Scenario Based Nursing Care Plan For Anastomotic Leakage, Stress And Ineffective Breathing Pattern

Problem Statement 1: Anastomotic Leakage

Discuss about the Scenario Based Nursing Care Plan for Anastomotic Leakage.

Anastomotic leakage is not only one of the commonest postoperative problems after colostomy but also among the most serious problems. In most cases, this problem occurs 3 to 5 days postoperatively (Floodeen, 2016). Anastomotic leakage has a high prevalence and contribution to mortality. For example, anastomotic leakage accounts for about 2.9% to an alarming 15.3% of severe problems that are particular to intestinal surgery(Floodeen, 201). As far as mortality is concerned, anastomotic leakage accounts for at least one third of all mortalities associated with colorectal surgery.

Mr. Peter Jones is in the third day of postoperative care. I have chosen anastomotic leakage as a postoperative problem likely to affect Mr. Peter Jones as high priority for a number of reasons. Firstly, it is because Jones is of male gender. Based on univariate analysis, the male gender is one of the major risk factors for anastomotic leakage (OR=3.5). As such, Mr. Peter Jones stands a higher chance of having this postoperative problem. Secondly, Mr. Jones has previous history of colostomy which is a risk factor for anastomotic leakage. Finally, Mr. Peter Jones has been previously diagnosed with cancer. Cancer is a significant risk factor for anastomotic leakage.

More often than not, stress that comes immediately after a surgical operation has been known to affect a couple of patient (Abd-Elfattah, 2014).  Basically, this kind of stress is linked to a range of physical factors that include, but are not limited to discomfort, the body’s reaction to specific painkillers and antibiotics (Jestin, Påhlman, & Gunnarsson, 2008). Also, stress after surgery can occur as a result of psychological factors including facing death possibility (I. Syed, 2016) . From the emotional point of view, post-operative stress can occur as a result of the patient’s disappointment in the likely results of the surgery and also due to  his/her resulting feeling of fear and vulnerability. The signs and symptoms of post-operative are mainly manifested in reduced appetite, fatigue, mood swings, despair and hopelessness.

I have chosen stress as the problem to likely affect Mr. Peter Jones on high priority for various reasons. Firstly, stress after operation affects scores of people, yet it goes unrecognized in most incidences. Stern opines that, of all the primary care physicians fail to recognize at least 50% of depression/stress cases in patient (“Feeling Co-Operative,” n.d). This is worrying since stress after operations affect lots of people. For example, as of 2007, 3 out of 100 Americans were diagnosed with stress after operation as compared to 1997 where only 2 people out of 100 people were affected.  Secondly, Mr. Jones stands high chances of being affected by stress owing to his medical history. Mr. Peter Jones has a history of cancer; a disorder that is associated with stress resulting from the possibility of death.

Just 48 hours after surgery, a patient may experience shallow, rapid breathing (Engoren & Blum, 2013) . In most cases, this occurs in incidences in which the lung experiences either systemic or direct insult. Though it is a rare condition, the complication requires care that is intensive in nature coupled with mechanical ventilation that has positive end pressure (Engoren & Blum, 2013).

I have chosen this problem as high problem for Mr. Peter Jones since he has predisposing risk factors to the complication. Firstly, he has undergone laparoscopy and colostomy. These surgical procedures are likely to have caused obstruction of the airways. Incisions in the right upper quadrant of the abdomen, a procedure associated with colostomy, is also linked to infective breathing patterns.

Nursing Diagnosis (From NADA-1)	Nursing Goal	Nursing Intervention	Rationale Evaluation/Expected    Outcome
1.      Colorectal anastomotic	Prevent Hypotension and cardiac dysrhythmias	Administer medication Emergence Cart Assessment of Cardiovascular Status Monitor Patient’s Activity	Various medications should be administered to prevent hypotension. Among the critical medications include diuretics, agents to cause vasodilatation and negative ionotropic agents (Rickert, Willeke, Kienle, & Post, 2009). However, care should be taken when administering these medications such that a physician should be consulted should the systolic blood pressure be less than 100mm Hg. Also, medications like opoiod analgesics should be administered in a cautious manner. Also, give medications like sympathomimetics The emergency cart should be available for the purpose of cardiopulmonary resuscitation (Fulde, Preisz, & Berry, 2009). Frequent cardiovascular assessment is critical to detect the symptoms and signs inadequate tissue perfusion (Shandilya 2013). These include cyanosis, cool skin, breath shortness, agitation, restlessness, decreased blood pressure, diminished peripheral pulses as well as the output level of urine The client should have reduced activity in the cases where the severity and tolerance of dysrhythmia
2.      Fear and Anxiety	Reduce fear and anxiety	Encouraging patient to use positive talks Music therapy (Provision of music for him to listen to) Administer Animal Assisted Therapy	By using positive talks like anxiety does not kill, the patient changes his feelings and behaviors. Essentially, this is a cognitive behavioral therapy technique whose aim is to positively change the patient feeling by simply altering his or her thoughts (Kropf & Cummings, 2017).  It helps replace a client’s negative feeling with positive feelings hence reducing anxiety. According to the recent research, when music is administered together with preoperative instructions, the rate of the reduction of anxiety and fear in the patients increases  (Dileo, Bradt, & Murphy, 2008). This is because, when patients are allowed to listen to their favorite music, the rate at which their heart beats greatly reduce or become lower. To a great extent, when a person interacts with animals, the level of cholesterol and blood pressure reduces (Fine, 2010). When these reduce, anxiety also reduces.
3.      Ineffective Breathing Pattern	Improvement in breathing pattern	Exercise Use of a  fan in the room Suction Secretions Medications for oxygen and respiration	Exercise programs are essential as they work by promoting the conditioning of the muscles of the body that are concerned about respiratory (TILLER, CAMPBELL, & ROMER, 2017). The fan helps to enhance air circulation. Basically, when the air is moving, the feeling of being hungry for air will decrease. This will help remove any blockages in the airway The most essential medications are the beta-adrenergic agonist whose work is to relax the airway’s smooth muscles, hence enhancing vasodilation that in turn opens up the airway (Johnson, n.d).

References

Abd-Elfattah, A. (2014). Stress, Cardiovascular Diseases and Surgery-Induced Angiogenesis. Current Angiogenesis, 3(1), 19-38. doi:10.2174/221155280301140929103647

Dileo, C., Bradt, J., & Murphy, K. (2008). Music for preoperative anxiety. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd006908

Engoren, M., & Blum, J. M. (2013). A comparison of the rapid shallow breathing index and complexity measures during spontaneous breathing trials after cardiac surgery. Journal of Critical Care, 28(1), 69-76. doi:10.1016/j.jcrc.2012.09.002

Feeling Co-Operative. (n.d.). Emotional Survival: An Emotional Literacy Course for High School Students Emotional survival: An emotional literacy course for high school students, 97-104. doi:10.4135/9781446212868.n16

Fine, A. H. (2010). Incorporating animal-assisted therapy into psychotherapy. Handbook on Animal-Assisted Therapy, 169-191. doi:10.1016/b978-0-12-381453-1.10010-8

Floodeen, H. (2016). Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness. O?rebro: O?rebro university.

Fulde, G. W., Preisz, P., & Berry, M. (2009). Cardiopulmonary resuscitation. Emergency Medicine, 1-11. doi:10.1016/b978-0-7295-3876-3.10001-2

Jestin, P., Påhlman, L., & Gunnarsson, U. (2008). Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Disease, 10(7), 715-721. doi:10.1111/j.1463-1318.2007.01466.x

Johnson, M. (n.d.). β2-Adrenergic Receptors: Effects on Airway Smooth Muscle. Airway Smooth Muscle in Asthma and COPD, 255-275. doi:10.1002/9780470754221.ch13

Kropf, N. P., & Cummings, S. M. (2017). Cognitive Behavioral Therapy. Oxford Scholarship Online. doi:10.1093/acprof:oso/9780190214623.003.0003

Rickert, A., Willeke, F., Kienle, P., & Post, S. (2009). Management and outcome of anastomotic leakage after colonic surgery. Colorectal Disease, 12(10Online), e216-e223.  doi:10.1111/j.1463-1318.2009.02152.x

Shandilya, S. (2013). Machine Learning and Non-Linear Dynamics to the Rescue: Assessment and Prediction of Cardiovascular Status for Decision-Support during Cardiac Arrest. Saarbru?cken: Scholars’ Press.

TILLER, N. B., CAMPBELL, I. G., & ROMER, L. M. (2017). Influence of Upper-Body Exercise on the Fatigability of Human Respiratory Muscles. Medicine & Science in Sports & Exercise, 49(7), 1461-1472. doi:10.1249/mss.0000000000001251