Discussion On Care Plan For Cholecystis

The importance of nursing assessment in the treatment process is concerned with the collection of information about the health abnormalities that the patient is undergoing and arrives at a coping strategy based on their present health conditions that will support their medical restriction at large. As the responsibility for the optimal care for the patients lies upon the nursing professionals they often need to make challenging clinical judgments regarding the safety and wellbeing of the patient under their care (Estes et al., 2015). Clinical reasoning cycle provides the best measure for the nurses to make the most logical and reasonable decisions that helps in constructing a smooth treatment pathway and also aids in orchestrating an optimal care plan. This essay will attempt to formulate a detailed care pathway discussing about cholecystis and different aspects associated with its treatment talking the help of a clinical reasoning cycle.  

Clinical reasoning cycle can be described as a series of strategically organized step by step actions that help in eliciting important information about the situational aspects of the patent under consideration, the signs and symptoms he or she is exhibiting and determine the cause of those abnormalities and arrive at the best treatment strategy that will be supportive of the patient’s current situation. Clinical reasoning cycle allows the health care professionals to elicit information, process the information and arrive at a clinical judgment by the means of linking theory with practice (Levett-Jones & Hoffman, 2013). As Banning in his article has stated, a sustainable and legit health care practice should focus on assimilation, analysis and differentiation of the evidences associated with health care, and the elements of clinical reasoning cycle can serve as a potent tool that can help the health care professional achieve that goal in a scientific and logical manner (Levett-Jones & Hoffman, 2013).

In this case study, the patient under consideration, Mr. Kasim Al-Mutar is a middle aged man who came to the emergency ward with a complicated case of cholecystis. The treatment procedure according to the steps of clinical reasoning cycle starts with the considering the patient’s situation (Giger, 2014). In this case the patient is a 49 year old man suffering with right upper quadrant abdominal pain, fever, and vomiting. All these symptoms are indicative of a cholecystis which is considered to be a highly medical concern in this age specifically for men. However studies suggest that females are at more risk to calculous cholecystis in comparison to the males. However, regardless of the gender the risk for cholecystis has been known to increase with growing age (Gutt et al., 2013).

The next step to clinical reasoning is to collect the information that can be o relevance to the present medical conditions of the patient. In this particular step the nursing professional is expected to elicit information about the past medical history of the patient, lifestyle and eating habits, vital signs and symptoms associated with the health care concern that the patient is experiencing (Gutt et al., 2013). Nursing handover can offer viable elements for this long list, the handover for the patient under consideration revealed that the heart rate for the patent had been 126 and the blood pressure ranged within 100/45. However the body temperature for the patient had been 38.8 F and had been in excruciating pain in the right upper quadrant of his abdomen. The general appearance of the patient was pale and he also had dry mucous membrane and had been demanding water frequently due to dry throat. He had given his pain severity a score of 7 out of 10 which significantly high and the patient us need of a surgery (McGillicuddy et al., 2012).

The next step to clnical reasoning cycle is evaluating the information assimilated about the patient and comparing them to theoretical clinical knowledge to gain a better understanding about the present condition of the patient. Cholecystis is considered to be common gall bladder disease that causes inflammation in the gall bladder mostly due to occurrence of gall stones that causes bile to trap in the gall bladder and causes inflammation and symptoms like pain in the right upper quadrant, vomiting and fever (Potter et al., 2013). Now gall bladder is a small pear shaped sac that stores digestive bile produced by the liver, now this digestive bile assists in the breaking down of food rich in fats and also helps in the absorption of certain vitamins. Now in case of a cholecystic or inflamed gall bladder the cystic duct for is blocked by gall stones mostly which traps the bile. This abnormality of the gall bladder is associated with high morbidity rates according to explorative research studies and the patient needs to be handled very delicately (Potter et al., 2013).

The major symptom associated with cholecystis is the right upper quadrant pain that is the result of biliary colic due to the trapped bile near the blocked cystic duct. This phenomenon generally occurs after consumption of fatty or greasy food that is harder to be digested without the digestive bile. This phenomenon also causes symptoms like nausea and can cause the patient to feel irresistible urges to vomit post consumption of greasy heavy food. Apart from that fever is considered to be a very common symptom of cholecystis and a cholecystic gall bladder can be tender to touch in most cases due to the inflammation (Riall et al., 2010). However in this the patent is pale in appearance and is having frequent dry throat syndrome and is having frequent urges to drink water. It has to be considering that in most cases the elder patients succumb to dehydration post admission to the health care facility which further complicates their condition. Hence care should be taken to be taken to ensure that the patient dose not develop dehydration at any circumstances as that will increase his chances to develop jaundice (Schmidt et al., 2011).

The next step to clinical reasoning cycle, is the identification of the issues that the patients is having and conducting different health assessments to arrive at a definite conclusion about the treatment plan. In this case the patent is suffering from acute pain in the upper right quadrant along with vomiting and fever. The health assessments that the patient needs to be undergone should start with a competitive blood count test as a marker of inflammation (Schmidt et al., 2011). Increased white blood cell count and increased bilirubin levels will indicate at bile congestion in the gall bladder and resultant inflammation. Depending on the positive results of this test the radio imaging of the right upper quadrant will confirm the presence of inflammation of the gall bladder. Generally these tests are enough for a medical practitioner to diagnose cholecystis however the symptom for cholecystis can be easily confused with other diseases like perforated peptic ulcer, kidney stones, colitis or pancreatitis, hence care should be taken to ensure that the assessments are being performed accurately (White, Duncan & Baumle, 2012).

Considering the present health conditions of the patient, he will require the service of a certified medical practitioner, abdominal specialist, nursing professionals, dietician and a community service worker. The patient will need to undergo a surgical removal of the gall bladder or a laparoscopic surgery of the gall bladder to remove in case there are stones that is causing the blockage of the cystic duct (White, Duncan & Baumle, 2012). The patient is under extreme pain due to biliary colic hence administered of analgesia will aid in relieving the pain that is going through. Prior to the surgery the patent needs to be educated properly about the surgery and how that is going to help him with his present medical concerns. Communication is an elemental part of a treatment procedure that ensures that there is a mutually respectful relationship between the patient and the health care professional caring for him. It will allow the patent to be comfortable enough to share his grievances and preferences to the nurse and will involve him in the treatment procedure which is known to increase the recovery chances significantly. Apart from that the vital signs of the patent should be diligently monitored before and after the surgery by the nursing professional (Yokoe et al., 2013). The nutritional requirement of the patient should be addressed with liquid light diet before and after the surgery that is rich in antioxidants that will aid in his speedy recovery. Apart from that the patient should be kept well hydrated and comfortable during his stay in the health care facility. Lastly the patient should be offered community physical aid therapy and regular home visits from community service nursing professionals to help him understand the precautionary measures to take and the lifestyle changes he needed to bring forth in his life to ensure that he attains full recovery (Yokoe et al., 2013).

On a concluding note it can be said that gall bladder inflammations are considered a very common health concern for a reason, the deteriorating life style habits and the paramount stress that the mass are under only aids the purpose of more health care complications. With the chasing lifestyle that we have nowadays the health problems are only going to escalate, the health care industry needs to continue to advance itself with concepts like clinical reasoning cycle top ensure that the dynamic needs of the patients can be met.

References:

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Giger, J. N. (2014). Transcultural nursing: Assessment and intervention. Elsevier Health Sciences.

Gutt, C. N., Encke, J., Köninger, J., Harnoss, J. C., Weigand, K., Kipfmüller, K., ... & Klar, E. (2013). Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Annals of surgery, 258(3), 385-393.

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McGillicuddy, E. A., Schuster, K. M., Barre, K., Suarez, L., Hall, M. R., Kaml, G. J., ... & Longo, W. E. (2012). Non?operative management of acute cholecystitis in the elderly. British Journal of Surgery, 99(9), 1254-1261.

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Riall, T. S., Zhang, D., Townsend, C. M., Kuo, Y. F., & Goodwin, J. S. (2010). Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. Journal of the American College of Surgeons, 210(5), 668-677.

Schmidt, M., Søndenaa, K., Vetrhus, M., Berhane, T., & Eide, G. E. (2011). Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: non-operative management is an option in some patients. Scandinavian journal of gastroenterology, 46(10), 1257-1262.

White, L., Duncan, G., & Baumle, W. (2012). Medical surgical nursing: an integrated approach. Cengage Learning.

Yokoe, M., Takada, T., Strasberg, S. M., Solomkin, J. S., Mayumi, T., Gomi, H., ... & Gabata, T. (2013). TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of hepato-biliary-pancreatic sciences, 20(1), 35-46.