Case Study Analysis: Post-Operative Care and Complications

This case study analyzes the post-operative care of an 82-year-old male, Ted Williams, who underwent bowel resection and colostomy. The case study explores the patient's medical history, including heart failure, diabetes, obesity, and gout, along with the psychosocial factors influencing his care. It delves into the clinical reasoning cycle, from data collection to goal setting and interventions, addressing complications like postoperative ileus and pulmonary edema. The assignment details the patient's symptoms, medications, and vital signs, along with the nursing interventions such as nasogastric suctioning, intravenous hydration, oxygen therapy, and pharmacological treatments including opioid antagonists and cyclooxygenase 2-inhibitors. Furthermore, the study emphasizes the importance of person-centered care and cognitive-behavioral therapy to address the patient's anxiety and social isolation. The case study provides a detailed overview of the patient's condition, nursing care plan, and the rationale behind the interventions. It is aimed at providing a comprehensive understanding of managing post-operative complications in elderly patients.

Running head: CASE STUDY
Case Study
Name of the Student
Name of the University
Author Note

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ANSWER NO.1
The initial phase of the clinical cycle reasoning emphases upon collection of
documents observing the current state along with evaluation and monitoring that collected
information. It is usually done in the healthcare to assess the condition and to identify the
health status or chronic disease that is present in any patient and consequently, treatment is
provided (Gummesson, Suden & Fex, 2018). The patient in the case study is an older adult of
age 82 who had surgery and is currently in a postoperative phase. He also had a complaint
about a temporary colostomy. The patient had a previous history of a malignant mass in the
body which severely affected the condition. The other condition that affected the patient is
heart failure, obesity and most marketable diabetes mellitus. The Roper Logan Tierney model
is a kind of nursing care planning model which focuses upon the patient's daily activity and
recognition of that factors that affect the life and activity of any patient (Williams, 2015). The
main psychosocial issues that are faced by the patient, in this case, are feeling of loneliness,
progressive age and detrimental perspicacity of stoma. The older patient in the case study is
already grasped with many diseases as he lived alone and socially isolated. This socially
isolated factor develops many diseases such as depression, anxiety and also post-traumatic
disorder (Malcolm, Frost & Cowie, 2019). The deterioration in health condition this patient
developed due to disoriented lifestyle, which resulted in psychological distress condition. The
older patient had many challenges in life, such as coping up with diseases such as obesity,
trauma, stroma (Marosi & Koller, 2016). The patient also moved into another city due to a
feeling of embarrassment and social avoidance for having a malignant condition. The patient
also lacked confidence, which impacted his life heavily.

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Answer 2
The second step of the clinical reasoning cycle focuses on collecting cues from the
patient. It is important in planning care because it includes clinical judgements and problem-
solving after the collection of health information about any particular patient (Leoni-
Scheiber, Mayer & Muller-Staub, 2019). The patient, in this case, was in a phase of the post-
operative period. The patient had a previous record of obesity, gout, diabetes mellitus and
heart failure. The patient is also suffering from cancer which is recognized and confirmed
after the biopsy test (Palmirotta et al., 2018). The patient was in a few medications such as
captopril for preventing and controlling the heart disease, and the metformin is used in
controlling the diabetes mellitus (Schlender et al., 2017). The patient was currently in a post-
operative state and is shifted from nil food diet to a very light liquid diet. This shifting of diet
resulted in vomiting and nausea. The patient was also distress because of inspiratory coarse
crackles on the right side of the chest which also resulted in coughing symptoms. The reason
for developing this bowel syndrome might be because of consumption of allopurinol, as this
produces an adverse reaction in the body like intestinal upset and rashes (Yang, 2020). The
chemical compound purine in the body is broken into uric acid and are usually excreted by
bowel movement or urine. The crystal form of uric acid is generally settled down in the body
giving rise to a painful situation (George & Minter, 2019). Bowel syndrome is a common
condition after surgery. It is more common after the removal of the small intestine from the
body. This amputation results in different malabsorption in the body, such as a defective
water retention system in the body, which give rise to diarrhoea and also poor nutritional
absorption Saha, 2014). The condition of the constant coughing is due to the accumulation of
fluid into the lungs, which results in long-lasting crackles. The condition can develop due to
chronic respiratory disease such as pulmonary oedema that can originate due to pneumonia or
bronchitis which results in high blood pressure due to pushing of excessive fluid into the

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alveoli (Sureka, Bansal & Arora, 2015). The patient was an elderly adult who also indicates
that the immune system of this person is lower, which can be due to age or because of
chronic diseases. The lung infection can also be due to lower immune function of the body or
due to hospital-acquired infections. The patient had abdominal pain with pain score 4 to 5 out
of 10. The pain rises due to palpitation, which is identified after proper observation. The
palpitation is primarily caused due to stress in mind, which results in increased heart rate and
can often result in a heart attack. The patient had a sign of abdominal distention (de Jesus et
al., 2015). It is also found that the area where the colostomy bag was injected is found to be
moist, warm, and slightly pinkish. The patient also did not pass any output after surgery but
had a sluggish bowel sound. The pus output was also minimum; it was drained by medevac
drain. The patient was also suffering from fever, which is identified after observing the
temperature, which was 38.1-degree centigrade. The heart rate of the patient was also found
to be very high, which was 98 beats per minute. The patient had high blood pressure with a
reading of 135/85 mmHg. The respiratory rate was found to be 26 beats per minute, and spo2
is 94%, both the rates were high.
The collective information suggests that the patient was suffering from a condition of
impairment of gastrointestinal mobility because of surgery. This condition results in
restriction indigestion, nutritional malabsorption, which results in nausea and vomiting
(Tobias & Sadiq, 2019). This is known as postoperative ileus. The condition is identified by
heavy accumulation of gas in the gastrointestinal tract, which leads to delay or no passage of
stools from the body. The patient was also intolerant towards any kind of food that is
provided, such as liquid or solid. It is known that any kind of surgery or injury rises the
triggers or stimulates the afferent nerves of the nervous system. The inflammation that
occurred in the body is due to the defective function of both parasympathetic and sympathetic

4CASE STUDY
nerves (Waxenbaum & Varacallo, 2019). The inflammation is also caused due to leakage of
chemical mediators which results in swelling in the tissue.
Answer 3.
The next step in clinical cycle reasoning focuses upon setting goals and interventions
by the nurse to treat any patient. The nursing care that is required for this case is mainly to
address two diseases of the patient, such as postoperative ileus and also pulmonary edema.
The patient also had anxiety and stress due to a chronic condition. The anxiety also results in
increasing pain and stress. The five nursing interventions that can be adopted for reducing
this state are nasogastric suction for lowering the patient symptom, drugs such as naxolone,
methylnaltrexone and alvimopan for reducing the state of postoperative ileus, pulmonary
edema can be accomplished by using oxygen therapy and vasodilator. The anxiety symptom
can be controlled by counseling or cognitive behavioral therapy.
 The major health issue that is faced by the patient (Ted) in this is Postoperative Ileus.
The primary intervention for this condition must be able to return the normal
gastrointestinal function in the body. This can be done by nasogastric suctioning. It is
a method of sucking out any kind of obstruction that is present inside the bowel,
which is a common problem in the postoperative ileus condition, and it is also helpful
in removing the obstruction as well (Achary, Arora & Kumar, 2014). It can be used
by healthcare practitioners in the association of other therapeutic interventions. The
patient can also be given intravenous hydration as he was intolerant towards any kind
of light or fluid diet. In this case, the patient must be provided with nutrition with
water intravenously. So, the patient must be provided with proper intravenous
injections, which is one of the vital plans for reducing postoperative ileus.

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 In maximum cases, postoperative ileus can be managed and cure with supportive or
compassionate treatment and observing the patient. In the meantime, the patient
already had many adjuvant diseases, his vitals sign should be constantly checked, and
he should be kept under close observation. The patient’s vital signs should be checked
continuously, and the tests must be conducted as well. Long- term Oxygen therapy
will be helpful in treating patients' conditions by enhancing the stamina and
improving sleep (Cousins, Wark & McDonald, 2016).
 The nurse can plan for the intervention of drugs after the guidance and direction of
senior healthcare practitioners. The drugs like alvimopan, methylnaltrexone and
naxolone can be used for this purpose. These drugs belong to the class of mu-receptor
antagonists, which has a restricted ability to pass through the blood-brain barrier and
blocking the receptors that are present in the gut, thereby reestablishing the condition.
The microbial flora of the gut helps in the metabolization of the drug. The drugs are
also absorbed and distributed in the blood plasma readily. The drug naxolone is
tertiary alcohol, and methylnaltrexone is a quaternary amine where both depresses the
effect of opioid drugs. These two blocks the analgesics effect and lowers the
constipating effect of the gastrointestinal drug (Streicher & Bilsky, 2017).
 Vasodilator therapy can be used in reducing the condition of high blood pressure with
a reduction of pulmonary edema. Hydralazine belongs to this class of drugs. It helps
in lowering the blood pressure by relaxing and reducing the smooth muscle with the
help of the peripheral vasodilation effect. The tightness and narrowing of the smooth
muscles are prevented, along with enhancing the blood flow through the entire body.
 The patient needs mental support as he is an older adult and also socially isolated. The
main approach for this state will be person-centered care, along with cognitive-
behavioral therapy. It is a kind of communication therapy in which nurses or health

6CASE STUDY
care practitioners needs to understand the patient condition and help in imposing
positive beliefs. This will, in turn, be helpful in lowering the pain along with blood
pressure and heart rate (Chand, Kuckel & Huecker, 2019).
Answer 4.
The patient in the case study had a symptom of postoperative ileus. The opioid drug
can not be provided in this case as these drugs increase the constipation state of the body.
This particular action is not beneficial for this patient as he was unable to pass any output,
which can be because of the side effects of the opioid. Opioid antagonist medicines can be
given in this condition as these drugs act by binding with the opioid receptors for blocking
the action. The drugs that can be given in this case are cyclooxygenase 2-inhibitors and
Naloxone. Methylnaltrexone and alvimopan can also be given. The Naloxone can be
administered intravenously as the patient was not in a stable condition for consuming the
drug orally. This drug will be useful in reducing the action of opioids and also reversing the
state. This drug has an affinity for the μ-opioid receptor (Theriot et al., 2019). The drug can
be administered by different ways such as nasal route, intravenous, subcutaneously. The
shows its action within 3 to 5 minutes after administration. The action of this drug is of very
short duration, and regular monitoring is essential in this case.
The cyclooxygenase 2-inhibitors belongs to the group of non-steroidal anti-
inflammatory drug and is used in the management of postoperative ileus. These drugs
decrease the activity and manufacture of prostaglandins, which are chemicals that promote
inflammation, pain, and fever. The patient had a fever as well, so this drug will be helpful in
reducing the current condition by inhibiting the enzyme cyclooxygenase. The drug can be
administered orally, and it quickly gets absorbed and distributed after 4 hours of consumption
(Mahboudi Rabbani & Zarghi, 2019).

7CASE STUDY
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