Consideration of the Patient
The purpose of the report is to analyze the case study of Brendan, who has been diagnosed with colon cancer. The report is a clinical reasoning cycle that takes into consideration the vital signs of the patient and the reason behind the administration of the patient to the hospital, along with the medical as well as social history. There will be a collection of further data and information, including clinical documents, laboratory results and reports of handover. The types of assessment done for the patient’s current clinical condition shall also be discussed along with the critical review of the same using justification. The information and data collected shall be analyzed and interpreted. In the end, the immediate problem of Brendan, which calls for diagnosis, shall be discussed with evidenced literature support.
Being a part of the Bundjalung people, it can be understood that Brendan is an Aboriginal Australian. Data reveals that the age-standardized incidence of colon cancer in this community is 21-51 per 100000 people across the areas of remoteness (AIHW, 2022). After studying the scenario of the patient, it can be understood that being an Aboriginal, Brendan might have had to face some disparities in places of availing healthcare services. Being a single man with no family living around, he is mostly introverted in nature and does not socialize around much. He was admitted to the hospital because colon cancer is a serious health issue and causes mortality among Aboriginals. Thus, bowel resection surgery is needed to omit cancer as otherwise, it may bring about a persistent change in bowel habits and stool consistency. The trouble can become chronic and long-lasting, and hence treatment is necessary.
Their surgery on Brendan went without any complications. Three days after the operation, the RN collected information on their progress of Brendan. He reported that he was feeling good and was awaiting a discharge. However, he was disappointed when he got to know that his discharge would take some more time. It is the role of a registered nurse to assess and identify the needs of a patient and plans medical treatment accordingly (Hickman et al., 2020). The vital signs collected by the RN during her round revealed that he had a normal body temperature and oxygen saturation level. However, his pulse rate was slightly lower than the normal range. The blood glucose level of 6.9mmol/L indicated that Brendan was prediabetic. He reports that his pain score is low and asks not to give him any more analgesics. From the pathological report, it was found that Brendan’s sodium level was quite a within range, while the serum potassium and creatinine levels were higher than normal. Karkouti et al. (2017) opined that surgical patients are often found to suffer from an increase in the creatinine level post-surgery. Even slight increases can bring about adverse outcomes in the health of patients. To Brendan, appropriate medications shall be administered to keep the same under control.
Their Colostomy Impact (CI) score of Brendan must be assessed and diagnosed to assess any kind of deteriorating condition (Kristensen et al., 2020). Along with this, their condition of the stoma that has been created in the abdomen of Brendan must be checked for any kind of infection as he has undergone a bowel resection. As Brendan suffers from moderate hypertension, it is important to note down the blood pressure level, especially when the condition is just three days after surgery. Surgery often increases the level of hypertension, thereby increasing the chances of cardiovascular and cerebrovascular events. The higher the pressure, the greater becomes the risk. Hence, it has to be monitored regularly and controlled accordingly.
Collection of Cues
As Brendan is an Aboriginal by ethnicity, the reason behind his restlessness can be easily understood. Aboriginals respect the value of kinship and family bonding as a part of their culture (Sylliboy et al., 2021). Despite the fact that Brendan does not have a family, he considers his pet dog to be his only family whom he wants to see and be with at the earliest. The score of Colostomy Impact is a must for assessment as it helps in detecting any kind of reduction in the quality of life of a patient occurring due to a stoma (Kristensen et al., 2020). A stoma is an opening made in the abdomen of the patient due to a bowel resection surgery which helps in the removal of waste from the body. This happens because due to bowel resection, movement of the bowel from the rectum is restricted. The condition of post-surgery hyperkalemia that has been noted in Brendan needs proper medical review along with attempts to reduce the same. It has been analyzed that postoperative hyperkalemia leads to irregular heartbeats or arrhythmia, and in an unattended condition, the same can lead to a heart attack (Li et al., 2018).
After surgery, there are different types of complications associated with the construction of a stoma. This includes necrosis as well as retraction along with irritation in the skin, obstruction of clear bowel movement, infection of the surgical wounds and sepsis. The problems are exacerbated in the absence of notice from the surgeon or the nurse leading to the suffering of the patient without getting any knowledgeable guidance as well as access to resources that are readily available (Correa Marinez et al., 2020). The complications or risk factors associated with the stoma are not under the control of the surgeon. It is the responsibility of the postoperative nurse who is assessing the patient (Hill, 2020). Thus, the Registered Nurse taking care of Brendan must conduct a proper care management plan for stoma before the discharge of the patient so that instances of reoperation do not occur. Proper post-discharge guidelines of stoma care should also be conveyed to the patient so that the open wound gets proper dressing.
Another issue or problem that needs to be catered to for Brendan is the adoption of culturally safe nursing practices for him as he belongs to the indigenous community. These people are not always able to accept the treatments provided by modern doctors and nurses due to the trauma of colonization their ancestors have faced. Under this situation, a liaison officer may help. A liaison officer is an individual who creates a bridge between the patient and the nurse by helping communicate post-discharge guidelines and practices in a culturally competent manner (Orr, Frederico & Long, 2021). Employing a liaison officer to do this task for Brendan would foster a safe environment by building rapport and trust. He will employ specific strategies of communication associated with cancer and its treatment by making use of language which is easy for the patient to understand with the help of visual aids like drawings and using metaphors. The liaison officer may gather support staff of the Aboriginal community and escort the patient by assisting in communication. The officer will employ all strategies by anticipating the conflict between Western medicine and the culture of Aboriginals in an unbiased manner. The liaison officer shall help develop efficient communication with the patient by incorporating patient-centered practices (Olver et al., 2022). He shall do this for Brendan by maintaining empathy, respect and honesty.
Conclusion
From the above essay, it has been concluded that Brendan requires major interventions for the stoma construction due to colostomy along with a culturally safe nursing intervention, where he can be guided for his post-discharge practice in a language and manner that is culturally comprehendible to him. Effective stoma care shall be provided by the attending RN, along with regular monitoring of vital signs. The increased serum creatinine and potassium level would be treated with the help of appropriate medications. The engagement of a liaison officer will benefit the patient by giving guidelines in a culturally safe manner.
Reference List
AIHW. (2022). Cancer in Aboriginal & Torres Strait Islander people of Australia, Colorectal cancer (C18–C20) – Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Retrieved 26 April 2022, from https://www.aihw.gov.au/reports/can/109/cancer-in-indigenous-australians/contents/cancer-type/colorectal-cancer#:~:text=For%20Indigenous%20Australians%2C%20the%20age%2Dstandardised%20incidence%20rate%20for%20colorectal,per%20100%2C000%20across%20remoteness%20areas.
Correa Marinez, A., Bock, D., Carlsson, E., Petersén, C., Erestam, S., Kälebo, P., … & Angenete, E. (2021). Stoma?related complications: a report from the Stoma?Const randomized controlled trial. Colorectal Disease, 23(5), 1091-1101. DOI: 10.1111/codi.15494
Hickman, S. E., Parks, M., Unroe, K. T., Ott, M., & Ersek, M. (2020). The role of the palliative care registered nurse in the nursing facility setting. Journal of Hospice & Palliative Nursing, 22(2), 152-158. https://doi.org/10.1097/NJH.0000000000000634
Hill, B. (2020). Stoma care: procedures, appliances and nursing considerations. British Journal of Nursing, 29(22), S14-S19. https://doi.org/10.12968/bjon.2020.29.22.S14
Karkouti, K., Rao, V., Chan, C. T., & Wijeysundera, D. N. (2017). Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 64(8), 801-809. https://doi.org/10.1007/s12630-017-0899-8
Kristensen, H. Ø., Krogsgaard, M., Christensen, P., & Thomsen, T. (2020). Validation of the colostomy impact score in patients ostomized for a benign condition. Colorectal Disease, 22(12), 2270-2277. https://doi.org/10.1111/codi.15290
Li, S., Liu, S., Chen, Q., Ge, P., Jiang, J., Sheng, X., & Chen, S. (2018). Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis. International Journal of Surgery, 53, 1-4. https://doi.org/10.1016/j.ijsu.2018.03.003
Olver, I., Gunn, K. M., Chong, A., Knott, V., Spronk, K., Cominos, N., & Cunningham, J. (2022). Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study. Supportive Care in Cancer, 30(1), 431-438. https://doi.org/10.1007/s00520-021-06430-3
Orr, E., Frederico, M., & Long, M. (2021). Messages for Good Practice: Aboriginal Hospital Liaison Officers and Hospital Social Workers. Australian Social Work, 1-14. https://doi.org/10.1080/0312407X.2021.1953552
Sylliboy, J. R., Latimer, M., Marshall, E. A., & MacLeod, E. (2021). Communities take the lead: exploring Indigenous health research practices through Two-Eyed Seeing & kinship. International journal of circumpolar health, 80(1), 1929755. https://doi.org/10.1080/22423982.2021.1929755
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