The case study presents a 36-year-old Melody King having peritonitis. Her condition resulted from a ruptured appendix. Peritonitis occurs due to the inflammation of an individual’s peritoneum (Dever, & Sheikh, 2015). The peritoneum is a membrane that covers the inner walls of the abdomen; thereby, protecting its organs from mechanical injury. This essay will use the Clinical Reasoning Cycle to provide legal, ethical, person-centered, and evidence-based care for Ms. Melody. Clinical Reasoning Cycle is a process that nurses and other health specialists can rely on to provide quality care to patients (Levett-Jones, 2013). The cycle has eight steps with the first one requiring caregivers to examine the situation of the patient. The second and third steps involve collecting and processing a patient’s information. The fourth and fifth steps include the identification of issues and establishing treatment goals. The sixth, seventh, and eighth steps involve taking action, evaluating the outcome, and reflection. This paper will discuss all the steps in the cycle.
Ms. Melody King visited the Emergency Department after 2-3 days of severe abdominal pain. The pain originated from the right lower quadrant of her abdomen. Ms. Melody has a medical history of major depressive disorder and asthma. Her current compliant and prescribed medications include Sertraline, Seretide, and Ventolin. Upon observation by the caregivers, the patient had a blood pressure of 95/45mmHg. She also recorded temperatures of 38.3ºC and a heart rate (HR) of 120 beats per minute. The patient also recorded a respiratory rate (RR) 22 beats per minute. Moreover, the patient’s oxygen saturation rate (SpO2) was 95%. Peritonitis made the patient experience a severe centralized abdominal pain (Kim et al., 2017). According to abdominal pain scale, the patient’s pain is ranked 7-8 out of 10. The other symptom of complication recorded by the patient was increasing nausea. Physical examination indicated that the patient had a generalized abdominal guarding and a distended abdomen. Pathological findings suggested that the patient had raised levels of White Blood Cells (WBC) and C – reactive protein (CRP).
The case study indicates that Ms. Melody reported to the Emergency Department to undergo an emergency laparoscopic surgery. The operation intended to remove the ruptured appendix. Apart from removing the ruptured appendix, a surgical remedy should treat the cause of the complication. Surgical treatment should also prevent the spread of the infection to other parts of the body like colon and stomach (Thornellet al., 2016). Caregivers should prescribe antibiotics to curb the spread of peritonitis symptoms in other areas. The duration and the type of antibiotic prescribed should depend on the nature of the condition. The patient records a lower blood pressure than the normal range. Caregivers should prescribe medications to stabilize the blood pressure. The patient should also take antidepressants to manage her major depressive disorder. Her temperatures are also slightly higher than the normal, a condition that requires close monitoring and correction.
The patient records higher than average temperatures due to her condition. The normal temperature of an individual under room temperature is 37ºC. High and rising body temperatures are indications of a medical emergency. Therefore, the emergency should alert the specialists to conduct surgery and remove the ruptured appendix. The average blood pressure should range from 120/80mmHg to 140/90mmHg (Lüscher, 2018). However, the patient records 95/45mmHg which is lower than the normal range. Like high body temperature, low blood pressure is an indication of a medical emergency. The standard heart rate ranges from 60-100 beats/minute while the patient has a high HR of 120 beats/minute (Shaffer, McCraty, & Zerr, 2014). A high heart rate indicates an abnormal cardiovascular function. Therefore, caregivers should find a remedy to return the HR to normal. The average respiratory rate (RR) ranges from 12-20 breaths/minute while the patient has a high record of 22 breaths/minute (Galiè et al., 2015). The patient requires oxygen therapy to stabilize her RR.
The patient has a wide range of complications due to her numerous symptoms like low BP, high RR, HR, and temperature readings. The low blood pressure can interfere with the patient’s recovery post surgery. Caregivers should advise the patient to drink large volumes of water to help in bring her BP to be normal (MacRae, Laing, & Partsch, 2016). A recent study has indicated that wearing compression stocking can assist in raising the blood pressure. The WBC counts should reduce after surgical operations. However, pathological findings indicate that the patient has an elevated number of WBC. Therefore, an elevation in WBC count can be an indication of other medical complications. The patient also experiences severe abdominal pain which is a common symptom of peritonitis. Caregivers should prescribe pain relievers to lower the extent of the pain (Lambert, 2014). The patient has a medical history of depression which can increase the severity of peritonitis symptoms like nausea and pain. Therefore, the patient should use antidepressants to curb the major depressive disorder (Leong, 2014).
The nursing goals intend to restore proper health of the patient after surgery. The first goal is to eliminate depression and asthma within two months. According to recent research, reducing the symptoms of depression lowers the physical manifestations of complications (Correll, Detraux, De Lepeleire, & De Hert, 2015). The second goal is to reduce the abdominal pain as a result of peritonitis infection. Eliminating abdominal pain can take three weeks and will make the patient comfortable. The third goal is to bring the BP, HR, RR, and temperature to the normal ranges. Bringing the mentioned ranges to be normal can take four months. The above goals assist the patient to regain normal health after the operation.
The first goal involves managing depression and asthma. Taking antidepressants assist in managing the major depressive disorder. The second action targets, reducing the severe abdominal pain in the right lower quadrant of the patient’s abdomen. Caregivers should prescribe antibiotics to alleviate the pain. The patient also records low blood pressure. Caregivers should recommend the patient to drink plenty of water to raise her blood pressure. Taking sufficient salt in food can also stabilize her blood pressure (Cogswell, Mugavero, Bowman, & Frieden, 2016). Ms. Melody has also recorded an elevated heart rate (HR) and respiratory rates (RR). The high RR and HR are due to anxiety as a result of Peritonitis infection. Care providers should prescribe antidepressants to lower the levels of stress. The patient also has raised temperature readings due to symptoms like pain and nausea. Managing the symptoms will restore the body temperature to the usual reading. Therefore, caregivers should monitor and control pain and nausea. An elevation in WBC count and CRP is another area that requires immediate medical action. Elevation in white blood cell count can result in gallbladder stones, liver diseases among other complications (Krishnan et al., 2017). The patient should undergo a CT scan to establish the exact cause of raised WBC count. Afterward, the caregiver should suggest an appropriate remedy to lower the number.
Taking antidepressants according to the doctor’s prescription made Ms. Melody to experience a reduction in depression symptoms. Drinking plenty of water also restored the blood pressure of the patient to normal. The patient also started taking meals with sufficient salt, a move that assisted in bringing her BP to be normal. Taking antibiotics helped to reduce the severity of the abdominal pain (Di Saverio et al., 2014). Managing anxiety helped to bring HR and HR back to normal. Additionally, managing peritonitis symptoms like pain and nausea helped to bring temperature readings back to normal.
Laparoscopic surgery is an efficient remedy for peritonitis as it removes the ruptured appendix; thereby, reducing abdominal pain (Angenete et al., 2016). A medical history of depression and asthma facilitate the severity of physical complications. However, antibiotic medication can help to curb the spread of peritonitis to other organs like the stomach and colon. Surgery can lead to the loss of a lot of blood. Therefore, a blood transfusion is necessary after the surgical operation. From the observation, taking plenty water help in raising the BP of an individual. Additionally, taking food with sufficient salt also increases the blood pressure. I also learned about the symptoms of peritonitis. Apart from abdominal pain, other symptoms include nausea, thirst, fatigue, and fever. A ruptured appendix allows bacteria into the peritoneum; hence, causing peritonitis. Therefore, an emergency surgical procedure is necessary to remove a ruptured appendix in case of peritonitis infection.
Conclusion
The case study presents a patient having peritonitis due to a ruptured appendix. The clinical reasoning cycle is essential in providing person-centered, ethical, legal, and evidence-based care to Ms. Melody. The patient has a medical history of asthma and depression. Clinical observation indicates that the patient has low blood pressure, high heart rate, and elevated temperatures. The patient also has an elevated reparatory rate. The goals of treatment should involve eliminating depression and pain. Additionally, appropriate remedies are required to restore the blood pressure to normal. Taking antidepressants help to curb the major depressive disorder. Taking plenty of water helps to raise the blood pressure. Apart from depression, antidepressants also help to lower anxiety. Implementing the above actions help restore the health of the patient. Apart from surgery, antibiotic treatment can help to manage peritonitis. The rupture of the peritoneum allows bacteria to enter the abdomen leading to peritonitis.
References
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