NRSG258: Acute Care Nursing

Introduction

The main goal of this assignment is to discover and discus health related issues concerning Cynthia Johns who is 49 years hold. Cynthia Johns who is a female patient experiences symptoms of dysmenorrhea which resulted to her being diagnosis of uterine fibroids.  Cynthia fails to recover from Abdominal Hysterectomy surgery carried on her through anesthesia leading to her being admitted in the hospital. Additionally, it is discovered that she suffers from mild depression

Aetiology of the Patient’s Presenting Condition (LO3)

From the case study, Cynthia Jones is a window who has been living in a rural area with her 13 years hold son after the death of her husband following a farm accident. Cynthia John is as been experiencing symptoms of dysmenorrhea which led her to diagnosis of uterine fibroids (Ciavattini et al., 2013). Dysmenorrhea refers to the painful menstruation experienced by women. According to various medical researches, dysmenorrhea can be categorized into two groups. There is primary and secondary dysmenorrhea. From the case study, the patient seems to suffer from secondary dysmenorrhea. The menstrual pain the Cynthia is suffering from is as a result of uterine fibroid which is a gynecologic disorder. The main causes of the secondary dysmenorrhea are drinking of alcohol, smoking lack of exercise, social and psychological stress, overweight as well as family history with dysmenorrhea (Caforio, et al., 2013). However, from the case study the patient seems to suffer from the disorders as a result of lack of psychological and social stress as a result of farm accident that led to the death of her husband. Moreover, it can be concluded that the patients suffer from the condition due to lack of enough exercise since she leaves in a rural area with only her son who is now 13 years old.

Secondly the patients seem to have low blood pressure of BP 90/50mmHg instead of (120/80-140/90) mmHg. The major possible causes of low blood pressure for Cynthia may include; lack of proper nutrients in her diet.  The food that he consumes might be lacking vitamins B-12 as well as folate responsible for stimulating the body to produce red blood cell thereby leading to low blood pressure (Moll, & Davis, 2017). Additionally, type of medication may also results to low blood pressure. From the case study, it is reported that the patients suffers from mild depression, therefore, consumption of tricyclic antidepressants such as doxepin, Silenor as well, as imipramine may have resulted to low blood pressure for the patients. Finally, the patients might also be suffering from the low blood pressure as a result of risk factors like suffering from certain diseases. Cynthia was diagnosed with dysmenorrhea, which may have contributed to her suffering from low blood pressure.

Finally, Cynthia Jones also suffers from high respiration and pulse rate as indicated in the case study. The patient experiences a respiration rate of 30 beats per minutes instead of 20-25 beats per minutes. Also, she the patient has a pulse rate of 130bpm instead of 60-100bpm which is the normal rate. From the case study, the patient might be suffering from tachypnea as a result of stress, anxiety and nervousness due to the accident that led to the death of her husband (Tucker, Knowles, Wright, & Fox, 2013). Tachycardia or pulse rate that the patient is suffering from may also be as a result of tachypnea.

Pathophysiology of Patient’s Presenting Condition (LO3)

Dysmenorrhea disorder refers to painful menstruation that involves cramp due to uterine contraction. One of the major causes of dysmenorrhea syndrome is uterine fibroids which are non-cancerous and grows within the muscle layers of a woman womb. According to different medical research, uterine fibroids mostly occur during or after reproductive years (Guo, Mao, Ma, & Liu, 2013).  High levels of estrogen as well as progesterone are the major causes of uterine fibroid. Additionally, dysmenorrhea syndrome may also occur to a woman after reaching their menopause (Chen, Kwekkeboom, & Ward, 2015). Stress, depression and panic increases the risk of dysmenorrhea disorder since they causes elevation of blood adrenocorticotropin (ACTH) and cortisol from the adrenal gland. (ACTH) remains high due to unresponsive tumor from the negative feedback of high levels of cortisol.

Underlying Pathophysiology of the Patient’s Post-Operative Deterioration

After undergoing abdominal Hysterectomy surgery through general anesthesia, the patient may have developed hypertension as a result of aldosteronism that may grows due to the removal of adrenal gland (Sivapurapu, Vasudevan, Gupta, & Badhe, A2013). Aldosterone mechanism as well as rennin angiotensin which helps in maintenance normal blood pressure often gets affected thereby this may have resulted to increase of Cynthia Jones blood pressure (Nygren, et al., 2013). Moreover, some renal action associated with the aldosterone often determines clinical characteristics. Aldosterone usually results to rise in the number of the sodium channels that are opened within the luminal membrane inside the collecting tubule causing increases in sodium reabsorption. Thus, this leads to signs of hypertension. Finally, Abdominal Hysterectomy surgery also causes damage of the renal structure leading to glomerular filtration rate decline thus causing decrease in urinary output (Urden, Stacy, & Lough, (2017). From the case study, Cynthia Jones experiences 10mls of urine output for the last hour with the help of indwelling urinary catheter insitu.

Prioritizing, Outlining and Justifying the appropriate Nursing Management of the Patient

The first priority should be given to the patient to help encounter the dysmenorrhea. From the case study, Cynthia John is using analgesic with Morphine 1 mg bolus to control her pain. However, environment, psychological and social factors also undermine nutritional intake. Since death of her husband, Cynthia has been residing in rural areas with her 13 years old while. She has been away from her other two kids. Therefore, the loneliness may place her at a very high risk of malnutrition (Baldwin, Black, & Hammond, 2014). Lack of proper nutrition may have resulted to her hospitalization and difficult in discovery. Malnutrition mays have caused worsening of respiratory muscles leading to increase in the respiratory rate has witnessed in the case study. Additionally, Depression development risk should be given the second priority. Depression is always common in most of the disease groups as compared to the general population. Life events such as passing of her husband through farm accidents also contribute to depression development. The social background of living in a rural area, feeling lonely and being anxious during admission to the at the hospital indicates that he she higher risk of depression development

Post-Operative Nursing Management

Nursing Diagnosis

Examination of infection risks associated with suppressed inflammatory response that is caused by increased levels of adrenocorticoid during the preoperative as well as adrenocorticoid replacement. Nonetheless, Injury related risk as a result of dramatic fluctuations of blood pressure that occur due to sudden changes in the adrenocorticoid levels should also be assessed (Powell-Cope, et al., 2014).

Nursing Interventions

The post post-anesthesia care unit nurses should assess patients’ pain levels to medicate her as required. Naturally, there will be no need to carry out patient-controlled analgesia as would be required when an open adrenalectomy is done as a result of small laparoscopic opening (Brogi, Kazan, Cyr, Giunta, & Hemmerling, 2016). The registered nurses should prescribe pain medication to Cynthia Jones on the need basis and at regular intervals. Physicians should also encourage Cynthia to ambulate for a short while following the surgery to enhance recovery. Cynthia Jones urinary drainage catheter should be removed after the first day of postoperative. There is a need to initiate a clear-liquid diet and advanced after the first postoperative day. A follow up by healthcare providers is often necessary after undergoing surgery. WBC levels, wound drainage as well as body temperature assessment should also be carried to the patient and use of sterile techniques to carry out dressing.

Three Members of the Interdisciplinary Healthcare Team

 Multidisciplinary Team (MDT) 

A multidisciplinary team refers to a group of healthcare providers who coordinate care plans for the patient before they are discharged from the hospital to their communities and homes. MDT team plays a crucial role towards the healing and recovery of the patients when they are out of the healthcare centers. A part from managing patient transfer care plan, MDT also communicates to the families of patient concerning their progress. A member of the MDT can meet the patient while still in the hospital but ready to be discharge or after leaving the healthcare settings. MDT team guide the patient on type of exercise, diet as well as helping the client to adhere to medication prescribe to them by the physician. Therefore, this helps in ensuring that there is quick recovery among the patients while they are at home.

Social Workers

Social workers play an important towards Cynthia Jones recovery and stability after hospitalization and surgery (Hauck, Winsett, & Kuric, 2013). They can the family of Cynthia to cope with the effects injury, illness as well as hospitalization. Social workers also offer emotional supports as well as counseling focusing on self-esteem, relationship management, adjustment and dealing with losses. Additionally, they assist with discharge planning as well as addressing the practical needs like finances and acting as a link to resources that Cynthia Jones may require in the community. Finally, social workers can partner with discharge planners to ensure that Cynthia has somewhere that is conducive to reside at as opposed to her rural area once she is discharged.

Psychologist

Psychologist assists with assessment, diagnose as well as counseling to enable the patient cope with bodily changes that Cynthia experience after the surgery. Additionally, they also help with management of disorder, adjustment to hardships as well as overcoming anxiety to the family and the patient.

Pharmacists

Pharmacist together with pharmacy technicians helps in reviewing as well as monitoring all the medication prescribes for the patient while in hospital and after post-operative surgery. The pharmacist examines drug interaction together with other possible safety concerns. Finally, they teach patients concerning their medication and answer question asked by the patients.

Conclusion

Lack of social and family support can results to severe health consequences on human beings. Environment, psychological and social factors are major determinants of health. Residing in lonely environment, psychological problems and lack of social support are main causes of depression which has serious impact on the healthcare as witnessed by the case of Cynthia Jones. Therefore, it is advisable for Cynthia Jones to move to a place where she can interact with people to help her overcome the death of her husband. Additionally, social workers, pharmacist and psychologist can help her with counseling, advice and prescription of medication to improve on her recovery and general wellbeing.

References

Baldwin, K. M., Black, D., & Hammond, S. (2014). Developing a rural transitional care community case management program using clinical nurse specialists. Clinical Nurse Specialist, 28(3), 147-155.

Brogi, E., Kazan, R., Cyr, S., Giunta, F., & Hemmerling, T. M. (2016). Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trialsLe bloc dans le plan du muscle transverse de l’abdomen pour réaliser une analgésie postopératoire: revue systématique et méta-analyse des études randomisées contrôlées. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 63(10), 1184-1196.

Caforio, A. L., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., … & Klingel, K. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European heart journal, 34(33), 2636-2648.

Chen, C. X., Kwekkeboom, K. L., & Ward, S. E. (2015). Self?report pain and symptom measures for primary dysmenorrhoea: A critical review. European Journal of Pain, 19(3), 377-391.

Ciavattini, A., Di Giuseppe, J., Stortoni, P., Montik, N., Giannubilo, S. R., Litta, P., … & Ciarmela, P. (2013). Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Obstetrics and gynecology international, 2013.

Guo, S. W., Mao, X., Ma, Q., & Liu, X. (2013). Dysmenorrhea and its severity are associated with increased uterine contractility and overexpression of oxytocin receptor (OTR) in women with symptomatic adenomyosis. Fertility and sterility, 99(1), 231-240.

Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence?based practice in an acute care hospital. Journal of advanced nursing, 69(3), 664-674.

Moll, R., & Davis, B. (2017). Iron, vitamin B12 and folate. Medicine, 45(4), 198-203.

Nygren, J., Thacker, J., Carli, F., Fearon, K. C. H., Norderval, S., Lobo, D. N., … & Ramirez, J. (2013). Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World journal of surgery, 37(2), 285-305.

Powell-Cope, G., Toyinbo, P., Patel, N., Rugs, D., Elnitsky, C., Hahm, B., … & Hodgson, M. (2014). Effects of a national safe patient handling program on nursing injury incidence rates. Journal of Nursing Administration, 44(10), 525-534.

Tucker, E., Knowles, K., Wright, J., & Fox, M. R. (2013). Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high?resolution manometry studies. Alimentary pharmacology & therapeutics, 37(2), 263-274.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2017). Critical Care Nursing-E-Book: Diagnosis and Management. Elsevier Health Sciences.