Discuss about the Theory Practice and Clinical Simulations.
This essay is about a 40 year old woman Janet Jackson is a single parent and has three teenage children. She has been experiencing symptoms which has led to the diagnosis of uterine fibroids (leiomyomas).She has a history of depression and is a heavy smoker. Janet was admitted to hospital for a vaginal hysterectomy via spinal anaesthesia. She was transferred to the ward after 2 hours in the post-anaesthetic recovery room (PARU).She has an indwelling urinary catheter in situ and patient controlled analgesia. Janet was observed on the basis of several parameters such as respiration rate 30 per minute, BP 90/50mm Hg, Pulse 130bpm, temperature 36.5o C, Pain 0/10 . She has an indwelling urinary catheter in situ with 10mls of urine output for the last hour .It has been planned for Janet to be discharged after two days on the ward.
Uterine leiomyomas (fibroids or myomas) are benign tumors present in the uterus. They are majorly found in women who are capable of reproduction. They occur from the myometrial layer of the uterine corpus or the uterine cervix. Uterine leiomyomas may occur single or in group after multiplying. They can be found within the muscular layer (intramural) or protrude outward to become subserosal in location or inward towards the cavity of endometrium, where they are called as submucous fibroids (White,2017).Abnormal vaginal bleeding occurs due the presence of fibroids and it occurs when the lining of endometrium gets distorted and hence is more commonly observed with submucous fibroids. An individual affected from Uterine leiomyomas leads to a variety of symptoms such as menstrual bleeding, dysmenorrhoea and inter menstrual bleeding, chronic pain in the pelvis, bloating in stomach, increase in urine output, and disturbed functioning in bowel. It may also result in the loss of reproductive functions and result in sub fertility, loss of pregnancy or complications.
There are several nursing management strategies that should be followed for Mrs. Janet.Since, the respiration rate of Janet is 30 per minute and a pulse of 130, which is quite high as compared to a normal respiration rate she should be taken for emergency help.She had an increased pulse rate of 130 which occurs due to the shortness of breath or tiredness. It may also result in cardiac arrest in Mrs.janet. There is also a risk of obstruction in the airway and the nurses should open the airway as soon as possible by lifting her chin and head in a tilted position (Ball et al., 2013).After opening the airway, nurses should check whether the patient is breathing normally or not for at least 10 seconds. The movement of chest should be observed in a careful manner and they should listen to his sounds of breathing and feel his exhaled breathing. The nurses and other health care staff should monitor the output of urine in Mrs. Janet.
The nursing staff and the clinicians should help Mrs. Janet in exercising regularly and provide physiotherapy sessions which would play a significant role in improving her mobility. It would make her independent again .Mrs. Janet should be advised to have a nutritional diet along with plenty of fluids which would help in the regeneration of tissue and healing (Epstein & Turner,2015).She should be advised protective measures to avoid various kinds of infection, injuries after the patient has under gone surgery. Mrs. Janet should be provided palliative care which is a special type of care given to patients. It should be given to her in an efficient way which would help her to get rid from physical pain and stress. It involves the collaborative efforts of several clinicians, nursing staff to help the patient in getting well soon and improve their health.
There are several nursing care goals for providing priority nursing care in relation to the nursing issues that have been identified. Mrs. Janet should be empowered and provided care by understanding her needs and demands. She should also be provided psychosocial care that will help her to get rid of depressive symptoms, pain and anxiety developed due to surgery. She should be advised to follow a few precautions to manage emotional issues like taking regular exercise and a well balanced diet (Daly, Speedy& Jackson, 2017).She should not be allowed to smoke after the surgery as she was a heavy smoker. She should also discuss her issues with other patients who had undergone vaginal hysterectomy. Mrs. Janet can also be provided counseling with a health counselor to share her feelings that will help her in feeling positive.
Mrs. Janet suffers from severe depression so she can also be advised to take the help of antidepressants, which is very helpful and her them feel good about themselves. The doctors and the nursing staff should provide proper care and post- operative follow ups to Mrs. Janet. She should also be asked about her mental and emotional issues or problems to assess her psychological status such as if he is still suffering from depression, anxiety, sadness, anger or frustration (Maslow, 2013).Nursing care for Mrs. Janet are that she should be encouraged to take appropriate amount of rest which would help in conserving her energy and avoid fatigue.
Mrs. Janet should be counseled and guided properly to take appropriate rest and several precautions to improve the condition of her health (Epstein & Turner, 2015).She should be advised to follow the principles of self- actualization which is known to lead to a healthy mental state and will foster to improve her positive attributes and do not focus on their negative attributes. She would be self-determined and have a high self esteem.
Self actualization plays a significant role in providing person- centered care to patients sufferings from psychosocial issues such as depressive symptoms associated with serious diseases. The nurses should follow the principles proposed by The Code of Professional Conduct for Nurses which aims to provide to provide guidance to the nursing professionals about their roles and responsibilities to provide care to the patients in an ethical and effective manner. It includes various values such as the nurses should maintain their dignity and their patients as well to listen to their patient (Ehde et. al.2014). It will develop a strong relation between the nursing staff and Mrs. Janet. This will develop a bond of trust and care and a between her and the doctor and ultimately would develop a positive approach and reduce the stress about her condition. It will reduce the complications in her and decrease in post operative complication. The nurses should improve time- management skills during dealing with patients and they should also to be more patient.
Mrs. Janet should be provided proper nursing care by the nursing staff and other health care professionals. Janet and her daughter should be provided appropriate guidance about the disorder, symptoms, procedure of treatment and the precautions to prevent any future health effe cts .A lack of proper communication may lead to issues and errors in the treatment. Janet should be been provided proper counseling and psychosocial support so that she becomes confident and does not remain tensed about the disease. She should be advised to ask if she has any problems and doubts about the health issue .This would motivate her and provide patient satisfaction thus improving her well being.
A proper communication to patients plays an important role in improving the hospital journey and reduces the anxiety, stress and depressive symptoms (Mischel, 2013).Lack of proper communication leads to issues such as a delay in treatment and sometimes may cause adverse health effects among them. This decreases their bonding with healthcare professionals such as clinicians and nurses and creates misunderstanding and confusion about the treatment and the precautionary measures that should be taken. She should discuss her problems with her daughters and friends since she is also suffering from hypotension and depression.
The interdisciplinary team for Mrs. Janet involves the hospital staff of the OT, counselor and the dietician .They would play an important role in providing person centered care to her so that she gets well soon. The staff of the OT would keep a check on the condition of Mrs. Janet by monitoring her signs and symptoms (Niemela & Kim, 2014). They also make sure that she is stable enough to take him to the recovery room. A counselor will motivate her to be positive and not be depressed so that she recovers soon from depression. A dietician will advise her to .They can also help in providing proper follow ups after the treatment to keep a track on the side effects of the medications prescribed to him.
It can be concluded that several strategies should be taken into account to provide proper information to family members in order to provide proper patient care and satisfaction. Regular follow-ups should also be conducted for the patient to keep a check on his health. It may lead to mental issues such as depression and may have an adverse effect on the psychological condition of the patient. The doctors should provide proper support and inform about the precautionary measures to be followed. She should be prohibited from smoking again and which may result in several health issues such as cardiovascular problems including heart stroke, heart attack and ultimately death .They should also make sure they solve their problems and issues. Mrs. Janet should be treated empathetically and with courteousness and should be counseled properly so that she can explain the severity of her pain. Various tools for the assessment of pain should be used if she is feeling discomfort. The nurses and other healthcare professionals should help her and provide psychosocial care along with palliative care so that she gets well soon.
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