Discuss about the Post Operative Care in Nursing.
It is very important for the health care professionals to be careful regarding the different postoperative care complications that the patient can acquire and how it can be managed properly to ensure that the patient is in optimal safe and comfortable stay while in the postoperative unit and there are no risks to the patient. For this assignment, the case study of a patient aged 48 years is chosen who had undergone a splenectomy surgery. For this assignment two different postoperative complications are taken into consideration in order to understand the pathophysiology of how these post operative complications occur and how best to prevent them from threatening the health and wellbeing of the patient. For this study, the first chosen complication is blood clotting in the vein that supplies blood to the liver of the patient (Coldwell, Hollingsworth & Wilson, 2011). Now it has to be mentioned that this is the portal vein, which supplies oxygenated blood to the liver. Following a splenectomy, that portal vein can be obstructed very easily and can lead to many secondary exacerbic complications threatening the recovery timeline of the patient and in certain cases even can lead to fatal consequences facilitating tissue necrosis in the liver (Subramanian, Raina & Gupta, 2016). The second exacerbation chosen for the study is injury to pancreas, which is also a very common post- operative complication after a splenectomy surgery. This assignment will attempt to discover the underlying pathophysiology of the complications, their correlation and the plausible management for the complications.
Splenectomy is a surgery that involves partial or complete removal of the spleen, a fist sized organ situated under the left side of the rib cage around the stomach. It has to be mentioned that spleen is a very important element of the immune system of the human body and hence removal of this particular organ can lead to various complications and exacerbations in the patients. On a more elaborative note, the main two functions performed by the spleen include containing the white blood cells that acts like the first line of defence in the body in order to fight the most common infections in the body by targeting and destroying foreign particles. Along with that, the other functions performed by the spleen include removing or filtering the old red blood cells from the circulatory system (Jiang, Luo, Sun & Gao, 2017). In this case, Francine, the patient in the case study had been through an accident that caused her severe abdominal injuries, especially to her spleen and hence the surgical intervention was administered to save her life. However, it has to be mentioned that the patient had been a chain smoker and smoked 20 cigarettes a day for past 35 years of her life and hence the chances of her acquiring a few postoperative complications are extremely high. The first post operative complication that she can develop is the damage to the hepatic portal vein of the patient after the surgical removal of the spleen (Davidson, Yaghoobi, Davidson & Gurusamy, 2017).
According to the Dong, Xu, Wang and Petrov (2013), the hepatic portal vein can be defined as the vessel that helps in circulating the blood from the spleen and gastrointestinal tract to the liver. The size of this particular vein is usually 3 to 4 inches in length, it is generally formed by the superimposition of the superior mesenteric and splenic veins behind the upper edge of the head of the pancreas. It has to be mentioned in this context that the hepatic portal vein is responsible for supplying almost 75 % of the blood flow to the liver, however it is not a true vein. Researchers are of the opinion that the portal vein thrombosis has become recognized as the one of the key postoperative complications associated with abdominal surgeries, especially the splenectomy surgeries. On a more elaborative note, it has to be mentioned that this particular postoperative complication is associated with a wide array of severity and can even threaten the life of the patient. According to the article by Gurusamy, Pallari, Hawkins, Pereira and Davidson (2016), the occurrence of hepatic portal vein thrombosis is a very common phenomenon resulting from an abdominal surgery, in case of splenectomy, the incidence rate of hepatic portal vein thrombosis is 10 to 15% in the adult patients. Exploring the underlying pathophysiology of the disease, it has to be mentioned that this particular postoperative complication is facilitated by the surgical trauma in the abdomen. It has to be mentioned in this context that, in the preliminary 48 hours after the surgery the chances of surgical site being inflamed is extremely high. The inflammation of the surgical site often exerts a crucial pressure on the surrounding organs and venous system around the area. Now, the hepatic portal is already a narrow structure and the excessive pressure on the vein causes it be constructed and hence blockage is facilitated in the hepatic portal vein. This blockage disrupts the blood flow to the liver, as the hepatic portal supplies nutrient rich blood to the liver, blockage of the hepatic portal leads to tissue starvation in the liver and paves way for more compliactioons in the patients (Peng et al., 2015 pan).
Considering the management of hepatic portal thrombosis, the preliminary intervention for the hepatic portal thrombosis is targeted at dissolving the blood clot that has formed in the hepatic portal. In this case, the nursing professional will have to assess the patient diligently for signs of hepatic portal vein bleeding and tissue necrosis. In case the patient is exhibiting the signs and symptoms of the same, administration of clot dissolving factors is the most important intervention technique (Cheng et al., 2015). The patient would need to be given tissue plasminogen activator is generally provided in order to facilitate thrombolysis that will dissolve the blood clot. In case the patient does not respond to the above mentioned intervention, more severe anticoagulants will be administered to the patient such as the heparin along with the plasminogen activator so that the clot can no increase in size. Along with that, in case portal hypertension facilitated by the blood clot causes varicose vein bleeding in the esophagus, administration of antihypertensive drugs such as the beta blockers and nitrates can also be administrated to reduce the portal vein pressure which in turn will reduce the bleeding in the esophagus (Petermann et al., 2012).
It has to be mentioned in this context, that another post- operative complication that can occur to the patient includes the injury to the pancreas. On a more elaborative note, pancreatic injury can be defined as any trauma sustained by the pancreas due to any blunt forces wor by anu abdominal surgeries. As per the evidence, the rate of the patient acquiring pancreatic trauma following a splenectomy surgery is 3 to 5 %. The injury to the pancreas following a spleen removal surgery generally leads to high serum amylase levels, which is generally clinically unrecognized (Ahmed Ali et al., 2012 pan). However, in certain cases, depending on the health status of the patient and the severity of the surgical procedure, the injury to pancreas can even lead to clinical pancreatitis and pancreatic fistula. Both of the conditions are known to exert a huge burden on the condition of the patient who is recovering from the splenectomy and accident trauma. Exploring more on the pathophysiology of how the post operative disorder develops, it has to be mentioned that, immediately after the splenectomy the enhanced hepatic portal hypertension often causes the vein to bleed in the surrounding areas. As a result fluid back up is created in the left subphrenic space immediately after the splenectomy leading to pancreatic fistula. However, Cheng et al. (2017), have contradicted that the pancreatic injury takes at least 24 to 48 hours to develop completely to become clinically recognizable. Moreover , due to this particular complication facilitated in the patient that vascular supply to the pancreatic tail is cut off, which has been reported as the clinical indication of the pancreatic injury in the patient. However, on the contrary, the Ahmed Ali et al. (212), have stated in the article that the most abundantly reported clinical indication of pancreatic injury, which facilitates easy clinical recognition, is by the formation of a well capsulated pancreatic pseudocyst. As mentioned by the Dong, Xu, Wang & Petrov (2013), in their article the failure of the nursing management to diagnose this condition properly leads to subphrenic abscess leading to protracted post- operative clinical course. Lack of careful manipulation of the pancreatic tail while performing the surgery has also been recognized as a significant cause to pancreatic injury in the patients.
The most important diagnostic intervention to check the presence of pancreatic injury is to perform Serum amylase or lipase determination on the second day of the surgery. Researchers are of the opinion that the signs and symptoms of pancreatic injury take at least 24 to 48 hours to manifest completely. As mentioned by the Qu, Ren, Li, Qian and Liu (2013), the chances of a patient with abdominal post surgery hemorrhage to acquire pancreatic injury is as high as 30%. Hence, with the possibility of the hemorrhage being high in the patient under the case study as well, the chances of the patient attaining pancreatic injury is also significantly high.
Considering the nursing management of the pancreatic injury, it is generally associated with acute pain in the patients. Hence, the nursing professional will have to focus on both nom pharmacological and pharmacological pain management. Hence, the nursing professional will have to administer mild analgesic to patient after successful assessment of the pain score using any recognized pain assessment tool. Along with that, the nurse will have to asminister nonpharmacological pain management such as relaxation and change of posture will alse be able to help the patient (Kehoe et al., 2009). The nursing professional will also have to encourage the patient to maintain the fluid volume in order to prevent renal failure in the patient due blood loss and low albumin levels. Along with that nurse will have to consider mild respiratory management in the patient to facilitate better breathing that can be obstructed by high risk to elevation of diaphragm, pulmonary infiltrates and even effusion. Lastly, the nurse will have to manage the biliary drainage by the placement and better management of biliary drains and indwelling tubes or stents that are placed in the pancreatic duct will also facilitate better drainage of the pancreas (Krauth, Lechner, Neugebauer & Pabinger, 2008)
Conclusion:
Post operative care can be defined as the extensive range of the care pattern followed for a patient after the patent had gone through a surgery. It has to be mentioned in this context that the impact of the surgery can have a huge burden on the patents in the initial period after the surgery. On a more elaborative note, the extent and nature of the post operative care depends on the particular type of the surgery that the patient has gone through, the type of the surgery that the patient has gone through decides the kind of pain management, wound management, injection control and other post operative care requirements that the patent will require. It has to be mentioned that within the 48 to 72 hours after the surgery, the patents is said to be under the most of the danger or threat to different post operative complications, which can even lead to fatal consequences for the patient if it is not adequately managed. Hence, it is crucial for the postoperative care team to understand the exact condition that the patient is under to be able to protect the patient from any possible postoperative complications. This essay has given key insights regarding two postoperative complications that can occur in case of the splenectomy along with key nursing managements
References:
Coldwell, C., Hollingsworth, A., & Wilson, C. H. (2011). Spleen conserving surgery versus splenectomy for injured patients with splenic trauma. The Cochrane Library. Doi: 10.1002/14651858.CD009042/full
Jiang, T. T., Luo, X. P., Sun, J. M., & Gao, J. (2017). Clinical outcomes of transcatheter selective superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis. World journal of gastroenterology, 23(41), 7470. doi: 10.3748/wjg.v23.i41.7470
Davidson, T. B. U., Yaghoobi, M., Davidson, B. R., & Gurusamy, K. S. (2017). Amylase in drain fluid for the diagnosis of pancreatic leak in post?pancreatic resection. The Cochrane Library. Doi: 10.1002/14651858.CD012009.pub2/full
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