Surgical Management For Medical And Nursing Practices: A Case Study

Surgical Management: Medical and Nursing Practices

Background of the Condition

Discuss about the Surgical Management for Medical and Nursing Practices.

Surgical management is a very crucial part in medical and nursing practices. The patients undergoing surgery needs additional care, attention and education, which are delivered by the nurse assigned to the patient (Edis, Grant & Egdahl, 2012). In accidental cases, usually, the patient undergoes massive pain and other complications. In this situation, nurses have to handle the critical situation tactfully. They have to use their critical thinking and problem solving skills to deal with those situations. Assessment is very important in these cases, as the chance of infection and other related complications are very common in the surgical cases. In this assignment, the surgical management of a 24 year old male patient, Mark Mason would be discussed, who has undergone a motorbike accident and his left leg has been injured. Thus, he immediately needs surgical management. In addition, pain management is also very important in this case. The nursing staffs are responsible for monitoring and completing the pre and postoperative assessment of the patient to evaluate the vital signs of the patients, based on which the interventions are planned. Here, in this assignment, after discussing the background and the patient’s current condition, the management of the patient’s situation and the potential complications would be discussed.

The assignment is focused on the 24 years old male, Mark Mason, who had undergone a motorbike accident, while riding in the bush. When he was taken to the hospital, he revealed pain in his lower left leg, which was rated 9/10 with deformity, significant swelling and a 5cm lacerated wound. Upon an x-ray, the result revealed an open fracture of the left tibia and fibula. Thus, the orthopedic team has decided to undergo a surgery for the open reduction and internal fixation (ORIF) of the fracture. The repair process would include the insertion of a metal rod and screws for fixing the fractured bone (Fishman, 2012). When his pre-operative assessment was done, it was seen that his left leg is in a split cast. His vital signs during the pre-operative assessment shown 36.4ºC body temperature, 80 bpm heart rate, 18 per minute respiratory rate, oxygen saturation at room temperature at room temperature was 95%, BP was 136/72, which can be considered as approximately normal blood pressure. However, the pain score was 10/10 in his left leg. Therefore, before the surgery, he was experiencing the worst pain, that can be experienced by a person. Therefore, pain management is very important in Mark’s intervention plan.

Management

Mark has undergone a massive injury in his left leg, thus he has been brought to an emergency department and his case has been classified as a surgical emergency. The medical team has  decided to undergo an open fracture surgery for Mark’s recovery. In this context, it has been revealed that pre-operative management is very important for Mark, as he is in an emergency and having severe pain (Clarke et al., 2012). Therefore, the nurse has to prioritize his physical needs initially. For this, the nurse has to go through his medical history and assess his current condition.

The initial management priority for this patient would be the overall assessment of the patient. Initially, the nurse would have to prioritize the nursing goals. The initial goal will be the establishment of therapeutic relationship with the patient. For this, the nurse has to communicate with the patient properly. As the patient is suffering from an emergency condition, his self-esteem would be very low, which needs to be enhanced. Through the effective communication, the nurse can enhance patient’s self-confidence and hope for faster recovery. After the establishment of the therapeutic relationship, investigation of the medical history would be the initial priority (Townsend et al., 2012). Mark would be asked about his drug allergies, regular medication (if any) and other medical history. Then his vital signs would be assessed again including his BP, BGL, RR, oxygen saturation at room temperature, HR. Then, the nurse would assess the condition of the injured area. The rationale behind the initial assessment is the reduction of misinterpretation during the decision-making about his nursing interventions and surgical procedures. Physical examination would include examination of the wound, as it has shown that his left leg is in a split cast (Mast, Jakob & Ganz, 2012). The examination revealed inflammation of the injury and deformity. Another vital investigation would be the level of consciousness of the patient and the amount of blood loss due to the injury. These assessments are prioritized, as the unconsciousness and massive blood loss, if left untreated, may lead to fatal consequences. Finally, the nurse has to ensure that Mark’s stomach is empty.

Mark has experienced an injury in his left leg upon experiencing a motorbike accident. His left leg was diagnosed with an open fracture of tibia and fibula bone. As a result of this deep injury, he was experiencing massive pain in his left leg. Thus, assessment of pain is one of the major priorities for Mark. Pain management is one of the key aspects of surgical management. When Mark was brought to the emergency department of the hospital, his pain score was 9 out of 10. Therefore, it can be said he was facing massive but tolerable pain in his leg. As his pain was severe, pain management is very important for Mark (Miller, Margules & Raikin, 2012). During the assessment, a pain scale was used and it was revealed that his pain was 10 out of 10, that means, his pain has been increased and now he is feeling the most severe pain, which one can suffer from. Therefore, immediately the patient needs to be relaxed through pain management. As the patient is not allowed to eat or drink anything before surgery, thus intravenous medication for managing his pain can be administered to Mark. In addition, other procedures for managing his pain can be applied (Carlino, Bartolo & Jennings, 2012), which includes the relaxation techniques. Pain alleviating medications are usually not applied before surgery. However, as Mark is experiencing the most severe and intolerable pain; instead of oral pain medication, mild pain alleviating medication, that do not contain aspirin or NSAIDS can be administered intravenously.

Physical Examination and Assessment

Mark has an open fracture in his left leg and the injured area has been swollen along with a 5 cm lacerated wound. As the injury is open to air, the chance of infection is very high. Infection in the injured area can lead to tissue necrosis and deterioration of Mark’s health status. Thus, management of the wound is very important during the pre-operative state (Choi et al., 2012). The nurse has to examine his wound very carefully and should wash the blood properly. The nurse should ensure that the operation table and instruments are sterile enough to reduce the transmission of infection during operation.

Finally, the patient’s consent should be taken for the operation, which is a very essential ethical concern for the medical professional.

Patient education is an effective approach for enhancing patient satisfaction. Initially, the patient is educated about his situation and then the pros and cons of the surgical process would be discussed. Patient education is very important nowadays, as greater awareness enhances the chance of patient’s recovery. When a patient is aware of the positive side of the surgical process, self-confidence would be enhanced, which will positively contribute to his recovery. On the other hand, the awareness about the negative sides and risk factor would eliminate the chance of misinterpretation and false hope of the patient (Dunn, Ganapathy & Chan, 2012). Here, Mark will be educated about his injury, about the problem he is having and the chance of his recovery. The entire surgical procedure will also be discussed with him, but the procedure will be brief, as he is suffering from massive pain and relaxation is the best way of relief. After explaining the surgical procedure, he will be explained about the precautions needed after surgery and then his informed consent would be collected. The side effects of the medication would also be discussed with him.

In the management of Mark, there would other members, who will play significant roles in the surgical management of Mark. These members would include the other members of orthopedic team. They are the orthopedic physician of Mark, the surgeon, the physiotherapist, the anesthesiologist, circulating and scrub nurse and the hospital staff.

The positive contribution of each member in the interdisciplinary team additively enhances the success of the surgical management. In case of Mark, the surgeon would lead the interdisciplinary team. The scrub nurse would assist the surgeon in the operation theater, while handling the correct instruments. On the other hand, the registered nurse would be responsible for setting up the operation theater for Mark (Elgazzar, 2012). Preparing Mark for operation and communication about all of his personal and medical needs would be addressed by the registered nurse. The anesthesiologist is responsible for administering the appropriate anesthesia before surgery and monitoring the vital signs of the patient after the procedure. It is important for surgery. The physiotherapist would also be involved in the team, who will educate Mark about his exercise plan after the surgery, which would promote his recovery. A dietician and some other hospital staffs would also be involved. The dietician would ensure the proper diet for Mark after surgery, for reducing the chance of sepsis.

Pain Management

There are several potential complications related to Mark’s open fracture surgery. The acute complications related to the bone fracture are usually occurring as a result of the initial trauma and include neurovascular and soft tissue damage, localized contamination, blood loss and infection. Systematic complications include fat embolism, shock and thromboembolism. The local complications include vascular injury, haemarthrosis, fracture blisters, tissue damage and wound infection (Miller, Margules & Raikin, 2012). The most common complication is the chance of infection at the area of injury. As Mark has a 5 cm Lacerated wound, it shows high chance of infection, if left untreated. Therefore, the professionals have to take good care of Mark’s wound to ensure the absence of infection and sepsis. Sometimes, problems with bone healing, such as non-union, delayed union and malunion are also seen. Physicians have to ensure the elimination of all the risk factors and the factors predisposing infection and other complications.

Conclusion

In conclusion, it can be said that the bone fracture can lead to severe complications, if not handled properly. Each members of the interdisciplinary team has made significant contributions in the surgical management of a patient. In this assignment, the focus was the young male Mark, who underwent a bike accident followed by a massive injury in his left leg. Through proper assessment and management of the prioritized needs of the patient, successful outcomes can be achieved in his case. The assignment has also included potential complications, which can be raised after surgery. Thus, enough precautions should be undertaken by the patient, patient’s family and the assigned physician.

Reference List

Carlino, W., Bartolo, C., & Jennings, G. (2012). Experiences of lower limb open fracture management at the Royal United hospital, Bath. International Journal Of Surgery, 10(8), S86. https://dx.doi.org/10.1016/j.ijsu.2012.06.457

Choi, K., Yang, J., Chung, H., & Cho, B. (2012). Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction. Arch Plast Surg, 39(4), 301. https://dx.doi.org/10.5999/aps.2012.39.4.301

Clarke, H., Bonin, R. P., Orser, B. A., Englesakis, M., Wijeysundera, D. N., & Katz, J. (2012). The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesthesia & Analgesia, 115(2), 428-442.

Dunn, G., Ganapathy, S., & Chan, V. (2012). Surgical palliative care and pain management. Philadelphia: Saunders.

Edis, A. J., Grant, C. S., & Egdahl, R. H. (2012). Manual of endocrine surgery. Springer Science & Business Media.

Elgazzar, R. (2012). Open Versus Closed Treatment of Mandibular Condyle Fracture. Dentistry, 02(07). https://dx.doi.org/10.4172/2161-1122.1000e110

Fishman, S. M. (2012). Bonica’s management of pain. Lippincott Williams & Wilkins.

Mast, J., Jakob, R., & Ganz, R. (2012). Planning and reduction technique in fracture surgery. Springer Science & Business Media.

Miller, A. G., Margules, A., & Raikin, S. M. (2012). Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg Am, 94(22), 2047-2052.

Townsend Jr, C. M., Beauchamp, R. D., Evers, B. M., & Mattox, K. L. (2012). Sabiston textbook of surgery. Elsevier Health Sciences.