This case study deals with a patient named Melody King, who had been admitted into the emergency department of the hospital with acute abdominal pain. He had undergone a laparoscopic surgery for the removal of the ruptured appendix. It has been reported that Melody is having post operative complications like increasing nausea, centralized abdominal pain and the assessment report shows that she is having an elevated WBC count and CRP. This study aims to discuss about the possible causes and the complications of the clinical conditions and nursing interventions that has to be taken up during the post operative period of the surgery. This study focuses on how to provide a holistic care of approach to the patient as a registered nurse.
A ruptured appendix can be a life threatening condition. When an appendix becomes obstructed or infected, the bacteria residing inside the organ will reproduce and multiply. Due to this the appendix may become filled with puss tissue cells, white blood cells (Biard et al., 2017). This will create pressure on the walls of the appendix as a result the amount of blood flowing in to the organ will reduce. Eventually the tissue of the appendix will die, causing breaking open of the muscular walls of the appendix. According to the case study provided such a condition will cause pain in the lower abdomen (Biard et al., 2017).
- Her blood pressure is 95/45mmHg, which is quite low.
- Heart rate – 120, which is high than the standard.
- Temperature- 38.3°Celcius. The body temperature is normal.
- RR 22/min and shallow
- SpO2 95% on room air
Her report indicates that she has got a high WBC count. Normally appendicitis can be diagnosed with elevated level of WBC. But it should get normalized after the application of the antibiotics. An elevated WBC indicates that the infection still persists, which has to be treated (Hussein, Bickel & Fischer, 2016).
The abdominal distension might have been caused due to the accumulation of gas in to the abdomen. Although, appendix has a very little physiological role in human body, inflammation in any organ is bound to create disturbance in the body. Abdominal guarding is the tensing of the muscles of the abdominal walls in order to the guard the inflamed organ. Since Ms. Melody had been suffering from Appendix infection, therefore it is normal that she will be faced with abdominal guarding (Flum, 2015).
Prioritization of the nursing issues
- Abdominal pain after the removal of appendix is quite normal, but if the pain is intense and is centralized then proper and special care has to be taken. It has been reported that the post operative pain generally decreases with time.
- To look for the complications-
Sometimes appendectomy is followed by complications that require immediate attention. Red skin along with drainage can come out through the incision point. The complication is known as Peritonitis. Things will worsen and will become life threatening if the infection enters the blood stream. Fever, vomiting, abdominal tenderness, abdominal guarding may indicate peritonitis (Giesen et al., 2017). The following case study gives information about the symptoms of then patient which may indicate peritonitis. Improper assessment of the patient, improper dressing of the wound, improper setting up of the nurse’s protocol, inefficient nursing interventions can pose threat to the life of the patient by bringing about the complications (Bjerrum et al., 2017).
- To look for the abdominal distension after the surgery
It is normal to face abdominal distension and bloating after an appendectomy, although it goes away with time. Proper medications should be administered to decrease the formation of gas in the stomach.
Nursing goals related to the case
The case provides with the information the Ms. Melody was suffering from some post operative complications like increased level of nausea, abdominal pain. She was having a centralized pain of about 7-8 on a scale of 10, which indicates that she was in quite a distress and the surgery has not been able to remove her from the pain that she was in with the appendix rupture (McAteer et al., 2015). The following can be the nursing goals to provide care to M.s Melody-
- To reduce the post operative pain
- To reduce the level of the nausea
- To reduce bloating
- To lower the rate of wound infection
- To prevent comfort
- To prevent complications
- To reduce the risk of deficient fluid volume.
- To assist in proper breathing.
- To impart proper knowledge to the patient and her family (Ms. Melody and her family)
- To chalk out an appropriate discharge plan catering to the need of the patient.
Post operative nursing care approach
The post operative nursing care approach involves (Jaschinski et al., 2014)-
- The pain and the location should be assessed properly, as in this case the pain is centralized. A complete physical assessment of the patient. Monitoring the vital signs of the patient; in this case the patient is suffering from increased nausea and abdominal pain. The patient should be kept in the semi fowler position in order to lessen the pain, as the inflammatory exudates localizes into the pelvis due to the gravity which gives relief from the pain. Holding a pillow against the stomach during or coughing or getting up can decrease the pain with these activities.
- Early ambulation has to be given in order to promote normalization of the function of the organs and to prevent complications. Ice bags should be kept on the abdomen during the initial 24-48 hours. The patients’ laboratory results should be well addressed. Patent IVF should be maintained properly. Proper antibiotics and analgesics should be administered on time after consulting with the doctor.
The dressings of the wound should be checked regularly and proper dressings should be done to prevent infections. The characteristics of the drainage should be monitored as it provides early detection of the developing infections like peritonitis. The drainage specimen can be obtained if needed. The patient should be encouraged to do the deep breathing and the coughing exercises. Assistance should be provided in early ambulation.
It should be noted the patient had a past history of depression and Asthma, so before applying any treatment plan and the medications, the past reports should be taken into account.
- NPO and NG suction should be maintained to decrease gastric irritation and abdominal distension. The bowel sound and the movement of the flatus should be assessed. Oral intake should be given in small amounts. The I&O and the hydration should be monitored.
It can be seen from the case study that the patient has not recovered after the appendectomy. The above mentioned nursing interventions possibly will be able to remove the complications that Ms. Melody is facing with. Antibiotics can decrease the risk of the post operative infections (Jaschinski et al., 2014).
Reflection on the patient outcome
The following nursing interventions are found to provide better outcomes in the patients. I believe that the pain will be controlled; the patient will appear to be relaxed. The nursing treatments would heal the wound timely and it would free of signs of infection, inflammation, erythema or fever. The given nursing goals would provide comfort to the patient. Further study of the case reveals that the patient had a past history of depression. A feeling of anxiety and fear is always built up within any patient undergoing surgery. Therefore it is the duty of a nurse to provide her with mental support to overcome the fear. As a registered nurse one should be able to adopt a mind-body-spirit-emotion-environment approach to nursing.
The analysis of the case study provides with the detailed information about the pathophysiology of the appendectomy with a linkage to the given case study. Researches provides us with the information that a proper nursing protocol and a holistic care of approach can bring about better outcomes in patients. Complications after Appendectomy can take an adverse turn if not diagnosed properly or not taken proper interventions. In this case study there might have been any mistake in the treatment or care imparted by the nurses that gave rise to such an adverse condition. Patient assessment and taking proper care can reduce the complications in the patient. Thus, it can be conclude that early detection, proper assessment of the patient’s condition, proper protocol of evidence based practice can bring better outcome in Ms. Melody King.
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