Delivery in day(s): 4
Critical Care Nursing Diagnosis and Management Assignment Help
This assignment would be aiming to answer a few questions related to Joan Middleton who is a 44 year old woman suffering from acute cholecystitis. The woman presented herself to the hospital with symptoms like tenderness, nausea, high fever and severe pain in the upper right area of her abdomen. Her body temperature was 38.9° C, which is too high from the normal temperature. She was immediately sent to the operation theatre for surgery. The surgery that happened was emergency laparoscopic cholecystectomy.
Her medical history indicates that she is obese with BMI of 37 and she is suffering from type 2 diabetes. Currently is not taking any prescribed medication and only following the diet control approach to control her body fats. She is a mother of three children and taking care of them alone. Undoubtedly, she is going through stress and difficulties in her daily routine.
She had an uneventful recovery and was admitted to a ward for post-operative care. When the patient, Joan was brought to the ward after the operation following were the observations. Her body temperature was high, that is she had fever. Drugs are to be given immediately to lower down the temperature of her body. The body will not be able to recover if the fever prevails for a long period. Pain in her right abdomen and shoulder was rated 8 on 10. This means she is having very severe pain and needs to take strong painkillers as soon as possible. Her body will be able to be normal and calm only when she feels less pain in the abdomen. Due to the pain, the pulse rate is very high. The patient is breathing heavily. At this time, there is a need to calm her down mentally and physically. The nurses and the spiritual service providers have to help her to bring back to normal. The patient is having 90/50 blood pressure. This indicates hypotension and is lower than the normal. Medication is given to curb it, as the person could feel weak or faint with such a low blood pressure.
The following factors are responsible for the patient’s health alteration in a small period:
1. The patients growing age is a reason as this ailment mostly strikes the senior citizens of the whole population.
2. The patient is a single parent of three children, so there would be some reason of serious stress and trauma that she would be going through.
3. In addition, the patient is diabetic in type 2, which is another factor that highly contributes to the ailment.
4. Obesity of the patient makes it her more prone to the ailment.
5. Some severe illness for a long time also becomes a reason for this ailment.
6. Neglect towards the abdomen pain results in the chronic condition of cholecystitis.
7. The feminist gender is more prone to the gallstones as compared to the masculine.
8. There is a possibility of a small tumor in the gall bladder, which also leads to the blocking of the bile ducts. (Brodsky, Matter, et al., 2000)
Nursing plays a vital role in the recovery of from the operation as the patient can be made to prepare herself mentally about all the after effects caused by the removal of the bladder. There are precautions to be made by the patient and make changes in their daily routines so that there are no further complications due to the surgery. (Morton, Fontaine, et al., 2005).
Other than the pre and post-operative care, the nurses are also responsible to bring the heart and mind of the patient at peace. With the help of the nurses, social workers and spiritual service providers, the patient will be able to recover soon. There is a need of the nursing staff to monitor the patient all day and all night long. The staff members have to work in coordination so that there is no delay in the delivery of any service to the patient and the patient could be discharged on the prescribed time with all the medical formalities done. (Leininger, 2002)
Answer 2. The Nursing Management
The goals to be achieved by the nursing staff are:
a. Reduce pain in the patient’s body.
b. Bringing the fluids in to balance.
c. Avoid the risk of complications.
d. Fetching details about the ailment in its treatment.
Role of nursing in the treatment process:
1. Diagnosis:The patient is to be accurately diagnosed and then treated. Complete documentation is to be made regarding the pre and post condition of pain and other symptoms.
2. Comfort:Activities that give comfort to the patient are promoted like tilting half of the bed and easy breathing postures etc.
Recreation: Activities that divert the mind of the patient from the pain and the operation should be carried out.
3. Friendly behaviour:The nurses are supposed to maintain friendly informal contacts with the patient. This way the patient feels more comfortable in sharing her actual condition.
4. Nutrition:The nutritional needs of the patient are met and that they take a proper diet comprising of the proteins, vitamins and minerals that are best suited for fast recovery from the operation.
5. Consent of the patient:The likes and dislike of the patient are taken in to consideration. The patient would eat properly id the food is of her choice and nutritional as well.
6. Diet of the patient:Patient has to take a proper diet and try to increase her appetite. Such operations and recovery medications makes a person loose his or her appetite. There should be other methods used to maintain the diet of the patient.
7. Technical view:The studies regarding the BUN, albumin, protein levels etc. are to be accurately read from the machines and documented.
Evaluation of the patient after the care provided to her:
A. The patient is not having fever and pain in her body. Her body is now safe from the after effects of the operation.
B. Homeostasis is achieved in the recovery period of two days.
C. There are no accepted complications in the patient’s body. Yet Joan is given some health tips to be followed to avoid the long-term problems.
D. The documentation of the ailment and its treatment with full detailed description is made for the hospital and also the patient.
The discharge guidelines that are given to the patient:
1. The postures that she has to make while coughing and sneezing are explained to avoid any sudden pain in the abdomen. In addition, the patient is suggested to not lift heavy objects.
2. A few medicines are prescribed to the patient in case if a pain arises and it becomes an emergency. The covering and protection of the four incisions is explained to the patient.
3. The diet that the patient should maintain for some period of time is given by the dietician.
4. The patient is explained about the tilting of the bed and the reclined posture that she can be in if anytime she feels uncomfortable.
5. The nurse’s duties also include that how the patient has to get along with the daily chore of her life.
Answer 3. The health care team:
The following health care team will be required for the patient who was recently operated for cholecystitis:
1. Physician:The physician is the one who examines the patient along with the surgeon. He has to come, see the patient for routine check-up, and give his consent for her discharge.
2. Nurses:The patient needs one full time nurse to take care of the health needs. Yet there is a need for the nursing staff who can attend the patient when the concerned nurse is unavailable. . (Bodenheimer, 2008).
3. Nurse Manager:There is a need of a manager to manage the nursing team and can assign duties to the nurses in the hospital.
4. Dietician:Every patient in the hospital follows a diet chart that is given by the dietician. The dietician is supposed to make two visits in a day. In addition, the dietician has to give a list of the food that should be consumed by the patient.
5. Technician:There is a need of at least one technician who can assist the staff members with the electrical appliances that are used in the ward.
6. Therapist:A therapist is needed so that they can give therapies that could help the patient to relieve the pain and come out of physical and mental stress.
7. Pharmacist:The pharmacist is required to supply medication at proper time intervals. He can coordinate with his team to do the assigned tasks.
8. Administrative and Supporting staff:The supporting staff is need to maintain the cleanliness of the ward and surroundings. The administration of the hospital is required for the overall functioning of the hospital and to see that the needs of each patient are fulfilled.
9. Social Worker:There is a need of the social who can assist the patient with the mental and financial issues they have to face cause of the disease and how they can cope up with the loss. (Plsek, & Greenhalgh, 2001).
10. Spiritual Support Provider:A person who is spiritual and positive in his conduct needed to be present in the hospital so that the patient can get good vibes when he or she feels low.
Critical Analysis of the disease:
Cholecystitis is a gall bladder ailment where there is inflammation in it due to the blocking of the bile duct, cause of gallstones. The patient, Joan Middleton was admitted to the hospital as a case of acute cholecystitis. In this there is 90% blocking of the bile juice in the gall bladder causing thickening of the bile juice and more than usual quantity of it in the gall bladder. The walls of the gall bladder of the patient were red and intense causing severe pain in the abdomen.
The treatment for cholecystitis is cholecystectomy. In this, the gall bladder of the patient was removed by conducting laparoscopic cholecystectomy as in this case. There are no serious complications in this type of cholecystectomy as there are only four small incisions made to take out the gall bladder in the patient’s abdomen.
When the patient came to the hospital, she showed clear symptoms of cholecystitis. An ultrasound was then performed to confirm the detection. In case of acute cholecystitis, immediate surgery is needed. There was no time to depend on ERCP or gall bladder drainage. Although, the discharge is given right after one or two days with a few precautions to be taken in the daily routine. (Schirmer, Winters, & Edlich, 2005)
The only possible complications in this ailment is the infection of the gall bladder due to the prolonged build-up of the bile duct in the bladder. The patient reached to the hospital on time and prevented herself from all these risk factors. The immediate response of the surgeon prevented the use of open cholecystectomy. (Tacchino, Greco & Matera, 2009).
Other complications can take the form of leucocytosis, as the body may increase the production of white blood cells in the process of homeostasis. The infection in the gall bladder might be transferred to the bloodstream taking the form of sepsis. To keep the patient safe from these complications, Joan was kept in the ward for two days of care in the hospital.
The following conclusions could be drawn from the essay. A close study of the patient, Joan Middleton has been done who has gone through cholecystectomy and has been kept in the ward for recovery. The need of the nursing staff and the importance of their duties is explained in detail. The ailment of cholecystitis explained extensively with respect to its treatment and causes. The factors that led to the patient to go through this health alteration are listed. The management that the hospital health care team is supposed to possess is studied in detail. Another list has been made in which the members of the health care team are mentioned that are required for the patient for her pre and post operation care.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2005). Critical care nursing: a holistic approach (Vol. 1). Philadelphia: Lippincott Williams & Wilkins.
Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of transcultural nursing, 13(3), 189-192.
Tomey, A. M. (2009). Nursing management and leadership. Elsevier, Missouri.
Mitchell, G. (2013). Selecting the best theory toimplement plannedchange: Improving the workplace requires staff to be involved and innovations to be maintained. Gary Mitchell discusses the theories that can help achieve this. Nursing Management, 20(1), 32-37.
Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical care nursing: diagnosis and management. Elsevier Health Sciences.
Tacchino, R., Greco, F., & Matera, D. (2009). Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surgical endoscopy, 23(4), 896-899.
Schirmer, B. D., Winters, K. L., & Edlich, R. (2005). Cholelithiasis and cholecystitis. Journal of long-term effects of medical implants, 15(3).
Brodsky, A., Matter, I., Sabo, E., Cohen, A., Abrahamson, J., & Eldar, S. (2000). Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted?. Surgical endoscopy, 14(8), 755-760.
Bodenheimer, T. (2008). Coordinating care--a perilous journey through the health care system. The New England journal of medicine, 358(10), 1064.
Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ: British Medical Journal, 323(7313), 625.