Standards For Perioperative Nursing

Assessing and diagnosing appendicitis

Discuss about the Standards for Perioperative Nursing.

Appendicitis is an inflammatory condition that affects the appendix. It is stipulated that the appendix is functionless in the human body. However, it performs insignificant immunological functions, and for this reason, one can survive without one. It usually fills with food substances and often empties to the cecum. In some cases, it empties ineffectively, and thus its lumen may be occluded causing obstruction, inflammation and vulnerable to infection. This condition is referred to as appendicitis (White & Duncan, 2013). Appendicitis causes acute abdomen, and it is among the leading causes of emergency abdominal surgeries in Australia. It causes a progressively severe generalized pain that becomes localized in the right lower quadrant at the location of the appendix. The inflamed appendix may become infected and fill with pus (Bowen, 2015). At this point, an emergency surgery is needed to prevent its perforation and rupture that usually occurs 24 hours after onset may result in peritonitis pelvic abscess, subphrenic abscess, and paralytic ileus. The clinical manifestations that ensue from the pathology include low-grade fever, nausea, and vomiting. Rebound tenderness is also experienced upon application of pressure at the McBurney’s point (Buja, Netter & Krueger, 2014). Various risk factors are attributed to the development of the condition. Children and young adults aged below the age of 30 years are at a higher risk for the other populations. A positive family history may also increase the risk of one developing the condition.

A review of the patient is significant in determining the course that is taken after surgery. Assessment and various diagnostic approaches are used. Physical examination is one of the most common initial approaches to prognosis. As well, the radiological findings such as x-ray, ultrasounds and computed tomography (CT) scan may be used as confirmatory assertions (Hamlin et al. 2011). As stipulated by Hogan (2014), the medical management of the side effects involves administration of drugs. Administration of pain relieving medication is contraindicated before a definitive prognosis is made. As pointed out by Brady (2014), administration of such medications may mask the symptoms of the condition leading to the misrepresentation and progression of the condition such that timely interventions are not provided leading to complications that ensue from its rupture. Intravenous fluids and antibiotics are administered after the surgery to prevent dehydration, electrolyte imbalance and infection. Prophylactic empirical therapy is offered in case of any rupture and peritonitis.

Medical management of appendicitis

Nursing care must be adhered strictly to avoid episodes of deterioration. The priority nursing intervention should be to alleviate the severe abdominal pain experienced following the surgical procedure (Rebeiro & Hunter, 2013). Other related goals include ensuring no fluid volume deficit as well as electrolyte imbalance occurs. On the other hand, anxiety is a common occurrence in any disease. The presence of a wound might evoke thoughts that can alter the perception of the patient about the condition. This can be as a result of unknown prognosis and intervention outcome for the patient and family. Therefore it is the role of a nurse also to alleviate anxiety. At this state, the patient is at a high risk of developing gastrointestinal infections, and it can be prevented through the implementation of various interventional strategies including the administration of administered prophylactic antibiotics. Other measures can also be taken depending on the need of the patient to prevent any actual or potential gastrointestinal disruption. Skin integrity should also be maintained by ensuring adequate hydration of the patient and repositioning after every 2 hours of hospitalization. The patient needs bed rest to enable the normal physiological functioning to take root making the skin to be under pressure especially when not changing positions due to fear of inflicting pain on the surgical site.

Recuperation after the surgery depends on the care that is provided before the procedure. Preparation of the patient for surgery is paramount in ensuring that affirmative prognoses are realized postoperatively. It is done by a nurse in collaboration with other multidisciplinary team members (Australian College of Operating Room Nurses, 2014). It is recommended that nothing should be consumed per oral by the patient as it is expected that general or spinal anesthesia is to be used during an appendectomy. As well, it is meant to reduce further irritation of the intestinal area. Hyperthermia is one of the nursing diagnoses that are often made preoperatively, and pharmacological and non-pharmacological interventions can be used in the regulation of the patient’s temperature. The nurse is also expected to monitor vital signs to identify any changes in temperature, respiratory rate, pulse rate and blood pressure to figure out how to normalize them. The pain level is assessed from time to time. Pain is a significant indicator of the progression of the condition and for this reason, use of pain relieving medication before surgical intervention is highly contraindicated (DiGiulio & Keogh, 2014).

Nursing care for appendectomy patients

Postoperative care must incorporate management of actual and potential risks. Alleviation of signs and symptoms can be established depending on the presenting signs of the patient. A multi-professional approach is vital in ensuring a vibrant care is accorded. The nurse determines the psychological needs of the patient and reinforces the use of coping strategies after the surgical experience. This is done by establishing baseline data that can also be used for comparison during and after the surgery. The nurse also identifies the prescription, overt the counter and other medications used that may have an impact on the surgical intervention to the patient condition. Cultural factors that may influence the post-surgical therapy of the patient are crucial in establishing an affirmative course of therapy. Notes such as the outcome of the operation will reflect the desire of the patient and relatives. Before the surgical procedure on the patient, the complete blood count test is done as well as the blood type and cross matching to ensure the availability of blood for replacement during and after the surgery if there is a need. During the recovery period after the operation, the chief role of the nurse should be to assess the extent of pain felt by the patient and ways to alleviate it (Hinkle, 2014).

Discomfort due to the surgical procedure ought to be curbed to enable the patient maneuver the therapeutic environment with ease. In the case of Lucy, the pain scale indicates it is 8 out of ten which can be termed as severe. This can be because there was an incision made and no pain relieving medication has been provided. Thus the nurse should administer not only the pain relieving medications but also the other prescribed drugs. The vital signs, as well as the surgical site, should be monitored for appearance, dehiscence, and drainage and any unexpected state should promptly be reported to the other team members for collaborative interventions. Before the patient resumes oral intake of medication and food, the gastrointestinal functioning should be confirmed through noting the presence of bowel sounds (Hinkle, 2014). However, at this state after surgery, the patient’s fluid intake and output should always be monitored since it has a direct impact on the fluid and electrolyte balance. For instance, Lucy has a blood pressure of 90/50 mmHg which is abnormally low. The respiratory rate is 26, slightly above the normal range. Related to it is the pulse rate of 126 beats per minute which is far much higher than the upper normal limit of pulse rate which should be 100 beats per minute. Tachypnea and tachycardia are physiological adjustments that occur in the body as compensatory mechanisms of the body to the reduced blood pressure to facilitate the supply of blood and oxygen to the vital organs especially the brain (Brady, 2014). This need may have been as a result of the anesthetic agent used or due to loss of fluid through bleeding during the surgery. This can be rectified through the administration of intravenous fluids. Her temperature is also 38.9 which is beyond the normal range. It is expected that post-surgery under general anesthesia, the patient should have a reduced body temperature (DiGiulio & Keogh, 2014). This phenomenon can be associated with a bacterial infection, and further laboratory tests should be done to ascertain the cause, but meanwhile, it should be stabilized by the use of both the pharmacological and non-pharmacological interventions.

Postoperative care for patients undergoing appendectomy

The therapeutic environment provided after the surgery must be vibrant so that management is escalated. For instance, effective communication is an essential requirement for a multidisciplinary approach to the management of the patient. The multidisciplinary team includes the anesthetist, the surgeons, physicians, nurses and general practitioners. According to Australian College of Operating Room Nurses (2014), the postoperative assessment is an extended role of nurses. They are an integral part of the perioperative process by providing a special link between the patient and the entire multidisciplinary team. Besides the roles above, they also work to identify the high-risk patients and institute laboratory investigations as well as refer them to other team members such as the physicians and anesthetists for further management.

Numerous side effects culminate due to the various drug regimens that are used during the surgery. The anesthetists assume the central role in the coordination of the rest of the team members by determining the physiological status of the patient. They should review the patient after the surgery and provide a recommendation on the kind of interventions necessary for the patient. The surgeon and the physician identify and document the surgical site besides facilitating the signing of the consent form before the surgery (Timby & Smith, 2014). The signing is done in the presence of the other team members after a patient demonstrates an understanding of nature of the operation to be done and the implications of the process. Adequate information must be received from the surgeon before the exercise. It paves the way for the execution of procedure during the post-recovery period. The nurse has a role of teaching the patient on the expectations during and after the surgery and the care modalities that can be applied. The family members are supposed to be involved fully if available in the recovery of the patient and thus are also expected to be made aware of what to expect by the nurse. The surgeon and the physician should also perform daily reviews to note the progress of the patient and recommend on other interventions (Grace & Grace, 2014). The vibrancy of the care that is accorded during post-operative period depends on the definitive interventions that are outlined by nurses and physicians.

The discharge plan must involve a health education. Care of the surgical site is crucial in curbing reinfection. Cleaning and administration of antibiotics are the core procedures that affirm the goal. The patient ought to be made aware of the signs that necessitate a visit to the hospital. For instance, wound dehiscence and production of exudates must be addressed promptly. As pointed out by Hogan & Gingrich (2014), counseling on health behavior is significant in ensuring that the status of the patient is maintained. Ingesting food materials that do not pose harm to the body makes systems to be vibrant. Strict adherence to medication regimens is essential in eradicating the pathology. The dosages and intervals must be known by the patient to prevent adverse ramifications during recuperation.

References

Australian College of Operating Room Nurses. (2014). 2014-2015 ACORN standards for perioperative nursing: Including nurses’ roles, guidelines, position statements, competency standards. Adelaide, SA: ACORN.

Bowen, W. H. (2015). Appendicitis. Place of publication not identified: Cambridge Univ Press.

Brady, A.-M. (2014). Fundamentals of Medical-Surgical Nursing: A Systems Approach. Chichester, West Sussex, UK: Wiley-Blackwell.

Buja, L. M., Netter, F. H., & Krueger, G. R. F. (2014). Netter's Illustrated human pathology. Philadelphia, PA: Saunders/Elsevier.

DiGiulio, M., & Keogh, J. E. (2014). Medical-surgical nursing demystified. New York: McGraw-Hill Education Medical.

Grace, P. J., & Grace, P. J. (2014). Nursing ethics and professional responsibility in advanced practice. Burlington, MA: Jones & Bartlett Learning.

Hamlin, L., Richardson-Tench, M., & Davies, M. (2011). Perioperative Nursing: An Introductory Text. London: Elsevier Health Sciences APAC.

Hinkle, J. L. (2014). Clinical Handbook for Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Hogan, M. A. (2014). Nursing fundamentals. Boston: Pearson.

Hogan, M. A., & Gingrich, M. M. (2014). Pathophysiology. Boston: Pearson.

Hogan, M. A., Dentlinger, N. C., & Ramdin, V. (2014). Medical-surgical nursing. New York: Pearson.

LeMone, P., Burke, K. M., & Levett-Jones, T. (2013). Medical-Surgical Nursing VS. Sydney: Pearson Education Australia.

Mogotlane, S. M., Mokoena, J., & Chauke, M. E. (2006). Medical-surgical nursing. Cape Town: Juta.

Rebeiro, G., & In Hunter, C. (2013). Fundamentals of Nursing: Clinical skills workbook. Chatswood, New South Wales: Elsevier.

Timby, B. K., & Smith, N. E. (2014). Introductory medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

White, L., Baumle, W., & Duncan, G. (2013). Medical-surgical nursing: An integrated approach. Australia: Delmar Cengage Learning.