Nrsg258-The Case Of Cynthia Rose Assessment Answer
Nursing care is associated with a variety of different external and internal factors linked to the disease that the patient is associated with and the particular care needs that the patient is exhibiting. As menti0onesd by the authors, the impact of diseases are different in different patients and it is highly associated with the vulnerability of the patient and how it has manifested in the patient (Matsumoto et al., 2017). On a more elaborative note, it has to be mentioned that the aetiological procedure associated with a disease and its pathophysiology is more or less unique for each patient and as a result it is crucial for the nurses providing care to the patient to understand the exact aetiology, pathophysiology and post-operative deterioration. On a similar note, the impact of surgery, the associated procedures and anaesthesia can have a significant impact on the physiological and metabolic procedures of the patients leading to a varied range of different postoperative deteriorations, which demands adequate interventions (Liu & Petrini, 2015). This essay will attempt to discuss the case of Cynthia Rose, a patient of uterine fibroids, its aetiology, and the post-operative deteriorations after her abdominal hysterectomy surgery that she had underwent concluding with three members of the interdisciplinary health care team to assist in her recovery.
The aetiology of uterine fibroids has not been yet completely understood by the researchers, however most of the studies have suggested that the condition of uterine fibroids tends to grow from the single uterine smooth muscle which is mutated and therefore known as the monoclonal tumours. However this promotion and initiation of the abnormal growth of this myometrial cell that is single is still unknown to the researchers. Specific translocations occur in addition to chromosomal rearrangement in some of the specimens that have been observed suggesting that this mechanism might be responsible for the proliferation and the initiation of the condition of uterine fibroids (Khan, Shehmar & Gupta, 2014). In most of the cases, there is a development of multiple leiomyomas through a de novo mechanism rather than a mechanism of metastasis. Risk factors associated with the aetiology includes that the development of uterine fibroids increases with age and the incidences decline after the occurrence of menopause. Other studies have revealed that factors like obesity and diet also has an effect on the incidences of uterine fibroids. The study also showed that smoking has a reduced risk of fibroids occurrence (Ciavattini et al., 2013).
There has been evidences through various studies which shows that the role of extracellular matrix effects the growth of the beta factors along with the collagen structure in the formation of leiomyoma. This provides evidences that there is an existence of molecular similarity between the keloids and the leiomyoma (Fletcher et al., 2013). In addition, a development model has been developed for creation of the abnormal response based on the repair of tissue in addition to disordered healing and an alteration of the extracellular matrix. From the myometrial layer, the uterine fibroids arises that lies in the uterine corpus. This is also known as the uterine cervix which often occurs singly and also sometimes multiply. Most of the time the fibroids remain in the intramural layer, however it may also protrude in an outward direction to become subserosal in the location. It may also protrude inwardly toward the direction of the endometrial cavity, and come to be known as submucous fibroids. This often causes endometrial lining distortion and in turn obstructs the menstrual flow, causing dysmenorrhea (Bulun, 2013). There have been evidences regarding the association of heavy menses and the occurrence of uterine fibroids. It also includes ulceration over the surface of submucous uterine fibroids in addition to anovulation that is associated with uterine fibroids.
While a patient is recovering from the surgery after a complex surgical procedure, there are various physiologic and metabolic changes in the body in response to the surgical procedure that the patient had underwent. Most of these changes have the potential to affect the hemodynamic stability of the patient and is easily manifested as alterations in the vital signs of the patient (Carten et al., 2015). In this case as well, post the abdominal hysterectomy surgery, there have been many changes in the hemodynamic stability in the patient and it was manifested in the vital signs. First and foremost, the normal respiratory rate of an adult in 12 to 16 per minute, the normal heart rate is 100 beats per minute, the blood pressure is 120/80 mmHg, and normal urine output is 0.5 ml/ hour. However, concerning the vitals of Cynthia, she had been exhibiting signs of anomaly in all of the mentioned vital signs. First and foremost, Cynthia had a respiratory rate of 30 breaths per minute which is almost double of the normal respiratory rate. Now there are various reasons why a patient might experience high respiratory rate due to a series of reasons such as high metabolic activity facilitating recovery, the impact of the anaesthesia and in certain cases, abnormally high respiratory rate is also indicative of as severe condition as sepsis. Although, with high volume of anaesthesia prescribed during or before surgery, the rate of respiration and the tidal volume experiences a considerable change due to the impact of the anaesthesia. The hyperventilation can also indicate that the CO2 is not being adequately removed from the breathing circuit via the CO2 absorber. Although as the patient had extremely high respiratory rate, the chances of a septic shock is high (Thürk et al., 2018).
The heart rate and blood pressure is also altered in the patient which can lead to cardiac emergency as well as sepsis (Novosad, 2016). Although a slight change in the heart rate is normal in major surgeries, a considerably high heart rate is due to either after effect of extreme anaesthesia or can even be the body’s response to an ongoing process of surgical site infection which can easily lead to sepsis. Low blood pressure which can be caused due to undergoing anaesthesia can also enhance cardiac load and increase the heart rate, in certain cases, the placement of the breathing tube can also be a cause of sensitivity reaction elevating heart rate. Although in this case, the after effect of anaesthetic treatment can be the cause to have a significant drop in the blood pressure reducing the oxygen availability of the body, which in turn enhances the heart rate. The high urine output can be due to a bladder injury or misplacement of the urinary catheter which can have led to a bladder injury enhancing urinary load as well (Mahomoodally, Ruhee Holmes, 2016).
Considering the anomalous vital signs cumulatively, it can be considered that the patient is under extreme anaesthetic effect and mild risk to surgical site infection that can lead to septic shock if interventions are not administered immediately. First and foremost, the care priority for the nurse will be to normalize the respiratory rate by providing adequate bronchodilating medication or even external oxygen therapy. Along with that, to increase the blood pressure and reduce the heart rate, which is the next care priority, the patient can be given anti-arrhythmic medication or medicine to enhance the blood pressure. The aid of electrolyte therapy can also be helpful to enhance the blood pressure. As the patient had no pain, the impact of anaesthesia block should be checked by the nurse along with the urinary catheter positioning (Røjskjær et al., 2015). Lastly, the nurse must monitor the vital signs diligently and clean the surgical wound dressing to avoid infection.
The aid of primary health care team is undoubtedly crucial for the patients recovering from a severe illness that required surgical intervention, however while nearing the discharge the aid of interdisciplinary or allied health care professionals are equally important to facilitate the recovery. In this case, Cynthia will first and foremost require the aid of a psychologist, who will provide her the aid of counselling to overcome her depression and trauma which can be exacerbated after the surgery. Additionally, psychotherapeutic interventions will help instil hopefulness and optimism in her which will further facilitate her recovery (Ngu & Chan, 2018).
The second interdisciplinary care member that Cynthia will require the care of includes a Community social support worker. Cynthia is a widow with a minor son living in the rural property with no one to care for her. Post the surgery, Cynthia will have to implement certain restrictions and lifestyle modifications to ensure safety, along with that she will also be vulnerable to fall risk and self-care deficit which will require a 24*7 support to assist her in all of the daily activities,
Lastly, a dietician will also be needed to be involved in the care planning before discharge for Cynthia so that she can understand the important of good and nutrient rich diet and how it can help in accelerating recovery and avoiding infection. Hence, a dietician or a nutritional expert will be able to develop a food chart for her in collaboration with Cynthia to help her maintain a healthy and recovery oriented living (Thürk et al., 2018).
On a concluding note, a surgery is a severe treatment intervention and is opted when other pharmacological treatment methods are not yielding fruitful results. Hence, the impact of a surgery on a critically ill patient is huge requiring intensive and individualized critical care. Post-operative deteriorations are warning signs for immediate adverse events risking the life of the patient, hence it is crucial for the care staff to recognize these deteriorations and act accordingly. This essay successfully recognized the post-operative deteriorations from the abnormal vital signs of the patient with adequate prioritized interventions. Along with that the essay also addressed the need for interdisciplinary care members in overall care planning for the patient before her discharge to further accelerate her recovery.
Bulun, S. E. (2013). Uterine fibroids. New England Journal of Medicine, 369(14), 1344-1355.
Carten, K., Power-MacDonald, S., Ng, J., & Sampson, S. (2015, March). Anesthesia residents using in situ simulation to educate operating room nursing personnel on high risk, low frequency anesthetic events. In Medical Education Scholarship Forum Proceedings (Vol. 2).
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.
Fletcher, N. M., Saed, M. G., Abu-Soud, H. M., Al-Hendy, A., Diamond, M. P., & Saed, G. M. (2013). Uterine fibroids are characterized by an impaired antioxidant cellular system: potential role of hypoxia in the pathophysiology of uterine fibroids. Journal of assisted reproduction and genetics, 30(7), 969-974.
Khan, A. T., Shehmar, M., & Gupta, J. K. (2014). Uterine fibroids: current perspectives. International journal of women's health, 6, 95.
Liu, Y., & Petrini, M. A. (2015). Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery. Complementary Therapies in Medicine, 23(5), 714-718.
Mahomoodally, M. F., Ruhee, C. D., & Holmes, T. F. M. (2016). A qualitative study of healthcare professionals' perceived trust in and willingness to recommend alternative medicines for the management of diabetes mellitus. African Journal of Diabetes Medicine, 24(1).
Matsumoto, H., Hara, Y., Yagi, T., Saito, N., Mashiko, K., Iida, H., ... & Sakamoto, T. (2017). Impact of urgent resuscitative surgery for life-threatening torso trauma. Surgery today, 47(7), 827-835.
Ngu, S. F., & Chan, K. K. (2018). Abdominal Hysterectomy: Preparation. In Hysterectomy (pp. 1041-1047). Springer, Cham.
Novosad, S. A. (2016). Vital signs: epidemiology of sepsis: prevalence of health care factors and opportunities for prevention. MMWR. Morbidity and mortality weekly report, 65.
Røjskjær, J. O., Gade, E., Kiel, L. B., Lind, M. N., Pedersen, L. M., Kristensen, B. B., ... & Foss, N. B. (2015). Analgesic effect of ultrasound?guided transversus abdominis plane block after total abdominal hysterectomy: a randomized, double?blind, placebo?controlled trial. Acta obstetricia et gynecologica Scandinavica, 94(3), 274-278.
Thürk, F., Matta, J., Kartal, F., Zeiner, K., Kampusch, S., Kaniusas, E., ... & Klein, K. U. (2018, June). Real-time assessment of high resolution vital signs recording for calculation of perioperative clinical parameters. In 2018 IEEE International Symposium on Medical Measurements and Applications (MeMeA) (pp. 1-5). IEEE.
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