NUR2203 Assignment: Acute Care
The essay assignment is a good combination of
interactive data and structures to present the most recent and effective data
about a patient (Tom Lewis) care who has undergone elective open left sigmoid colectomy. The first section of the assignment provides the
academic literature devised plan of care for Tom post-surgery. The second
section of this assignment analyse the potential clinical complications of
history of smoking and cardiac problem on post-surgery, specifically first 24
hours post-surgery. This section will also present the nursing interventions
for the identified issues. The lasts section of this paper will present the
discharge plan of care for Tom Lewis.
1: Utilising the case scenario and academic literature to devise a plan of care
(may use 10 font and two A4 pages)
- Heart rate
- Pulse rate
Stoma (wound opening after surgery) circumstances:
- Absence or presence of sphincter at stoma
- Signs of bleeding from wound
- Stoma color à normal, or reddish color
- Inflammation signs
- Stoma position
- Flow or character of effluent and flatus from stoma
- Drainage or secretions
Alterations in fecal elimination:
- Intake and output volume
- Losses through the abnormal routes like
perineal wound drainage tubes or NG/intestinal tube
- Consistency, color, and odor of stool
- Loss through normal routes- diarrhea or
- Absorption of fluid
- When pain arises (repetitive or continuous)
- Psychological causes if any
Is sleep and rest needs being met:
- Stoma disrupts sleep or not
- Sleeps well or not
- Any environmental factors contributing to sleep disturbance
- Any psychological factors complicating sleep
and noting characteristics, location, and intensity on 0-10 scale.
patient to communicate concerns with active listening with consistent
Providing comfort measures like repositioning,
back rub, etc assuring that it will not injure stoma.
Administering indicated medications like PCA,
analgesics, and narcotics.
evaluating discomfort degree and analgesia effectiveness and can reveal
complication development. The abdominal pain generally subsides gradually by
3rd or 4th day post operation, but increasing or
consistent pain can reflect healing delay or peristomal skin irritation.
fear/anxiety promotes comfort or relaxation.
of oral mucosa and linked discomfort which also decreases muscle tension and
This relieves pain and improves comfort
discomfort, decreases edema, and promotes perineal wound healing.
deficient fluid volume
intake and output, measuring liquid stool, and weighing regularly.
Monitoring vital signs, tachycardia, postural
hypotension and evaluating skin turgor, mucous membranes, and capillary
Monitoring laboratory outcomes like electrolytes
Administering IV fluids and indicated
This gives direct indicators of fluid balance and
greatest fluid losses usually occur with colectomy.
hydration status and the plausible requirement for enhanced fluid
This detects imbalance or homeostasis and helps in
replacement need determination.
essential for maintaining adequate organ function/ tissue perfusion.
Observing open wound and noting the
characteristics of drainage.
Changing dressings as required using aseptic
Encouraging side-lying position with elevated head
preventing prolonged sitting.
Providing sitz baths.
hemorrhage usually occurs within first 48 hours post-surgery and infection
can develop anytime.
drainage amounts need dressing change frequently for reducing skin irritation
as well as infection potential.
Promotes drainage from the perineal drains/wound,
decrease in pooling risk. Moreover, prolonged sitting raises perineal
pressure, delays healing, and reduces circulation towards wound.
cleanliness and also facilitates healing.
diarrhoea or constipation
patient’s earlier bowel lifestyle and habits.
absence or delayed onset of effluent auscultate bowel sounds.
dietary amount or pattern, kind of fluid intake.
physiology and irrigation management of sigmoid ostomy.
Helps in timely
formulation or efficacious irrigating schedule for patient.
paralytic or/and adynamic colon resolves within 48-72 hours and colectomy
starts draining within 12-24 hours post surgery. The delay can indicate
persistent stomal or colon obstruction that could occur due to edema,
prolapsed, or stoma stenosis.
intake and roughage gives bulk, and fluid is the imperative factor to
determine stool consistency.
patient understanding about individual care needs.
(Brady, Keller & Delaney, 2015); (Rodriguez-Bigas,
2017); & (Tebala, Keane, Osman, Ip, Khan & Perrone, 2016)
2: Analysing the case to identify potential clinical issues (800-1000 words)
Cigarette smoke consists of 4000 substances. Some of
its constituents result in cardiovascular issues, increasing heart rate, blood pressure,
and the systemic vascular resistance (Grønkjær, Eliasen, Skov-Ettrup, Tolstrup,
Christiansen, Mikkelsen & Flensborg-Madsen, 2014). Cigarette smoking of
patient can also cause respiratory issues in patient post-surgery by
interfering with oxygen uptake, delivery, and transport. The interference
occurs with respiratory function during as well as after anesthesia (Ozgunay,
Karasu, Dulger, Yilmaz & Tabur, 2018). Even the passive smoking impacts anesthesia.
The best aspect is to stop smoking for about 8 weeks before the surgery or at
least for 24 hours prior surgery. Tom is an active smoker who has a history of
smoking 2-3 cigarettes daily. Post his elective open left sigmoid colectomy returning to PACU, the observations of Tom clearly depicts the
complications due to his smoking history as decreased respiration rate of 12
and imbalanced blood pressure as 90/54 and heart rate as 88.
Smoking leads to higher risk under anesthesia
because smoking disturbs the body’s healthy functioning certainly in heart and
lungs. The cigarette smoke’s carbon monoxide combines with RBCs (red blood
cells) and decreases the capability to oxygen transportation that decreases the
supply of oxygen to the lungs and other cells (Rodrigo, 2000). The carbon
monoxide results in poor heart pumping which further decreases the oxygen
amount delivery to the rest of the body. On worsening note, nicotine from
cigarettes raises the oxygen amount requirement (Grønkjær et al., 2014). This
makes heart fucntioning highly complicate during general anaesthesia. Moreover,
active smoking habit of Tom would have affected his lungs in multiple ways. There
would be more mucus secretion and reduced ability of lungs for clearing these
secretions. With smoking, even the small airways become narrowed making lungs prone
to collapse (Ozgunay et al., 2018). This makes the lungs highly susceptible to
infection which includes chronic cough and several breathing complications. Tom’s
lungs are highly reactive and sensitive due to smoking presenting higher possibility
of bronchospasm and other complications due to anaesthesia. This risk increases
by 6 times and smoking will also delay his wound healing which can result in
heart issues like heart attack (Ozgunay et al., 2018).
Further, myocardial infarction history of Tom has
also impacted major body functions. Due to infarction also known as heart
attack, when the portion of the myocardium dies, it deteriorates the efficacy
of the cardiac system (Authors/Task Force Members, Kristensen, Knuuti, Saraste,
Anker, Bøtker & Heyndrickx, 2014). The dead tissue does not