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Importance of nursing problem

Discuss about the Case Study Of Darren Diagnosed With Cholecystitis.

As per the case study, Darren was diagnosed with cholecystitis, which is associated with the symptoms such as upper abdominal pain, nausea, and vomiting. The physicians have already identified the remedy and after admitting him in the hospital, transferred him to the surgical ward for elective laparoscopic Open Cholecystectomy. However, the risk of nausea and vomiting is still present in Darren as usage of anaesthesia and opioid-related medication can increase the episodes of vomiting and nausea. The laparoscopic cholecystectomy is an important intervention as, without this, the patient will face multiple episodes of nausea and vomiting leading to more distress in the patient’s daily life (Pierre & Whelan, 2012). Therefore, it cannot be avoided. AS well as, opioid medications and anaesthesia are important aspects of surgery and is administered to prevent anxiety and stress in the patient’s body. Hayes et al. (2016) also mention that anaesthesia and opioid medications are associated with postoperative episodes of nausea and vomiting which, if untreated, can increase the health complication in patient’s body. There are several shortcomings that are associated with this situation such as it increases the patient’s stay at the hospital by increasing nausea and vomiting related situation. Therefore, in the case of Darren, while undergoing laparoscopic cholecystectomy, usage of anaesthesia and opioid medications are severe risk factors that can increase the patient complications (Pierre & Whelan, 2012).

While discussing this nausea and vomiting problem of Darren, several research articles should also be mentioned that determine the significance of these symptoms in postoperative situation after the usage of anesthesia and opioid medications as a part of ambulatory and day care practices (Ajori et al., 2012). This symptom occurs in the first 12 hours of surgery and the risk factor ranges from 30% to 80% in patients and can increase the risk level for recovery that can affect the patient’s health improvement. Further, as Darren had Cholecystitis, which is associated with episodes of abdominal pain, nausea, and vomiting to extreme levels, it can affect the health of Darren by increasing the rate of morbidity. The first four hours of return from surgical ward is important for Darren as Shaw et al. (2012) mentions that the effect of anaesthesia lasts from 3 to 5 hours after any surgery and during this period the area where surgery has been done is numb and senseless. However, it is also evident from medical history and recent researches that laparoscopic surgery is also associated with side effects such as prolonged nausea and vomiting related episodes, infection at the incision site, abdominal pain and the risk of damages in internal body structures. However, Elgueta et al. (2012) mention that episodes of nausea and vomiting are common due to the risk of anesthesia and the type of anaesthesia used in the surgery. However, despite being a common phenomenon in post-operative situation for all type of surgeries, in case of Darren it is a major risk factor as he already suffered from several episodes of nausea and vomiting due to his Cholecystitis and similar situation in postoperative condition, within the effect of anaesthesia can lead to severe health complication (Ajori et al., 2012).

Patient-centered SMART goal

In this case, the SMART goal will be preventing the episodes of nausea and vomiting in the first four hours post-operative situation using several well-researched nursing interventions.

The three nursing interventions that will be used to reduce the chances of nausea and vomiting will be-

  1. Hydrating patient
  2. Administrating drugs that can prevent these symptoms from occurring.
  3. Education

The first intervention that will be applied on the patient to prevent his post-operative nausea and vomiting will be maintaining his hydration level as it has been seen that more than 10% of the PONV (Post-operative nausea and vomiting) occurs due to the dehydration level in patients after laparoscopic cholecystectomy. Therefore, researchers Yavuz et al. (2014) has conducted several research studies to identify the effect of hydration on the implementation of hydration studies to prevent PONV condition in patients in post-operative condition. For this purpose, the researchers divided 50 patients among two groups who were supposed to undergo laparoscopic cholecystectomy after 24 hours. The researchers provided the group 1 with 15ml/kg of Ringer’s lactate solution (for hydration purpose; pre-operative 1 hour) whereas, did not provide any hydration to , however, provided both the groups with intraoperative 5ml/kg/h of Ringer’s lactate (Apfel et al., 2013). It was seen after the operation that the group of patients that received pre-operative fluid for hydration, shown fewer episodes of PONV with the presence of several medications (Yavuz et al., 2014). This is because the usage of Ringer’s lactate solution helps in replenishing the ion and fluid balance inside the patient’s body that also helps to maintain the blood pressure ion post-operative scenario. Hence, this intervention can be used in case of Darren to rehydrate him, in pre and intraoperative case (Apfel et al., 2013).

The second intervention can be the usage of the different type of anesthesia as a condition of nausea and vomiting also arises due to the usage of the different type of anaesthesia that exerts effects for more than 6 hours of surgery. Further, there are researches that mention the use of several drugs that can prevent PONV condition in patients who have undergone laparoscopic surgery (Gan et al, 2014). This drug is known as Propofol which in combination with dexamethasone or diphenhydramine, promethazine, and ondansetron which can be given to the patient in the presence of nausea or as a preventive measure. For this purpose, the researchers Apfel et al. (2012) divided 60 patients into two groups randomly and both the group were provided with two different combinations of drugs such as a subhypnotic dose of propofol with metoclopramide and dexamethasone respectively. The patients were kept under observation for 24 hours and after that the surgery took place. After the surgery, it was seen that the rate of PONV condition in both the groups were 50 and 23.5% respectively (Apfel et al., 2012). Further on analysis, it was seen that within 0 to 4 hours of post-operative situation, 14 patients showing the signs of nausea and vomiting in group 1 whereas only 9 patients shown such symptom in group 2. Therefore it was interpreted from the research that usage of such subhypnotic drugs in combination with hydration fluids help in the prevention in the PONV related condition in maximum cases where patients underwent laparoscopic cholecystectomy surgery. Hence, this intervention can be applied for Darren to prevent PONV related episodes (Gan et al, 2014).

Interventions

The third intervention will be educated about his condition and will be asked to apply few preventive measures preoperatively so that his PONV related condition does not arise in post-operative condition (Shaikh et al., 2016). Darren will be asked to drink plenty amount of water so that his hydration can be maintained. Further, w=he will be asked to have consumed very simple and clear food so that his body can digest them properly both pre-operative and post-operative condition. Further, he will be asked to co-operate with the healthcare professionals in drug administration so that the PONV related condition can be controlled (Yavuz et al., 2014).

Assessment is an important section of application of nursing intervention as it helps to identify the effectiveness of the applied strategy or medication on the health improvement of the patient (Lee & Lee, 2017). In this case, Darren and his nausea and vomiting related conditions will be assessed postoperatively as the interventions for the same condition will be applied in pre-operative condition. The evaluation will be carried out after the application of interventions such as an application of subhypnotic dose of propofol with dexamethasone and hydration fluid Ringer’s lactate and the time limit will be 24 hours so that effectiveness of the drugs and onset of PONV condition can be determined (Ryu et al., 2013). The assessment will be divided into two sections. In the first part, the effect of opioid drugs and anaesthesia with the preventive measures will be assessed and the level of distress inpatient in 0 to 4 hours of post operation will be assessed. The patient will be assessed for early signs of fluid loss such as a headache, loss of concentration, weakness and dry skin as well as postural hypotension and presence of hypervolemia will also be assessed (Brescia et al., 2013).

Further, in the case of medication-related assessment, it will be difficult as several drugs which are administered in the cholecystitis condition can lead to signs and symptoms of nausea and vomiting. As well as, anxiety, depression can also lead to PONV symptoms. Therefore, the clinician conducting the assessment should be aware of the process and carry out the assessment of the medication-related assessment after the physiological assessments (Ryu et al., 2013). Moreover, for the assessment of abdominal pain and related distress, the pain should also be assessed as the application of hydration and PONV preventive measures are associated with VDS and if the pain score is more than 3, they should be provided with intravenous diclofenac so that the associated pain can be relieved. This assessment method is subjected to the health condition of the patient and if the patient and will be applied after the proper consent from the patient. Further, if the assessment shows very less improvement or neutral patient condition then the interventions will be modified and the effectiveness of single interventions will be carried out (Brescia et al., 2013).

Assessment

References

Ajori, L., Nazari, L., Mazloomfard, M. M., & Amiri, Z. (2012). Effects of gabapentin on postoperative pain, nausea and vomiting after abdominal hysterectomy: a double blind randomized clinical trial. Archives of gynecology and obstetrics, 285(3), 677-682.

Apfel, C. C., Heidrich, F. M., Jukar-Rao, S., Jalota, L., Hornuss, C., Whelan, R. P., ... & Cakmakkaya, O. S. (2012). Evidence-based analysis of risk factors for postoperative nausea and vomiting. British journal of anaesthesia, 109(5), 742-753.

Apfel, C. C., Turan, A., Souza, K., Pergolizzi, J., & Hornuss, C. (2013). Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis. PAIN®, 154(5), 677-689.

Brescia, A., Gasparrini, M., Nigri, G., Cosenza, U. M., Dall'Oglio, A., Pancaldi, A., ... & Mari, F. S. (2013). Laparoscopic cholecystectomy in day surgery: Feasibility and outcomes of the first 400 patients. the surgeon, 11, S14-S18.

Elgueta, M. F., Echevarria, G. C., De la Fuente, N., Cabrera, F., Valderrama, A., Cabezón, R., ... & Cortinez, L. I. (2012). Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy. British journal of anaesthesia, 110(4), 607-614.

Gan, T. J., Diemunsch, P., Habib, A. S., Kovac, A., Kranke, P., Meyer, T. A., ... & Bergese, S. D. (2014). Consensus guidelines for the management of postoperative nausea and vomiting. Anesthesia & Analgesia, 118(1), 85-113.

Hayes, I., Rathore, R., Enohumah, K., Mocanu, E., Kumar, D., & McCaul, C. (2012). The effect of crystalloid versus medium molecular weight colloid solution on post-operative nausea and vomiting after ambulatory gynecological surgery-a prospective randomized trial. BMC anesthesiology, 12(1), 15.

Lee, C. M., & Lee, J. I. (2017). A Preliminary Study on Indoor Air Quality for the Development of Risk Assessment Methods for Central Nervous System Disturbances. Global Journal of Health Science, 9(8), 10.

Pierre, S., & Whelan, R. (2012). Nausea and vomiting after surgery. Continuing Education in Anaesthesia, Critical Care & Pain, 13(1), 28-32.

Ryu, J. H., Chang, J. E., Kim, H. R., Hwang, J. W., Oh, A. Y., & Do, S. H. (2013). Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective, randomized, and double-blind study. International Journal of Surgery, 11(2), 183-187.

Shaikh, S. I., Nagarekha, D., Hegade, G., & Marutheesh, M. (2016). Postoperative nausea and vomiting: a simple yet complex problem. Anesthesia, essays and researches, 10(3), 388.

Shaw, A. D., Bagshaw, S. M., Goldstein, S. L., Scherer, L. A., Duan, M., Schermer, C. R., & Kellum, J. A. (2012). Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Annals of surgery, 255(5), 821-829.

Yavuz, M. S., Kazanc?, D., Turan, S., Ayd?nl?, B., Selçuk, G., Özgök, A., & Co?ar, A. (2014). Investigation of the effects of preoperative hydration on the postoperative nausea and vomiting. BioMed research international, 2014.

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My Assignment Help. Nursing Interventions To Prevent Post-operative Nausea And Vomiting In Patients With Cholecystitis [Internet]. My Assignment Help. 2019 [cited 25 February 2024]. Available from: https://myassignmenthelp.com/free-samples/darren-diagnosed-with-cholecystitis.

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