Case Study: Analysis of Ted's Post-Operative Condition and Care

This case study analyzes the case of Ted, an 82-year-old widower who underwent bowel resection and colostomy due to a malignant mass. The study applies the clinical reasoning cycle to evaluate the bio-psychosocial, spiritual, and cultural impacts on his life, considering his medical history of heart failure, diabetes, and obesity. It assesses his post-operative condition, identifying health problems like obesity, nausea, vomiting, abdominal pain, and palpitations. The analysis includes vital signs, symptoms of respiratory distress, and the status of his colostomy. The case study proposes five intervention plans addressing the malignant mass, bowel resection, respiratory issues, and abdominal pain, including medication plans involving analgesics and beta-blockers. The assignment emphasizes the need for expert consultation, monitoring of wound healing, and patient education to manage his complex health needs effectively. The case study showcases the use of RLT model for nursing including assessment, diagnosis, planning, intervention and evaluation.

Running Head: CASE STUDY
CASE STUDY
Name of the Student
Name of the University
Author’s Note

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Question 1
This case study is about Ted who is an 82 year old widower. He lives alone because his children
live in different cities away from him. The clinical reasoning cycle has to be applied in this
situation to evaluate the bio-psychosocial, spiritual and cultural impact in his life. In the past he
went through a surgery of bowel resection and before 4 days, he had a formation of temporary
colostomy and due to which he is in his post-operative care. He had gone through bioscopy and
colposcopy, which indicated that he has a malignant mass and after that he had his surgeries. His
medical history shows that he had an episode of heart failure previously, type 2 diabetes mellitus,
obesity and gout. Ted’s health history has been complicated and is a reason for his current health
condition (Jangland, Kitson & Muntlin Athlin, 2016). His social background shows that he has
been living alone since his wife died because his daughter lives with her husband and three
children in another city, and his son lives with his wife overseas. A year ago Ted moved to a
retirement village had a partner known as Gwen, a 78 year old. Ted went through a bio-
psychosocial impact due to his surgery as he already used to live alone after his wife died so he
had no one to share his dilemma. He had to depend on others for his medical needs (Arigo, Suls
& Smyth, 2014). After using the RLT model for nursing, it was seen that an efficient nursing
practice includes assessment, diagnosis, planning, intervention and evaluation. Ted was assessed
for his condition, which suggested that he needed a bowel resection. After his surgery, he was
not given food for the next 48 hours. He started vomiting when he was given his regular diet and
it was not a positive implication for his health. The care plan given to him will be linked to the
planning, intervention and evaluation done for his surgeries. His family will get affected from the
spiritual and cultural aspect as it will make an impact on their lifestyle seeing their loved ones
going through pain. The major reason for his family to get affected is because he lives alone.

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Question 2
The evaluation of this patient and identification of the health problem will be done according to
the information given in the case study. He has a BMI of 37.6 m2, which is under the category of
obese grade III. This is not an ideal weight for him considering his health history, which includes
heart failure and diabetes. The chronic diseases he is suffering from is due to the excess fat in his
body and it is also the reason for further complications he is going through such as kidney
dysfunction, bowel obstruction, and cardiovascular diseases. His other tendencies include nausea
and vomiting when he started with his usual diet, which indicates that his bowel resection still
needs to be observed because it might not have healed properly. The symptoms of improper
bowel resection includes bloating, abdomen pain, no flatulence and no bowel movement
(Rottenberg, Jacobs & Stessman, 2015). The abdomen is distended, and he has more pain due to
the palpitations he is suffering from, which is measured in the scale of 7/10. People with non-
cardiac surgery can also suffer from palpitations, which includes vascular surgeries and
abdominal operation. Ted is having an abdomen pain due to the surgery and the occurrence of
palpitation is common in patients post-surgery. The vital signs of this patient showed that his
SpO2, heart rate and temperature was normal, his blood pressure was above the range (135/85)
mmHg and his respiratory rate was also higher (26). The elevation in his blood pressure indicates
that it happened due to the side effect of the surgery, and that happens because of the anesthesia
given before the surgery (Erb, Hyman & Osler, 2014). However, the palpitation could also be a
sign of arrhythmia because he has suffered heart failure. The respiratory rate is above the range,
which is due to the palpitations as irregular heart beat is due to pulmonary hypertension. Further
observation also indicated that he has signs of right sided inspiratory coarse crackle and a moist
cough, which is an indication of fluid in his lungs due to pulmonary oedema, pneumonia or

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chronic heart disease. Due to his symptoms of coarse crackle and moist productive cough, it
becomes easier to understand that it might be due to his previous history of cardiovascular
disease such as heart failure and palpitations (Pecorelli et al., 2017). To reduce his pain he was
given a PCA morphine so that he could feel comfortable and at rest. Later, when more
examination was done it was seen that his colostomy bag was intact including his stoma. His
stoma was inserted when the surgery took place and it was moist, warm, pink and slightly above
his skin. The stoma had no output since the surgery took place such as flatulence and sluggish
bowel movements. Sounds of inactive and slow bowel movement was heard, which indicated
that his bowels were not functioning properly after the surgery (Vester-Andersen et al., 2014).
The patient needs to be asked about the passing of gas, which is the usual protocol to understand
if the bowel was healed post-surgery. The symptom of no flatulence and improper digestion is
due to malfunctioning of the bowels. There was no evidence of ooze in his occlusive dressing
after the laparotomy in the abdominal area, which shows that his wounds were healing (Byrne et
al., 2015). 30 ml of haemoserous fluid was found in his redivac drain and that is a normal
occurrence after a surgery depicting that the wounds are not infected. The urinary catheter
showed that he passed 6-70 ml urine every hour and that is a normal range post-surgery because
an incomplete bladder discharge indicate high amounts of residual urine volume. All these signs
show that his physiological condition is improving post-surgery.
Question 3
5 intervention plans are planned for Ted according to his current condition such as:
1. The diagnosis of malignant mass was done after he had his colposcopy and bioscopy
before his surgery took place. The cancer cells make the malignant mass, which has the
ability to spread all over the body and the tissues, and that is a life threatening condition.

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The symptoms of cancer has to be considered while making the care plan such as proper
diagnosis and the relevant treatment. The nurses should consult an expert oncologist so
that his malignant can be examined more properly. The treatment for cancer should be
started in the initial stages with chemotherapy so that he has more chances of survival
than being in a critical condition in the later stages. It is difficult to cure cancer in the last
stage as the cancer cells have already spread in all the tissues of the body.
2. He also needs to be examined and observed for his bowel resection surgery that includes
his temporary formation of colostomy. The nurses have to keep him in complete bed rest
for his wounds to heal so that he can have a proper bowel movement without
obstructions. His intervals of flatulence should be observed without having the symptoms
of vomiting and nausea post-surgery. The urine output and its quality should be examined
to detect any abnormal tendencies in his excretory system that includes amount, odour
and colour that is released from the stoma or the surgical drain. The wound has to be
examined for any type of infection or wound drainage. The issue of no flatulence should
be dealt with proper medications such as antacids that will allow his bowel movement to
function properly (Deelder et al., 2014).
3. Ted has been showing tendencies of right sided inspiratory coarse crackle including moist
productive cough and that requires the nurses to examine his respiratory system through
the process of auscultation, which helps in understanding respiratory distress. The
difference between wheezes and crackles have to be understood so that proper diagnosis
can be identified related to his respiratory system. When the lung sounds are examined
properly, it helps in understanding the pathophysiology of the health condition, which

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makes it necessary for Ted’s respiratory system to be assessed (Sabaté, Mazo & Canet,
2014).
4. Ted complaint of abdominal pain and he rated it 4/5, and that showed the severity of his
pain indicating that he needs medical intervention. The treatments that can be utilized to
reduce his pain could be muscle relaxants, hot or cold treatment, analgesics and antacids.
The nurses should also look after his hydration and if it is not adequate then he should be
given intravenous solution. His bowel sounds and frequency of bowel movement will be
an indication of the functioning of his system and that will also include the texture and
odour of the stool (Pucher et al., 2014).
5. The abdominal pain was accompanied by an episode of palpitation and it was rated as
7/10. Palpitation occurs after any surgery even if it is non-cardiac such as gastrointestinal
surgery because it has chances of medium cardiac risk. Nurses have to position the
patient in a comfortable position to reduce his risk of heart failure and respiratory
distress. Patient education should be used as a strategy so that Ted can understand his
condition and ways to deal with it during emergencies (Gurusamy et al., 2014).
Question 4
Ted needs to be given medical intervention for his condition because he has several
complications as he is also in his post-operative stage. He will be given two types of drugs for
his immediate care and intervention. The first drug prescribed to Ted should be an analgesic,
which is used for reducing pain or as a pain killer for fever, muscle pain and cramps. This
medicine will be given to him to reduce his abdominal pain. The mechanism of this medicine is
such that it inhibits the secretion of chemical messengers such as prostaglandin that functions to
reduce pain and inflammation. The drug under this class of medicine is known as

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acetaminophen, which blocks the production of cyclooxygenase (COX) enzymes, and this
enzyme is the reason for prostaglandin secretion. The side effects of this medicine includes
dizziness, constipation, dry skin, rashes and constipation. The suggested dose for this drug is
1000 mg oral tablet ones in a day, and the patient should not lie down immediately after
consuming the medicine as a nursing implication (Manglik et al., 2016).
The second drug that will prescribed for Ted will be beta blockers such as propranolol, atenolol
and metoprolol. The speed of heart rate is reduced leading to less chances of palpitation with the
help of beta blockers. Beta blockers are also known as beta-adrenergic blocking agents, which
helps in reducing blood pressure through the inhibition of epinephrine hormones, which is also
known as adrenaline. The increased speed of heart rate is due to adrenaline and when the
secretion is reduced then palpitation comes under control. Side effects of beta blockers are
headache, weakness, cold hands and feet. This medication has to be taken after consulting the
doctor only if there are any signs of fast heart rate as a nursing implication (Wexler, Pleister &
Raman, 2017).

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