Outcome Assessment In Advanced Practice Nursing: Nursing Care Plan For A Patient With Septoplasty And Right Ethmoidectomy Surgery

Discuss about the Outcome Assessment in Advanced Practice Nursing.

The essay will comprise of describing the condition specific to the given case scenario where the nursing process and nursing management will be carried out for the patient in post surgery situation. Nursing management will be undertaken by following the vital steps of assessment, nursing diagnosis, planning, implementation and evaluation. Furthermore for the sake of ensuring complete recovery of the patient, post-operative education will be discussed. The potential complications that might arise will be discussed as well to better inform and aware the nurse. The involvement of the interdisciplinary team in treating the condition of the patient will be explained as well.

i	IDENTIFY	·         Registered Nurse posted at the surgical ward to care for patient in post-surgery. ·         Kelly Malone is a 49 year old female who has recently underwent surgery of septoplasty and right ethmoidectomy.
S	SITUATION	·         In post-surgery phase patient is found to be alert and awake and having a nasal bolster under her nose with moderate sanguineous ooze. ·         Her vital parameters read normal with a moderate exhibition of pain score. ·         Intravenous (IV) fluid administered along with other medications ·         I am calling because the patient is having moderate sanguineous ooze that might lead to hemorrhage and cause complication.
o	OBSERVATIONS	Recent examination of vital parameters: ·         T- 36.2? C ·         HR- 68 bpm ·         RR- 18 pm ·         BP- 111/73 mm of Hg ·         O2- 93% RA ·         Pain score- 2/10 Ongoing Medications: ·         IV Compound Sodium Lactate 1L administered at 4/24 rate into left arm ·         Paracetamol 1g IV/PO 6 hourly ·         Celecoxib 200mg PO BD ·         Tramadol SR 100mg PO BD
B	BACKGROUND	·         Medical history of disrupted sleeping pattern because of difficulty in breathing through nose ·         Accustomed to mouth breathing through proper breathing techniques to stabilize the breathing pattern to avoid dizziness during physical exhaustion or exercise activities ·         Sensitivity to Codeine ·         Not under any other medication ·         No history of other medical problems
A	AGREED PLAN	The sanguineous ooze needs to be treated to avoid the risk of hemorrhage and infection
R	READ BACK	Follow-up with the anesthetist and the ENT surgeon is required to treat the wound drainage of sanguineous type in post-operative situation

Data pertaining to the physical and psychological health status of the patient was obtained by means of appropriate clinical assessment devices, diagnostic apparatuses and tools (vide Appendix).

The analysis of the assessment data revealed the prevalence of three chief nursing issues that need to be addressed on a priority basis through proper justifications made (vide Appendix).

The continuity to care, compliance, safety and quality of treatment is fostered by means of proper nursing plan through recording of the interventions and assessment of their corresponding effectiveness (vide Appendix).

The intervention and initiatives taken to achieve the SMART goals and attain the desired outcomes was considered by means of proper justifications backed by evidences (vide Appendix).

The success or failure of the planned goals was measured by means of utilizing proper tools to further determine whether the expected outcomes were met (vide Appendix).

In order to render enhanced recovery of the patient in the post-operation condition, a multidisciplinary education program will be provided to the patient. It will be essential to strictly follow the doctor’s instructions after getting discharged from the hospital and complying to medications as prescribed. The potential complications need to be tackled with caution while abiding by the follow-up appointments. The normal activities need to be resumed safely and gradually (McDonald,2015). In the specific condition of Kelly, wound management is necessary to account for quicker recovery. Hence professional care service must be sought that is capable of taking proper care of her sanguineous drainage in postoperative condition. The doctor needs to be consulted immediately in case of development of fever, elevated pain or bleeding at the surgical site. Moreover the post-operative care should be holistic in approach so that the physiological demands of the body are met properly without compromising on the health front. Ambulatory care service is considered as an effective medical service performed on outpatient basis even outside the realm of hospital setting (Fox et al., 2014). Post-operative education will help her to carry out her daily activities smoothly. Measures must be taken to ensure that the patient has satisfactorily understood the intended purpose of education and reminders in the form of written instructions may be provided.

SITUATION

Nurses need to be aware of the possible ill effects following the post-operative states. The individual responses to septoplasty surgery might vary in relation to surgery, healing outcomes and anesthetic reactions. The nurses must be aware of the complications related to swelling of the turbinates, bleeding, and chronic nasal discharge. Septal perforation, impaired restoration of the gustatory and olfactory sensation must also be checked for in the patient following the surgery. Moreover, allergy evaluations also need to be conducted for any adverse reactions. Persistence of pain that might impair the healing also needs to be assessed. The efficacy of the utilization of nasal bolster needs to be assessed as well for any bleeding predisposition (Sreenivasulu et al., 2016).

Kelly’s management of care will involve the participation of the ENT surgeon, anesthetist and nursing professionals. The otolaryngologist or ENT physician will be responsible for following the condition of the patient in post-operative phase. The corrective surgery in the nasal septum to prevent obstruction thereby enabling proper breathing will be done by him that need immediate follow up for ensuring quicker recovery.  The anesthetist will engage in pain management through by providing respite to the post-operative pain through proper medications and associated therapeutic modalities. Sustaining quality of life in Kelly will be the major objective of the interdisciplinary team where referral will be made to the ENT physician in case of any complication (Bugten et al., 2016).

Conclusion

The assignment helped to devise a proper nursing care plan pertaining to the specific condition of the patient who has recently underwent septoplasty and right ethmoidectomy surgery. The chances for speedy recovery is directly dependent upon factors that might interfere with her physical health status in post operative condition that need to be treated following proper interventions. Therefore the improvisation of a suitable nursing care plan through assessment and prudent nursing diagnosis will pave the way for better health outcomes in the patient.

References

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Sreenivasulu, M., Hemanth, V., Durgaprasad, B., & Sowmya, L. (2016). Septoplasty With And Without Nasal Packing: A Comparative Study. J. Evid. Based Med. Healthc. 2016; 3(36), 1765-1767.