Managing Intraoperative Hypotension: A Case Study Essay.

Intraoperative Hypotension as a Common Nursing Problem

After Getting Back From An Operation Theatre A Patient Experiences Numerous Health Complication Intraoperative Hypotension Is One Of Nursing Problems Is Common in a patient who has gone through a surgery few hours ago. Darren Robert is a 51 years old adult. He underwent a surgery concerning Cholecystitis few hours ago and got discharged from the Post Anaesthetic Recovery Unit (PARU) 4 hours ago. A series of incidents results in lowering down blood pressure after the completion of the surgery such as loss of huge amount of blood during the surgery, high dose of anaesthesia, loss of excessive water and sodium comment from the body (Vernooij et al., 2018). Treatment and handling strategies at that time requires nurses to have critical thinking ability so that they can take decisive actions as per the requirement of the situation. Clinical reasoning in these kinds of scenario helps nurses to make necessary treatment plans. Positive outcomes have been seen in the case of patients whose treatments involve clinical reasoning cycle. On the other hand, nurses who had treated patients with a poor clinical reasoning are found to have less idea about the condition of the patient, due to which treatment takes longer time for the recovery of the patient (Nursingmidwiferyboard.gov.au, 2022). Clinical reasoning cycle consists of few rounds which are conducted one followed by another. In Darren’s case, first of all, patient’s health status would be measured and information is being collected from the patient, family members and associated mid wives or nurses. Sometimes, patients are not capable enough to express anything. Therefore, in this condition, information from patient can be exempted. In third step, health professionals process and analyse collected information. After that, recognition of problems, taking actions for the problems, analysis of recovery rate, these steps take place. All these phases demand for deep analysis of patient’s background which can be further achieved thorough health assessment.

In the condition of intraoperative hypotension (IOH), firstly, the nurse should be aware about the medication management that whether the routine medication will be able to control hypotension. In that case, along with medication, the patient needs high observation (Pancaro et al., 2020). If needed, vasopressor can be given. As mentioned above, hypovolemia is one of the reasons for IOH, so necessary measures can be taken such as infusion of blood components through intravenous pipes.

Patient care seems to be the most basic work responsibility for a nurse. However, when critical conditions arrive like Darren, care delivery should be more concise and constructive. Henceforth, the SMART Goal for Darren will be patient care.

Assessment of Post-Surgery Effects

After getting relief from the PARU, the registered nurse takes review of the pathology reports of the patient. The procedure helps a nurse to identify necessary measures which is needed to be taken after the surgery. Also, it reduces the chance of any unforeseen outcome. Such as, in Darren’s case, while going through the review it can be concluded that he was having high chance of intraoperative hypotension as he is an obese and the habit of smoking and drinking. Therefore, knowing these things will help to control the postoperative problem of the patient. The pathology review also involves discussion between the patient and nurse which in turns results in boosting confidence of the patient. Also, some patients use to be curious about the health status. The patient should be informed so that the patient can be self-aware. Pathology review helps the patient to get other opinions from doctors and family members.

After coming out from the operation theatre, there is a need to assess post-anaesthesia effects. In the context of that registered nurse says to conduct a complete assessment of the body which includes respiratory pathway, circulatory functions, level of pain, level of consciousness, a saturation of oxygen, and many such post-operative nursing problems.  Nurses also consider the body temperature and look after the ventilation facility and medication routine. After surgery feeling of pain is a common occurrence (Kappen & Beattie, 2021). Untreated pain is harmful in various ways such as it can create more complications, will increase stays in hospital and the wound will take time to heal. Therefore, interventions for pain relief are the crucial responsibility of a nurse. Also, it reflects the recovery rate of the patient. In the case of Darren, the most common intraoperative outcomes are leakage from the bile duct, infection excessive bleeding, and lowering of the count of platelets. When the patient gets back from the PARU, knowing these aspects would help to take the measures necessary for his betterment (Mou et al., 2019). Apart from this, hygiene and cleanliness would be maintained and proper dressing of the surgical wound has to be taken care of. At the same time, the status of the mental stress and emotional downfall should be analysed.

Educating and helping the patient to practice deep-breathing mild exercise of muscles and coughing is a necessary part of post-surgery treatment. Physiotherapy is an important part of treatment. It is followed by a proper medical assessment along with routine medication. Because of the surgery, there is a chance of development of bedsore. Due to long-term inactivity of the body, muscles become stiff and mobility issues arise. For the improvement from this condition, mild exercise is needed (Wesselink et al., 2018). Physiotherapy has lots of different benefits. It improves the blood circulatory level of the patient's body and maintains blood pressure and blood sugar level. Along with mild physiotherapy, deep breathing should be suggested to improve the respiratory pathway which most of the time used to be affected by the surgery. Moreover, coughing is exercised so that proper saturation level of oxygen c could be maintained and the respiratory tract provides a clear pathway for the process of inhalation and exhalation which reduces the chance of tracheostomy. Nonetheless, mild exercise and meditation posture motivate patients to fast recover.

Interventions to Achieve Smart Patient Care

As a part of the clinical research cycle, evaluation of the intervention measures is a very important aspect of the treatment procedure. Without analysing methods of treatment, one cannot come to a conclusion that whether the necessary intervention methods worked for the patient or not. In this method, at first, it is monitored what pointers were involved in the procedure of intervention (Clarke et al., 2019). After analysing the taken measures it can be concluded how fruitful was the intervention was. Knowing this fact will need three possibilities. First, if the methods of intervention did not work for the patient, then the procedure needs to be stopped then. Second, it guides health professionals to consider some alternative methods of intervention Which will be helpful for any unforeseen circumstance. The third possibility is to use interventions on the patient in a more effective way such as increasing or decreasing doses of medicines, the need for saline or blood to the body, pain relief approaches, and many more. Valuation helps healthcare workers to understand the need of different patients at different points in time. This also develops an understanding of the need for specific types of medical interventions for specific types of patients (Karaca & Durna, 2019). Looking into the case study of Darren suggests that after the surgery of cholecystitis, he had gone through the excessive loss of blood and content of water and sodium from the body, nausea, and usage of anesthesia which resulted in another health complication intraoperative hypotension (Hung et al., 2021). Now the medical condition of Darren demands a dual aspect of treatment which can be effectively treated after surgery shock along with low blood pressure. Nursing practice requires to be extra attentive while dealing with a patient. Apart from this, the time of healing the surgery is a matter of concern. Postoperative problems are a common occurrence that can be dealt with the proper and advanced nursing techniques. The patient also needs to have the desire for a healthier lifestyle (Gregory et al., 2021). Darren used to have smoking and drinking habits. These all habits should be restricted for a long period even after the wound of the surgery starts healing. There is a need to acquire a conception of healthy food so that he can control his obesity which was the biggest reason for cholecystitis. Nurses are the best health professionals who can educate about the benefits of these behavioural changes which is again a crucial part of the clinical research cycle.

References:

Clarke, G. M., Conti, S., Wolters, A. T., & Steventon, A. (2019). Evaluating the impact of healthcare interventions using routine data. BMJ, 365.

https://doi.org/10.1136/bmj.l2239

Gregory, A., Stapelfeldt, W. H., Khanna, A. K., Smischney, N. J., Boero, I. J., Chen, Q., ... & Shaw, A. D. (2021). Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. Anesthesia and analgesia, 132(6), 1654.         

https://dx.doi.org/10.1213%2FANE.0000000000005250

Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing open, 6(2), 535-545.

https://doi.org/10.1002/nop2.237

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490.

https://doi.org/10.1016/j.ijnurstu.2019.103490

Hung, Y. L., Sung, C. M., Fu, C. Y., Liao, C. H., Wang, S. Y., Hsu, J. T., ... & Jan, Y. Y. (2021). Management of patients with acute cholecystitis after percutaneous cholecystostomy: from the acute stage to definitive surgical treatment. Frontiers in Surgery, 8.

https://dx.doi.org/10.3389%2Ffsurg.2021.616320

Kappen, T., & Beattie, W. S. (2021). Perioperative hypotension 2021: a contrarian view. British Journal of Anaesthesia, 127(2), 167-170.

https://doi.org/10.1016/j.bja.2021.03.015

Mou, D., Tesfasilassie, T., Hirji, S., & Ashley, S. W. (2019). Advances in the management of acute cholecystitis. Annals of gastroenterological surgery, 3(3), 247-253.

https://doi.org/10.1002/ags3.12240

Nursingmidwiferyboard.gov.au. (2022). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 24 March 2022, from

https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx.

Pancaro, C., Shah, N., Pasma, W., Saager, L., Cassidy, R., van Klei, W., ... & Lirk, P. (2020). Risk of major complications after perioperative norepinephrine infusion through peripheral intravenous lines in a multicenter study. Anesthesia & Analgesia, 131(4), 1060-1065.

doi: 10.1213/ANE.0000000000004445

Stonehouse, D. (2018). How SMART are your patient goals?. British Journal of Healthcare Assistants, 12(5), 233-235.

https://doi.org/10.12968/bjha.2018.12.5.233

Wesselink, E. M., Kappen, T. H., Torn, H. M., Slooter, A. J. C., & Van Klei, W. A. (2018). Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. British journal of anaesthesia, 121(4), 706-721.

https://doi.org/10.1016/j.bja.2018.04.036

Wüller, H., Behrens, J., Garthaus, M., Marquard, S., & Remmers, H. (2019). A scoping review of augmented reality in nursing. BMC nursing, 18(1), 1-11.

https://link.springer.com/content/pdf/10.1186/s12912-019-0342-2.pdf

Zandee, W. T., van der Zwan, J. M., de Herder, W. W., & Van Velthuysen, M. L. F. (2020). Importance of complete pathology reporting for neuroendocrine carcinoma: WHO guidelines are a good start but not enough. Neuroendocrinology, 110(11-12), 994-1000.

https://doi.org/10.1159/000505920