Essay: Antibiotics For Surgical Site Infection - Clinical Reasoning Cycle.

Discuss about the Release Of Antibiotics For Surgical Site Infection Management.

Consider the person’s situation

It is important for a registered nurse to understand the current health condition of the patient in order to proceed with adequate treatment (Smolowitz et al., 2015). The case study is about Melody King, a 36 years old woman that has been suffering from peritonitis with ruptured appendix. She was presented to the emergency department with the consequence of 2 to 3 days abdominal pain in the right lower quadrant. According to the health condition of the patient, an emergency laparoscopic surgery was required in order to remove the ruptured appendix. After the operation she has reported about increasing nausea and centralised abdominal pain. The pain rating was 7 to 8 in the scale of 0 to 10. The patient has been found to have generalised abdominal guarding and distended abdomen. In order to investigate further health condition pathological tests have been suggested.  

In order to identify the actual health problem of a patient it is important to collect adequate information regarding the health condition of the patient. Collecting information about the previous health history of the patient is important as it could help to identify the contribution of any previous health related problem in the current health condition of the patient (Salminen et al., 2014). In this case, a past medical history of suffering from depression and asthma have been found. General physical observation provides the information about the abnormality in the blood pressure, respiratory rate, heart rate, oxygen intake and body temperature (Forbes & Watt, 2015). The general assessment of Melody has indicated blood pressure level 95/45 mmHg. Her heart rate was 120 and respiratory rate was 22 per minute and shallow. SpO₂ has been found to be 95% at room temperature and body temperature was 38.3⁰ Celcius. On the report of suffering from excessive pain and identification of distended abdomen and generalised abdomen pain pathology has been suggested. The pathology test has identified significant increase in the white blood cell (WBC) and C- Reactive Protein test has also indicated rise in the CRP level. Her current medications include Ventolin, Seretide and Sertraline. Such information would help to identify the potential health risk and health related problem in an effective manner.

In the step of process information the collected data from the assessment and past health history have been analysed in order to identify the potential signs and symptoms and patient outcomes. In order to process the information it is important to compare the data with normal and abnormal consequence. It would help to discover the health problems of the patient in an effective manner (Salminen et al., 2014). In case of Melody, it has been found that she has been suffering from peritonitis which caused due to the inflammation of peritoneum (tissue of the inner wall of abdomen). Another issue is related to the ruptured appendix. The vital sign assessment of the patient has identified blood pressure 95/45mmHg, which is low enough than the normal blood pressure (120/80mmHg). The heart rate has been identified as 120 which is high than the normal range of 60 to 100, thus she has been suffering from nausea. Her body temperature has indicated that she has been suffering from fever as well. The blood oxygen saturation level and respiratory rate were normal (Forbes & Watt, 2015).

Collect information

On the other hand, the patient has been suffering from severe pain after her surgery of appendix. The appendectomy or surgery of appendix could lead to allergic reaction, infectious condition of incisions, inflammation in the abdomen and pus collection in the abdomen. Such condition leads to the consequence of severe pain (Lee et al., 2013). It can be said that the pain of the patient has been arisen due to such effect of appendectomy. Fever is one of the symptoms of peritonitis, thus it can be said the fever of the patient has caused due to peritonitis (Li et al., 2016). Study has revealed that increase in the WBC and CRP is related to the presence of infection and inflammation. As the blood report of the patient has shown significant increase in the WBC and CRP level, thus it can be said that she has been suffering from infection due to appendectomy. Such increase in CRP level may lead to cancer as well (Yu et al., 2013).

From the analysis of collected data regarding the patient’s health three major health problems have been identified. The infection due to the appendectomy is a priority area for nursing care as the condition could lead to severe infection in the whole abdomen. The risk of infection is high as the appendix was ruptured. Increase in the WBC count and CRP level have indicated the infection and inflammation due to appendectomy. In such case, the increase in the infection may lead to the consequence of cancer as well (Hughes, Harrison & Paterson-Brown, 2013). Thus, it is important to provide proper nursing care to control the post-surgical infection. Another priority area is the pain management because untreated acute pain could transform into the condition of long-term chronic pain (Skou et al., 2014). The third priority area of care is irregular vital signs. It is important to maintain the normal heart rate, body temperature and blood pressure in order to foster the recovery and achieve expected outcomes. Improvement in the vital signs could help the patient to address the issue of nausea and maintain well-being (Rowlands et al., 2013).

The nursing goals for Melody are as follows-

• Control the post-surgical infection in order to reduce inflammation and risk of cancer.
• Introduce adequate treatment for pain management in order to reduce the pain.
• Provide adequate nursing care to maintain the vital signs such as blood pressure, body temperature and heart rate in order to increase the rate off recovery and provide well-being to the patient.

Nursing care plan in order to control the surgical infection include proper dressing of the site of infection. Sterile saline could be used to clean the surgical site. The dressing need to be change regularly. In this case vacuum assisted closure could be used for dressing.  The pus would be drained if present. In order to cure the internal infection, proper antibiotic medication would be provided to the patient. In this regards the pus would be tested in order to identify the proper antibiotic for the patient. Furthermore, suggestion from a tissue viability nurse could be taken for appropriate dressing and management of surgical infection (Aiken et al., 2015).

Process information

In order to manage the pain proper analgesia could be provided to the patient. Intravenous patient control analgesia (PCA) could be provided through the computerise pump that allows the pain medication to the intravenous line. Epidural catheter need to be provided to attach the PCA pump. In this case sedative medication would be needed to relax the patient. Some effective oral medication would be provided such as morphine, hydromorphone, oxymorphone and fentanyl. Relaxation technique would be taught to the patient to relief the pain (McNerney & Farry, 2014).

In order to manage the vital signs such as low blood pressure the patient would be provided diet containing sodium, thus increase in the salt intake would be recommended. The patient would be suggested to drink more water. In addition, several medications such as midodrine could be recommended to raise the blood pressure (Williamson et al., 2016). Several exercise could be recommended such as practicing deep breathing, valsalva maneuvar and carotid maneuver would be helpful to manage the rapid heart rate. Furthermore heart rate controlling medication could be provided (Palma & Benarroch, 2014).

The care strategy would be beneficial as proper dressing would help to dry the surgical wound and control further spreading of infection. Testing the pus would help to identify the proper microbial infection, thus would help to introduce appropriate antibiotics to control the infection. Referral to tissue viability nurse would help to process the control of infection with the suggestions of expert (Aiken et al., 2015). The analgesia for pain management such as PCA and oral drugs could help to reduce the pain in an effective manner. The relaxation technique would help to relax the nerve, thus could help to reduce anxiety as well (McNerney & Farry, 2014). On the other hand, increasing water and salt intake is helpful; for the person with hypotension, it would help to raise the blood pressure from low to normal in combination with adequate medication (Williamson et al., 2016). Furthermore, the exercise and heart rate reducing medication would help to manage the rapid heartbeat (Palma & Benarroch, 2014). Such care plan would help the patient to recover faster and maintain well-being in an effective manner.

From the case of melody I have learned about the effective care plan for a patient with surgical infection. I have understand how the process of infection control helps to reduce the inflammation and provides relief to the patient and reduce the risk of severe infection or consequence of cancer due to rupture appendix. The experience has helped me to identify the proper interventions in order to manage pain in an effective manner. I have learned about the effectiveness of relaxation process to reduce the anxiety and post-operative health complications. Furthermore I have gathered knowledge regarding the assessment and management of vital signs and maintain the haemostasis of the body to improve the health condition. Such experience has helped me to understand way of fast recovery and achieve positive health outcomes. I would like to utilise this experience in order to improve my skill and establish myself as a successful nurse in near future.

Identify problems

References:

Aiken, S. S., Cooper, J. J., Florance, H., Robinson, M. T., & Michell, S. (2015). Local release of antibiotics for surgical site infection management using high-purity calcium sulfate: an in vitro elution study. Surgical infections, 16(1), 54-61.

Forbes, H., & Watt, E. (2015). Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences.

Hughes, M. J., Harrison, E., & Paterson-Brown, S. (2013). Post-operative antibiotics after appendectomy and post-operative abscess development: a retrospective analysis. Surgical infections, 14(1), 56-61.

Lee, W. S., Choi, S. T., Lee, J. N., Kim, K. K., Park, Y. H., Lee, W. K., ... & Lee, T. H. (2013). Single-port laparoscopic appendectomy versus conventional laparoscopic appendectomy: a prospective randomized controlled study. Annals of surgery, 257(2), 214-218.

Li, P. K., Szeto, C. C., Piraino, B., de Arteaga, J., Fan, S., Figueiredo, A. E., ... & Struijk, D. G. (2016). ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International, pdi-2016.

McNerney, T., & Farry, T. (2014). Surgical Pain Management. Pain Management for Veterinary Technicians and Nurses, 93.

Palma, J. A., & Benarroch, E. E. (2014). Neural control of the heart Recent concepts and clinical correlations. Neurology, 10-1212.

Rowlands, G., Khazaezadeh, N., Oteng-Ntim, E., Seed, P., Barr, S., & Weiss, B. D. (2013). Development and validation of a measure of health literacy in the UK: the newest vital sign. BMC Public Health, 13(1), 116.

Salminen, H., Zary, N., Björklund, K., Toth-Pal, E., & Leanderson, C. (2014). Virtual patients in primary care: developing a reusable model that fosters reflective practice and clinical reasoning. Journal of medical Internet research, 16(1).

Skou, S. T., Graven?Nielsen, T., Rasmussen, S., Simonsen, O. H., Laursen, M. B., & Arendt?Nielsen, L. (2014). Facilitation of pain sensitization in knee osteoarthritis and persistent post?operative pain: A cross?sectional study. European Journal of Pain, 18(7), 1024-1031.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.

Williamson, J. D., Supiano, M. A., Applegate, W. B., Berlowitz, D. R., Campbell, R. C., Chertow, G. M., ... & Kitzman, D. W. (2016). Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged≥ 75 years: a randomized clinical trial. Jama, 315(24), 2673-2682.

Yu, C. W., Juan, L. I., Wu, M. H., Shen, C. J., Wu, J. Y., & Lee, C. C. (2013). Systematic review and meta?analysis of the diagnostic accuracy of procalcitonin, C?reactive protein and white blood cell count for suspected acute appendicitis. British Journal of Surgery, 100(3), 322-329.