the wound should be checked regularly and proper dressings
should be done to prevent infections. The characteristics of the drainage should be
monitored as it provides early detection of the developing infections like peritonitis. The
drainage specimen can be obtained if needed. The patient should be encouraged to do the
deep breathing and the coughing exercises. Assistance should be provided in early
ambulation.
It should be noted the patient had a past history of depression and Asthma, so
before applying any treatment plan and the medications, the past reports should be taken
into account.
o NPO and NG suction should be maintained to decrease gastric irritation and abdominal
distension. The bowel sound and the movement of the flatus should be assessed. Oral
intake should be given in small amounts. The I&O and the hydration should be
monitored.
It can be seen from the case study that the patient has not recovered after the
appendectomy. The above mentioned nursing interventions possibly will be able to remove the
complications that Ms. Melody is facing with. Antibiotics can decrease the risk of the post
operative infections (Jaschinski et al., 2014).

6REFLECTION ON THE CASE STUDY ON M.S MELODY KING
Reflection on the patient outcome
The following nursing interventions are found to provide better outcomes in the patients.
I believe that the pain will be controlled; the patient will appear to be relaxed. The nursing
treatments would heal the wound timely and it would free of signs of infection, inflammation,
erythema or fever. The given nursing goals would provide comfort to the patient. Further study
of the case reveals that the patient had a past history of depression. A feeling of anxiety and fear
is always built up within any patient undergoing surgery. Therefore it is the duty of a nurse to
provide her with mental support to overcome the fear. As a registered nurse one should be able to
adopt a mind-body-spirit-emotion-environment approach to nursing.
Conclusion
The analysis of the case study provides with the detailed information about the
pathophysiology of the appendectomy with a linkage to the given case study. Researches
provides us with the information that a proper nursing protocol and a holistic care of approach
can bring about better outcomes in patients. Complications after Appendectomy can take an
adverse turn if not diagnosed properly or not taken proper interventions. In this case study there
might have been any mistake in the treatment or care imparted by the nurses that gave rise to
such an adverse condition. Patient assessment and taking proper care can reduce the
complications in the patient. Thus, it can be conclude that early detection, proper assessment of
the patient’s condition, proper protocol of evidence based practice can bring better outcome in
Ms. Melody King.

7REFLECTION ON THE CASE STUDY ON M.S MELODY KING
References
Baird, D. L., Simillis, C., Kontovounisios, C., Rasheed, S., & Tekkis, P. P. (2017). Acute
appendicitis. BMJ, 357, j1703.
Bjerrum, F., Strandbygaard, J., Rosthøj, S., Grantcharov, T., Ottesen, B., & Sorensen, J. L.
(2017). Evaluation of Procedural Simulation as a Training and Assessment Tool in
General Surgery—Simulating a Laparoscopic Appendectomy. Journal of surgical
education, 74(2), 243-250.
Flum, D. R. (2015). Acute appendicitis—appendectomy or the “antibiotics first” strategy. New
England Journal of Medicine, 372(20), 1937-1943.
Gasior, A. C., Knott, E. M., Holcomb, G. W., Ostlie, D. J., & Peter, S. D. S. (2014). Patient and
parental scar assessment after single incision versus standard 3-port laparoscopic
appendectomy: long-term follow-up from a prospective randomized trial. Journal of
pediatric surgery, 49(1), 120-122.
Giesen, L. J., van den Boom, A. L., van Rossem, C. C., den Hoed, P. T., & Wijnhoven, B. P.
(2017). Retrospective multicenter study on risk factors for surgical site infections after
appendectomy for acute appendicitis. Digestive surgery, 34(2), 103-107.
Hussein, A., Bickel, K., & Fischer, R. (2016). Long-term complications after appendectomy. Der
Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 87(12), 1074-1076.

8REFLECTION ON THE CASE STUDY ON M.S MELODY KING
Jaschinski, T., Mosch, C., Eikermann, M., & Neugebauer, E. A. (2015). Laparoscopic versus
open appendectomy in patients with suspected appendicitis: a systematic review of meta-
analyses of randomised controlled trials. BMC gastroenterology, 15(1), 48.
McAteer, J. P., Richards, M. K., Stergachis, A., Abdullah, F., Rangel, S. J., Oldham, K. T., &
Goldin, A. B. (2015). Influence of hospital and patient location on early postoperative
outcomes after appendectomy and pyloromyotomy. Journal of pediatric surgery, 50(9),
1549-1555.
Salminen, P., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., ... & Sand, J.
(2015). Antibiotic therapy vs appendectomy for treatment of uncomplicated acute
appendicitis: the APPAC randomized clinical trial. Jama, 313(23), 2340-2348.
Sauvain, M. O., Slankamenac, K., Muller, M. K., Wildi, S., Metzger, U., Schmid, W., ... &
Hahnloser, D. (2016). Delaying surgery to perform CT scans for suspected appendicitis
decreases the rate of negative appendectomies without increasing the rate of perforation
nor postoperative complications. Langenbeck's archives of surgery, 401(5), 643-649.
Shogilev, D. J., Duus, N., Odom, S. R., & Shapiro, N. I. (2014). Diagnosing appendicitis:
evidence-based review of the diagnostic approach in 2014. Western Journal of
Emergency Medicine, 15(7), 859.
Skarda, D. E., Schall, K., Rollins, M., Andrews, S., Olson, J., Greene, T., ... & Scaife, E. (2015).
A dynamic postoperative protocol provides efficient care for pediatric patients with non-
ruptured appendicitis. Journal of pediatric surgery, 50(1), 149-152.