Cultivating the sensitivity of health care to Patients’ requirements and demands is quite challenging in healthcare situation like in Melody’s case. Therefore, the expectations and experiences of the patient in health care are progressively explored using the survey among patients, focus group meetings, interviews and the outcomes of which are applied to motivate change in care delivery. Nurses are liable to provide the patients with high-quality care. For instance, Ms. Melody is suffering from Peritonitis which requires keen attention of the nurse. If the nurse does not give keen attention to her, the conditions may worsen. They are faced with some ethical tasks in their professional practice, so they need to be acquainted with ethical codes of conduct and the basics of ethical decision making. The nurses’ ethical, legal, profession code of conduct as it pertains to their work, nursing problems, as well as relevant and realistic goals and set objectives towards patients’ care, will be evaluated, analyzed and discussed in the easy. The clear overview and description in this easy is demonstrated based on the clinical reasoning cycle.
According to Melody’s emergency situation, it is quite important to quantitatively measure, evaluate and elaborate via physical and some chemical examination the main cause of the pain. The information recorded was blood pressure, respiratory rate, temperature pulse rate information, skin color, moisture, white blood cells count and also the investigation of the status of the peritoneal membrane (Yu, Hamill, Liley & Hill, 2013).
Ms. Melody’s presented complains after she was admitted to the emergency department; severe abdominal pain in the right lower quadrant, which called for laparoscopic surgery to remove the appendix. Her current complains about the prescribed medication that included Seretide, sertraline, and Ventolin. She also reported centralized abdominal pain that read 7- 8 from the medical scale of 0- 10. Ms. Melody’s history of medication were asthma and depression complications. After the physical assessment, it was observed that she had a swollen abdomen and general abdominal guarding. Other observations from her body changes included; HR 120, 38.3 degrees Celsius, SpO2 95% at the room air, BP 95/45mmHg and shallow RR22/min. It was realized that she had increased white blood cells count from further treatment examination (Binda et al., 2012). All the information was recorded and used to investigate the type of treatment that was required after the laparoscopic surgery.
After the proper interpretation and analysis of the current patient’s symptoms, complaint’s information, the assessment observations and according to her history, the pathologist deduced that Ms. Melody suffered from Peritonitis due to the ruptured appendix. Peritonitis is a chronic or acute swelling of the peritoneum membrane which covers the abdominal cavity and other splanchnic (Dahabreh, Steele, Shah & Trikalinos, 2015). The disease is known to decrease the intestinal mortality and result to distention of intestine with gas. When the intestinal mortality reaches 10% can result in death due to bowel obstruction. Nursing care necessary for a peritonitis patient is frequent monitoring and measures to avoid the spread of the disease or further complications. The six nursing care plans for peritonitis that a registered nurse has to prioritize on includes; handling the acute pain, fear and anxiety, risk of infection, dangers of the unbalanced diet, adequate fluid volume and sufficient knowledge. Some of the infection risks include immunosuppression, insufficient primary defense, and invasive procedures. According to the history of diagnosis of peritonitis the patient’s signs and symptoms in rare cases are unpredictable and the most appropriate recommended way of preventing the disease is through nursing interventions (Bansal et al., 2014).
The experimentation and examination of the obtained specimen from the wound culture, serial blood and urine to monitor the cause of the infection were carried out. The experiment was to determine and identify the causative agent of the disease and help in assessing the effectiveness of the antimicrobial regimen. Registered nursing handling the peritonitis patient has to maintain a sterile technic when providing catheter care and always ensure cleaning of perineal on a daily basis to prevent bacterial growth in the urinary path (Warady et al., 2012). A nurse has to control visitors including the staff and family members in an appropriate way to reduce the exposure risk or secondary infection to the immunocompromised patient. The microbial agent identified to be the cause of the problem are clindamycin, amikacin, and gentamicin through peritoneal membrane.
The therapy through the data and information collected showed that the gram-negative bacteria called bacilli which is aerobic was necessary for the disease. The lavage process is useful in removing the necrotic debris and to treat the inflammation of poorly diffused peritoneal membrane (Gill, Switzer, Driedger, Shi, Vizhul, Sharma & Karmali, 2012). Some of the cause of pain to the patient is due to the postoperative laparotomy surgery. The patient requires proper nursing interventions because of the hyperglycemia condition that may result from the lack of knowledge on the disease and poor diet.
The first nursing goals is to reduce the level of pain for the patient. Ms. Melody king has lower abdominal pain which requires attention of the nurse to relieve the pain and the nurse can do this by administering antibiotics intravenously, but they can also be infused straight into the peritoneum and it could be much helpful. Secondly, the nurse needs to restore fluid and electrolyte balance for the patient. The nurse closely monitors and administers fluids to ensure that they are as desired. Thirdly the nursing goal for a peritonitis patient is to prevent complications that may occur as a result of the infection and finally, the nurse is required to restore normal gastrointestinal (GI) functions for the patient to ensure that it was operating as it should. Some of the nursing issues that arose during nursing management to the patient included how to balance between the electrolyte and the fluid. Assessment in response to the gastrointestinal functioning and controlling the increased pain in the patient were other major issues. Another prominent issue was the risk for shock and secondary infections in relation to hypovolemia or septicemia. Controlling the visitors’ movement to the patient was not an easy exercise to a nurse as the family members were a bit radical to convince about the situation. (Schultz et al., 2015).
Nursing interventions centered on the following measures. Pain management where administration of antibiotics, analgesics and body positioning can help to reduce pain. The nurse is supposed to ensure the patient maintains a strict aseptic method in caring for abdominal drains. Cleanse with the appropriate solution. Monitor urine output and fluid the patient is taking. Accurate recording of all intake and output could help in the assessment of fluid replacement (Worni et al., 2012). This will ensure that the fluid balance in the body is maintained at the desired levels. The nurse administers and carefully monitors fluids. Drainage monitoring, the nurse should monitor and record the character of the drainage postoperatively. The nurse should perform and show the patient proper hand washing technique to minimize the risk of cross-contamination and the spread of infection. Monitoring the patient’s blood pressure levels. The blood pressure for the patient is to be monitored by arterial line if the shock is present to avoid any further complication and any other complication as indicated in her diagnosis history should be thoroughly checked (Johnston, Arora, King, Bouras, Almoudaris, Davis & Darzi, 2015).
By considering the individual common risk factors such as peritoneal dialysis, acute appendicitis, and abdominal trauma can help to increase the effectiveness of the treatment for the patient. Application of quality and efficient nursing ethics and experience in sterilizing the process of the patient medication is the best choice in such an emergency situation. Regular monitoring and taking measures on the vital changes in the signs and symptoms of the patient are very influential (Wigg, McCormick, Wundke & Woodman, 2013). Noting and recording the hypotension progression, fever, tachycardia, tachypnea and decreased pulse pressure are essential signs of imminent septic shock. To improve the insufficient volume of the body fluid intervention on the endotoxins circulation that produces vasodilation which promotes low output state by ensuring the airways are operational (Ignatavicius, & Workman, 2015).
It is crucial to note the changes in the patient’s mental status like stupor, discombobulation and cognitive sense. Hypotension, acidosis, and hypoxemia are the significant changes to check on for they are responsible for impairing psychological condition. Monitoring the urine output can assist in oliguria prevention that results from decreased perfusion in the renal, toxins circulation and as the consequences of antibiotics (Nygren, Thacker, Carli, Fearon, Norderval, Lobo & Ramirez, 2013).
Conclusion
The easy elaborate how to apply quality and efficient nursing care goals both at prior and postoperative interventions in the emergency department of laparoscopic surgery during the treatment a peritonitis infection. The easy illustrate the procedural involved in the technique to handle the pharmacology, culture, physiology, pathology and ethical measures of a registered nurse in the surgical department. The paper shows the establishment of goals, logical sequence, legal-ethical, evidence-based and quality person-centered care approach.
Reference
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