Importance of Pre-Operative Assessment
Discuss about the Pre-Operative Health Assessments.
A number of pre-operative assessments can be undertaken to prevent harm in the patients. A pre-operative risk evaluation is the preliminary step in the delivery of optimum patient care. As suggested by Halaszynski (2018), the cardiac and pulmonary complications of the patient should also be taken into consideration before the administration of anaesthesia and surgical methods. Surgical procedures administered are corroborative with complex stress response produced within the patient, which corresponds to magnitude of injury, total operating time, intraoperative blood loss and post-operative pain. One of the prime objectives to promote faster recovery within the patient is by reducing the complex stress response (van Noort et al., 2018). As mentioned by Chung et al. (2016), reduction in the stress response and trauma can reduce the length of hospital stay. Some of the goals of peri-operative evaluation have been identified over here such as documentation of the conditions for which surgery is required, assessment of the overall health status of the patient, analysis of hidden conditions which could aggravate health issues in the patient during and after surgery, peri-operative risk determination, development of an appropriate peri-operative care plan, educating the patient on various aspects such as surgery, anaesthesia , intraoperative and post-operative pain treatment and management can reduce anxiety within the patients.
As mentioned by Bookey?Bassett et al. (2017), assessment of the skin appearance can help in identification of the hydration pattern of the patient. On contrary, a flushed out skin could be associated with poor hydration patterns or liver dysfunction. The elimination pattern of an individual can also point towards the rate of recovery and overall body functioning. In this respect, effective documentation pattern could be followed by the nurses for taking an update of the amount of water intake and the rate of urination measured through a foley catherer, which signifies the manner of functioning of the kidney (Kutzleb, 2015).
A multidisciplinary approach could be undertaken for the implementation of effective nursing care. In this respect, the patient Mr. Panang was an 87 year old man and had been presented with a number of conditions such as fractured right neck, scalp laceration over right temporal region, fractured hip etc. For the planning and delivery of an effective care the past medical history of the patient need to be taken into consideration. From the scars present on the sternum of the patient, it could be deciphered that the patient had undergone open heart procedure and had a long history of obesity.
Reducing the Complex Stress Response for Faster Recovery
The care duty could be distributed among a number of health professionals for the complete stabilization of the patient. This involves the orthopaedic, neurologist, cardiologist as well as the nursing professionals entitled to care for the patient post surgery. The primary line of care undertaken by the orthopaedics is the resuscitation of fractured neck. However, for the purpose of which a general anaesthesia need to be provided to the patient. Since the patient had a past history of open heart surgery cardiac anomaly or dysfunction could be a concern over here. Therefore, the anaesthesist need to work in collaboration with the heart specialist. Based upon the present conditions of the patient further surgical procedures could be suggested. The patient Mr. Panang had also suffered a small scalp laceration over his temporal region which resulted in indeterminate unconsciousness and confusion within the patient. Therefore, a neurological assessment was required to be undertaken for the patient. Hence, an exchange of health records within different care professionals could help in detailed understanding of the condition of the patient (Crisp et al., 2016). Some of the pivotal aspects which govern the success and failure over here are the communication approaches undertaken. Therefore, a transparent and effective communication gateway is a pre-requisite for the implementation of the required amount of healthcare response (Bee et al., 2015).
The pharmacodynamics and pharmacokinetics of medicines are very important in understanding the active administration process. The patient had been provided with a list of medications such as digoxin, simvastatin, furosemide and potassium chloride. Digoxin is used for the treatment of congestive heart failure within the patient. It has also been found to be effective in the treatment of supraventricular arrhythmias. It inhibits the Na-K-ATPase membrane pump resulting in the increase in intracellular sodium. The sodium calcium exchanger tries to remove the excess sodium from the cell. On the contrary, it pumps in more calcium, which promotes the activation of contractile proteins such as actin and myosin.
The simvastatin is a lipid lowering agent which is a competitive inhibitor of hydroxymethylglutaryl COA reductases. It interferes with the steroid hormone production and also increases the breakdown of LDL cholesterol.
Furesomide is a sulfonamide type diuretic and is used in the treatment of congestive heart disease and renal failure. It acts by inhibiting water absorption in the nephron by blocking the sodium-potassium –chloride cotransporter .
The potassium chloride could have been suggested for the effective and normal contraction of the cardiac muscles along with maintenance of normal renal function. The patient had also been noted for less production of urine. Therefore, the patient could be monitored for renal abnormality. In this respect, the patient had been diagnosed with cardiac anomaly. Therefore, provision of general anaesthesia could worsen the condition of the patient by affecting the rate of heart beat (Chen, Zhu & Zhou, 2014). Hence, digoxin could be suggested to the patient for the treatment of supraventricular arrhythmia. Since, the patient had recorded lower production of urine; potassium chloride could be administered to the patient along with Furosemide which acts as a potent restorer of cardiac function.
Multidisciplinary Approach for Effective Nursing Care
Some of the effective factors which could be considered for post-operative risk assessment are the presence of conditions such as ischemic heart disease, congestive heart disease, liver renal dysfunction, diabetes mellitus and chronic respiratory disease. As mentioned by Kobalava et al. (2016), the anaesthetic drugs can have profound effect on the cardiac and reparatory function. Some of the common side effects which are produced as a side effect of general anaesthesia are pain in the chest, dyspnoea, palpitations and swelling in the ankle. Some of the vital features which need to be taken into consideration for risk assessment are skin and elimination functions (Kranke et al., 2015). Therefore, apart from the additional risk assessment procedures a number of patient education procedures and strategies could be undertaken over here.
The active areas where sufficient patient education could be provided are with regards to pain management, care of surgical site, diet, physician follow up. Hence, after getting released from the hospital the patient Mr. Panang may suffer from a huge number of clinical complications. Some of these are with regards to management of the post-surgery pain and dressing of the site of wound. Some of the factors which could facilitate the fast recovery within the patients are effective control and management of diet along with undergoing sufficient physical activities (Crisp et al., 2016). As mentioned by Kang et al. (2018), pain has often been referred to as a situation of extreme discomfort within the body of the patient. The pain could be effectively managed within the patient through cognitive behavioural therapy, which modifies the attitude of an individual to pain (Forbes & Watt, 2015). The patient should be educated to choose high protein food which helps in the process of healing. A diet plan rich in chicken, beef, cheese and tofu could be suggested to the patient over here.
In this respect, an ISBAR framework could be used by the registered nurse for the handover process. Here, ISBAR refers to identification, situation, background, assessment and recommendation. These parameters could be used over here for a comprehensive review of the condition of the patient.
Identity- the patient Mr. Panang had suffered fracture in the neck along with laceration in the front tempral region
Situation – the patient had been unconscious for an indeterminate amount of time and could not recollect where and how did he fall
Background- the patient slipped in his bathroom which led to this situation; the patient had a past open-heart surgery
Pharmacodynamics and Pharmacokinetics of Medicines
Assessment- the patient has suffered a head laceration along with fracture of femur which is the immediate cause of pain and unconsciousness.
Recommendation- active stabilisation of the fracture along with removing the blood clot in the head
References
Bee, P., Price, O., Baker, J., & Lovell, K. (2015). Systematic synthesis of barriers and facilitators to service user-led care planning. The British Journal of Psychiatry, 207(2), 104-114.
Bookey?Bassett, S., Markle?Reid, M., Mckey, C. A., & Akhtar?Danesh, N. (2017). Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. Journal of advanced nursing, 73(1), 71-84.
Chen, Y., Zhu, L. L., & Zhou, Q. (2014). Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Therapeutics and clinical risk management, 10, 437.
Chung, F., Memtsoudis, S. G., Ramachandran, S. K., Nagappa, M., Opperer, M., Cozowicz, C., … & Fleetham, J. (2016). Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesthesia and analgesia, 123(2), 452.
Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (2016). Potter & Perry’s Fundamentals of Nursing-Australian Version-eBook. Elsevier Health Sciences.
Forbes, H., & Watt, E. (2015). Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences.
Halaszynski, T. M. (2018). Preoperative Assessment and Evaluation for Maxillofacial Surgery. In Perioperative Assessment of the Maxillofacial Surgery Patient (pp. 13-30). Springer, Cham.
Halaszynski, T. M. (2018). Preoperative Assessment. Perioperative Assessment of the Maxillofacial Surgery Patient: Problem-based Patient Management, 13.
Kang, E., Gillespie, B. M., Tobiano, G., & Chaboyer, W. (2018). Discharge education delivered to general surgical patients in their management of recovery post discharge–a systematic mixed studies review: Authors. International journal of nursing studies.
Kobalava, Z., Kotovskaya, Y., Averkov, O., Pavlikova, E., Moiseev, V., Albrecht, D., … & Langenickel, T. H. (2016). Pharmacodynamic and Pharmacokinetic Profiles of Sacubitril/Valsartan (LCZ 696) in Patients with Heart Failure and Reduced Ejection Fraction. Cardiovascular therapeutics, 34(4), 191-198.
Kranke, P., Jokinen, J., Pace, N. L., Schnabel, A., Hollmann, M. W., Hahnenkamp, K., … & Weibel, S. (2015). Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery.
Kutzleb, J., Rigolosi, R., Fruhschien, A., Reilly, M., Shaftic, A. M., Duran, D., & Flynn, D. (2015). Nurse practitioner care model: meeting the health care challenges with a collaborative team. Nursing Economics, 33(6), 297.
van Noort, H. H., Ettema, R., Vermeulen, H., Huisman de Waal, G., & Basic Care Revisited Group (BCR). (2018). Outpatient preoperative oral nutritional support for undernourished surgical patients: a systematic review. Journal of Clinical Nursing, 115-225.
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