Discuss about the Role of Ultrasound in Diagnosis.
The body of individuals in exposed to different forms of health problems that are caused by some defined and undefined risk factors. Suffering from a known health condition might be worsened by some other forms of body discomforts. Lucy was presented in the emergency department suffering from appendicitis. Medical check-ups are crucial to understand the ideal states of the body parts, hence assisting in preventing possible infection and diseases. Lucy is a student who has been doing well with her daily life activities until she suffered severely, without understanding the health problem (Sander, 2016). Her daily activities including being are school either personal learning or lectures, working in a supermarket or enjoying herself with friends.
There are higher chances that she might have been suffering but making no effort to visit a health centre for consultations. She has been living alone in student accommodation, hence spending most of the time doing personal activities. Without the company of any other student in her room, she might have been in pain for a longer time before she could call for help to be taken to a hospital. The observed symptoms, severe nausea and vomiting contributed to increased heart rate to over 100 beats per minute. Delaying to seek the required medical help lead to more pain, hence affecting her blood pressure, which led to increased respiratory rate from the normal range of 12 – 18 breaths per minute to 26 bpm. The pain was very severe for her to overcome, hence affecting her body temperature which rose to 38.9oC (Zalon, 2014).
Lucy has been using party drugs, which must have affected her body normal functioning. These drugs acted as a painkiller and she could not notice that her appendix was getting worse and she needed to acquire medical assistance (McGregor, 2011). Her excessive drinking also worsened the condition of the appendix by creating room for bacteria growth. She has been working three evening a week which means that she is always tired and does not take enough rest for her body. The only time Lucy could be resting is on Fridays and weekends but she mostly spends her time with friends on parties and alcoholism. The body’s fatigue highly contributed in worsening the condition of the appendicitis. Enough rest is required for the body to function well and be able to respond significantly to any form of abnormalities. It could be assumed that Lucy was having enough rest, she could have realised that she was having problems with her appendix.
The other factors that contribute to Lucy’s health alterations the facts that she was suffering from appendicitis. This is a condition that might have caused by fungal, viral or bacterial infections, which spread to the organ (Al-Maqbali, 2013). This is a medical condition which mostly affects individuals aged between 10 and 25 years of age. Early diagnosis is important so that it can be treated, otherwise, its swelling might lead to further complications. This was the case experienced by Lucy because it was not treated in advance, which lead to severe pain, guarding in the right abdomen and severe nausea and vomiting. The doctor advised for a laparoscopic appendectomy after diagnosis because the appendix was already damaged out of the infection and it had to be removed to relieve Lucy from pain (Alzahrani, 2016).
Nursing Care Plan
Lucy is in a critical condition and she needs to be engaged in a good nursing management plan to control her condition. The first priority is to ensure that the pain levels are managed by providing her with the appropriate medications (Hawker et.al, 2011). Since the pain is severe, it will be advisable to use opioid analgesics for quicker response of the medicines to the body. This drug will significantly manage the pain although they might have some side effects on her health such as drowsiness and feeling exhausted. Some of the opioids include morphine and oxycodone (Sidhu, 2010). These options will be advised by the doctor, considering that she has been operated and her body still has anaesthetic induced during the operation process. Although anaesthetic control pain, the use of party drugs might have affected its effectiveness, hence being unable to control the pain (Carpenito-Moyet, & Carpenito, 2012).
Secondly, the nurses should ensure that Lucy is placed in a good position where she can breathe comfortable and acquire sufficient flow of oxygen. The well-ventilated area will allow balancing of the respiration rate after the pain management drugs have been administered. The increased respiration rate has been affected by the fact that Lucy is alcoholic and she frequently uses party drugs to boost her pleasure as she enjoys with friends. Therefore, tests on the drug content of her blood will be important to avoid over-dosing with other pain management drugs (Chung, & Joung, 2012). After ensuring that she in a comfortable position, Lucy should be left to have a rest and encouraged to breathe deeply to for sufficient supply of blood into the body. Reducing respiration rate will also lead to a reduced pulse rate, hence managing her oxygen saturation. This is a process which requires being undertaken in care and close examination to avoid emergencies related to increased work of breathing.
Low is experiencing low blood pressure which is always by using drugs that are not prescribed by the doctor and in some cases diarrhoea, fever and vomiting leading to dehydration. Therefore, the ideal treatment for Lucy’s low blood pressure is to help in hydrating her body though artificial method or providing her with lots of non-alcoholic drinks (Chisholm, & Anpalahan, 2016). This intervention will help her to gain strength and felt relieved and it will also help in managing her pain. She should be advised against alcoholism because it is one of the main caused of her hypotension which might lead to heart conditions in future (Ettehad et al., 2016; Schultz et al., 2011). Lucy’s blood pressure will be managed if dehydration issue is dealt with and she is provided with glucose to re-energise herself from the lost energy.
Finally, her body temperature needs to be balanced and according to diagnosis is seems to have been caused by dehydration. The objective will be to maintain and resume her body temperature soonest possible. Adjusting the room conditions and ensuring that all the environmental factors are controlled will be of assistance in managing her body temperature. The blankets used in her blood and air conditioner should be balanced close to normal body temperature. Also, antipyretics can be administered is the doctor prescribes because of its effective in reducing the temperature (Buchheit, & Laursen, 2009). Drinking lots of fluid will also be an effective method. Ensuring that these options are implemented, Lucy's body temperature will be drawn back to the normal range, hence improving her health condition.
Roles Interdisciplinary Health Care Team to be involved in Lucy’s Case
Management of a patient in the ward requires a combination of expertise to ensure the every point of concern is well addressed (Hall, 2013). Lucy's cases is an emergency and it should be addressed in the shortest time possible to resume all the rates to the normal ranges. As a nurse, I would require the following expertise to assist in cases of consultations based on the diagnosis report. Physical examinations might also be important to undertint specifics on Lucy's conditions. The specialists will also offer advice on how Lucy should manage the conditions upon discharge.
A respiratory therapist will provide advice on how the respiratory rate will be managed in cases of failed medication. If there are any forms of damage in the respiratory system due to severe levels, treatments will be offered to help manage Lucy's health.
The physical therapist will be of much importance in managing the normal body functioning such as reducing the temperature levels and resuming normal pulse rates. In addition, he will be providing treatment plans that can be used in resuming normal functioning of Lucy’s body.
Identified health conditions. Immediately after the physician has observed the ideal issue, the next professional is the pharmacist to provide the drugs. For instance, the drugs to be used in managing Lucy’s severe pain will be advised by the pharmacist.
A physician assistant is always working in-line with the physicians. They usually diagnose and conduct examinations, prescribe medications and treat illness. In this case, a physician assists in prescribing the appropriate medications to be in managing Lucy's severe conditions. The management of the post-surgery wound will also be advised by the physician assistant.
Lucy needs to be advised on the type of food to take so that she can resume to normal blood pressure and body temperature. In this case, a dietician will be consulted based on Lucy's medical conditions to offer most appropriate advice on helping to manage her condition. For instance, Lucy will be advised why taking a lot of alcohol is connected to low blood pressure and how it can end up being heart disease (Chung, & Joung, 2012). Also, the dietician will be consulted on the most effective fluids to be used for effective hydration.
Certified RN Anaesthetist
Pain management requires the use of anaesthetic in severe conditions. Therefore, certified registered nurse anaesthetic will be consulted on how to use opioids in pain management and advice on the possible effects. The RN anaesthetist will be making frequent visits to observe how Lucy is responding to the drug and instructing the nurse on how to manage observed change.
Al-Maqbali, M. (2013). Appendicitis: a case study. Nursing Standard, 27(42), 35-41. https://dx.doi.org/10.7748/ns2013.06.27.42.35.e7584
Alzahrani, D. (2016). Role of Ultrasound in Diagnosis of Acute Appendicitis. Journal of Medical Science and Clinical Research. https://dx.doi.org/10.18535/jmscr/v4i9.16
Buchheit, M., & Laursen, P. (2009). Treatment of hyperthermia: is assessment of cooling efficiency enough? Experimental Physiology, 94(6), 627-629. https://dx.doi.org/10.1113/expphysiol.2009.047761
Carpenito-Moyet, L., & Carpenito, L. (2012). Nursing Care Plans & Documentation (1st Ed.). Philadelphia: Walters Kluwer Health.
Chisholm, P., & Anpalahan, M. (2016). Orthostatic hypotension - pathophysiology, assessment, treatment, and the paradox of supine hypertension - a review. Internal Medicine Journal. https://dx.doi.org/10.1111/imj.13171
Chung, S., & Joung, K. (2012). Risk factors of heavy episodic drinking among Korean adolescents. Journal of Psychiatric and Mental Health Nursing, 20(8), 665-671. https://dx.doi.org/10.1111/j.1365-2850.2012.01954.x
Ettehad et al. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957-967. https://dx.doi.org/10.1016/s0140-6736(15)01225-8
Hall, R. (2013). Patient flow (1st Ed.). Boston, MA: Springer US.
Hawker et al., (2011). Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF. Arthritis Care & Research, 63(S11), S240-S252. https://dx.doi.org/10.1002/acr.20543
McGregor, I. (2011). S.23.05 MDMA and other party drugs: neural and social effects in rodents. European Neuropsychopharmacology, 21, S223. https://dx.doi.org/10.1016/s0924-977x(11)70335-2
Sander, S. (2016). A review of the studies about appendicitis of the Turkish Pediatric Surgical Centers and a preliminary study to form a publishing index for pediatric appendicitis. Turkish Association of Pediatric Surgeons. https://dx.doi.org/10.5222/jtaps.2016.061
Schultz et al., (2011). Masked hypertension is “unmasked” by low-intensity exercise blood pressure. Blood Pressure, 20(5), 284-289. https://dx.doi.org/10.3109/08037051.2011.566251
Sidhu, P. (2010). Emergency Management of Severe Opioid-Induced Hyperalgesia. Journal of Pain and Symptom Management, 39(2), 368-369. https://dx.doi.org/10.1016/j.jpainsymman.2009.11.283
Zalon, M. (2014). Mild, Moderate, and Severe Pain in Patients Recovering from Major Abdominal Surgery. Pain Management Nursing, 15(2), e1-e12. https://dx.doi.org/10.1016/j.pmn.2012.03.006