When a patient is admitted into hospital a holistic health care team approach is essential to ensure the right measures are established for a successful recovery. This paper follows a case study of an elderly woman named Mrs. Win, who is post operative Laparoscopic Cholecystectomy. The paper will explore her pervious medical history and the impact that it may have on her current health. Possible nursing problems post surgery will be explored, with focus on one key issue. Through collaboration with allied health services these complications can be addressed holistically. A nursing care plan will be constructed in accordance to the case study in regards to giving the patient the highest quality of care whilst in hospital and after discharge.
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Mrs Win is a 66 year old female patient who is vacationing around Australia in a caravan with her husband. The patient has a medical history of hypertension which is defined as having a persistent high blood pressure, as well as osteoarthritis which is the breakdown of cartilage in joints causing pain on movement (Berman, et al., 2008). Both conditions she self medicates with Atenolol, Paracetamol and Glucosamine. Mrs Win has just undergone a Laparoscopic Cholecystectomy which is a procedure that involves the removal of the gallbladder through microsurgery. Using advanced laparoscopic technology it is now possible to remove the gallbladder through a tiny incision in the stomach, this has numerous advantages for the patients wellbeing opposed to the traditional open abdominal surgery. The patient may have had her gallbladder removed for several reasons, these may include cholelithiasis (gallstones), acute and chronic cholecystitis (inflammation of the gallbladder) or gallbladder cancer (Herbert et al., 2007). Post surgery Mrs Win has moderate pain, with respirations above the normal limits, her blood pressure is still consistently high however her pulse and oxygen saturation are regular (Berman, et al., 2008).
After Mrs Win Laparoscopic Cholecystectomy there are several skills expected of nursing staff to implement so the patient avoids potential problems post operative and furthermore to manage current issues that may be associated with the surgery.
Pain management is paramount to the care of a patient. Mrs Win is experiencing pain 3/10 in her abdomen and 5/10 at her right shoulder tip. It is crucial that pain is managed effectively as it can have a detrimental effect on her physical and psychological state, which will impact on her daily functions (St Marie, 2002).
Mobility may also become an issue for Mrs Win post procedure due to a variety of reasons which will be discussed in detail later in the paper.
Nutrition and hydration are essential to fuelling the body with energy. Mrs Win is complaining of nausea and is only tolerating small sips of water which is inadequate to sustaining normal daily function. Lack of nutrition impacts on her activities of daily living, hampers wound healing, the capacity to fight infection and her general recovery (Dudek, 2001).
Mrs Win is also at a risk of impaired skin integrity due to poor nutrition, restricted mobility and her age. Without proper nursing support many factors could work against the patient and begin to breakdown her skin. It is essential pressure area care is performed every few hours to prevent decubitus ulcers (Berman, et al., 2008).
Impaired respiratory function is also a key nursing issue as complications can arise with Mrs Win’s breathing. Mrs Win is on oxygen therapy of 3L per minute via nasal cannula and currently has a respiratory rate of 22 breathes per minute which is above the normal range 20 breaths per minute (Berman, et al., 2008).Other potential breathing problems can be initiated by the narcotics she is taking for pain management this includes morphine as it can suppress the respiratory system (Bullock & Manias, 2011).
Wound care is a crucial nursing issue for Mrs Win post surgery as she has four incisions in her abdomen with Verivac drains insitu. Maintaining clean wound sites is essential to help guarantee the site heals effectively without the invasion of micro organisms which can cause infection that may lead to further complications (Bowler, Duerdun, & Armstrong, 2001).
Constipation with Mrs Win can become a potential nursing issue whilst in hospital and after discharge. This implication can arise due to the gastro Intestinal track being lethargic after surgery because of general anaesthetic or the trauma received to stomach during the operation. Peristalsis may also be delayed as constant lying on the back can inhibit this movement of the bowel( Mattson Porth, & Matfin, 2009) This would make Mrs Win feel uncomfortable and can be medicated with oral laxatives or suppositories (Bullock & Manias, 2011).
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Mobility would be a major issue for Mrs Win during her hospital stay and furthermore after her discharge because she is travelling around the country by caravan. Mobility is defined as the ability of a person to move efficiently and effectively from one place to another with comfort and ease (Crepeau, Cohn & Schell, 2003). A person being immobile can severely impacts on their activities of daily living and take away their independence, which can become detrimental to the persons mental wellbeing (Crisp & Taylor, 2005).Post surgery from Mrs Win Laparoscopic Cholecystectomy her mobility would be significantly affected for various reasons. She is experiencing pain which will put off any movement as it would be uncomfortable furthermore she is nauseous and may not feel confident getting out of bed. Mrs Win may be dizzy and fatigued from the pain medication which may also restrict her movements. Additionally the patient is on oxygen therapy, an intravenous line and Verivac drains insitu these factors may discourage movement. Anxiety of these restricting factors may also deter Mrs Win to ambulate. Impaired mobility can have detrimental affects the body physically and mentally. Without movement venous circulation slows down and the coagulation of blood increases causing thrombus and embolus (“Nursing fundamentals: the effects of immobility,” 2007) The respiratory system can be notably affected as hypostatic pneumonia may develop because immobile patients have pooling of chest secretions in the lungs and this congestion predispose the respiratory tract to infections (“Nursing fundamentals: the effects of immobility,” 2007). Other consequences from immobility include muscle atrophy due to lack of exercise and the formation of pressure sores if left in the same position for a prolonged time (“Nursing fundamentals: the effects of immobility,” 2007). Impaired mobility can hinder Mrs Win personal hygiene which can psychologically affect her if she feels she is losing her independence (Crisp & Taylor, 2005).
Allied health services would be of great assistance to help Mrs Win recuperate after her operation. Holistic care can be provided to the patient to help with her issue of immobility, the professionals that can help include: an Occupational Therapist, a Physiotherapist, Dietician and a Social Worker.
An Occupational Therapist would be beneficial for Mrs Win to help her resolve the issues which hamper her undertaking activities of daily living. An Occupational Therapist considers the persons environment and implements strategies or equipment to help clients increase their independence with daily tasks including washing, dressing and getting in/out of caravan(Crepeau, Cohn & Schell, 2003).The occupational therapist could asses her caravan and see if it is suitable for a person recovering from surgery who also has a history of osteoarthritis and if needed make changes to help Mrs Win cope with immobility (e.g. a rail to help her step up into the caravan).
Physiotherapist’s endeavour to develop functional ability of physically impaired clients which will improve their quality of life. A Physiotherapist develops plans based on individual needs to help their clients ambulate with reduced pain and to restore the normal functions of body movement (Herbert et al., 2007). Mrs Win would profit from the help of a Physiotherapist because she is in pain and has decreased mobility following surgery, furthermore her osteoarthritis is contributing to her condition. Mrs Win would have problems with carrying out daily tasks so she can take benefit from care planning and exercises to assist the return of strength, normal function and mobility.
An essential element to recovery from surgery is the consumption of a nutritional and healthy diet which is why a dietician would help Mrs Win recuperate post surgery. Dieticians have skills to personalise healthy diets and educate individuals on good nutrition (Dudek, 2001). Mrs Win would benefit from this service as she is not eating hence her meals need to be designed to give maximum nutrition to create the energy needed to facilitate a recovery and fuel mobility. A dietician can additionally educate Mrs Win on foods which stimulate the production of bile needed to break down foods. Bile production is crucial for Mrs Win as she no longer can store bile in her gallbladder so she may need to produce more to help with the digestion process.
Incorporated into Mrs Win’s care planning could be a Social Worker whose role is to improve the quality of living by assisting them to handle and solve issues with daily life (Payne, 2005). Travelling around the country in a caravan, Mrs Win is away from her support networks and may struggle to deal with daily tasks due to poor mobility. The social worker can organise coping mechanisms to help her deal with the immobility or alternatively arrange accommodation close by until Mrs Win is healthy enough to travel again.
This paper explored the case study of Mrs Win a 66 year old female post operative from a Laparoscopic Cholecystectomy. We explored her pervious medical history and defined the implications it can have on her current health and furthermore discussed the patient’s medical diagnosis. In relation to her medical diagnosis several nursing issues where identified with the emphasis on the key problem of immobility and what impact this has on Mrs Win. The paper proposed which allied health services could be beneficial to Mrs Win’s recovery. Finally a care plan was constructed with the intent to better the patient’s health by setting health goals and plans to achieve them. An evaluation was made to determine whether these plans where effective in improving Mrs Win quality of living with all documentation supported with relevant and reputable information.
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