Nuances of Postoperative Care - Essay Example

Postoperative Care Postoperative Care Postoperative care is a process that starts right in the recovery room and consequently continuing throughout the period of recovery. Critical control within this process involves pain management, chest drain management or control, wound healing as well as the airway clearance commonly referred to as respiration. Other controls are also necessary for specific conditions for clients with special conditions. Monitoring of other aspects among them glucose proves essential until a patient manages to eat (Conseiller, 1992, pg. 57). Postoperative care, therefore, starts immediately after a surgical procedure takes effect. Type of care given to different patients varies with the surgery option that an individual undergoes. The process is, therefore, continuous after surgery throughout the time a patient stays in hospital. The patient is made aware of any potential side effects as well as complications that may arise during postoperative care. Regarding the type of surgery a patient undergoes, respective potential complications occur during the postoperative care period (Beaman, 2011, pg. 24). During the hospital stay, the care continues after the surgery in the patients room. Mostly a patient stays with an IV on the arm. An IV is a device put on the finger that measures oxygen levels in the patients’ blood as well surgical site dressing. Breathing apparatus and other instruments are useful in ensuring continuous monitoring of the patients signs of progress. The paper examines Mrs Violet scenario and the process of postoperative care that she will undergo after going through surgery. The patient has lung cancer with a tumour located in the right lobe; therefore, a right middle lobectomy takes place during the surgery with follow-up chemotherapy procedures to follow later. The patient is aged sixty years with an extended family close to her that remains concerned about her diagnosis as well as the prognosis of her future. A critical evaluation relating to decision-making process as well as the care planning process for Mrs Violet occurs through focusing on three main aspects namely: respiration, pain management, as well as chest drain monitoring. The first focus refers to Respiration care needs that Mrs Violet will need to undergo. A lobectomy procedure occurs in the surgical ward so as to remove one lobe of the lungs. Mrs Violet is suffering from lung cancer; therefore, removal of the portion is essential. After removal of one lobe, the remaining healthy tissue is expected to maintain adequate lung functioning. The process occurs through surgical incision of the chest. After the procedure, Mrs Violet observation takes place in the room. After the surgery, her history on respirations indicates 18bpm. Respiration observations are below normal and require improvement so as to enhance good recovery. Oxygen saturations amount to 24% through a venture mask 92%. Inserting a chest tube near the surgical incision will enhance in draining the oxygen saturations. 24% of oxygen saturation in the chest will cause discomfort for Mrs Violet, it leads to inadequate functioning of the remaining healthy lung tissue resulting breathing discomfort. It proves important to approach Mrs Violet as well as her close family members since they are concerned about her diagnosis ad prognosis. Explaining the procedure to the patient will ensure that she gets prepared psychologically together with her family members (Thorek, 2008, pg. 42). The aspect of preparing her psychologically provides she goes through the process with ease. It proves essential because the chest tubes are painful when the patient moves, breathe deeply or even cough. The explanation will enhance in ensuring Mrs Violet remains stable as she undergoes the process. The chest tubes removal will occur after forty-eight hours period is over. Paracetamol 650mg administered 4 hourly IV, Droperidol 1.25mg administered 6 hourly IV, as well as inhalers administered 12 hourly through an inhaler, will prove essential in ensuring Mrs Violet breathing problems that she encounters during postoperative respiration care. Since the medications will enhance in improving the breathing process, her recovery will improve during the course of forty-eight hours. The medication will also play a significant role in relieving lung pain encountered during respiration (Falter, 2012, pg. 23). Measuring of oxygen levels in her blood will be enhanced by putting an IV on the patients arm. Teaching Mrs Violet deep breathing exercises, as well as coughing techniques, will prove essential in enhancing the re-expansion of the lung (Beaman, 2011, pg. 116). The exercises and coughing techniques will also improve in preventing postoperative pneumonia that result from breathing complications. Patient’s movement will be tolerated while she is still in bed as well as getting out of bed if her strength improves. Putting into consideration that the patient suffers from Chronic Obstructive Pulmonary Disease (COPD) will also play a significant role in respiratory management of Mrs Violet. Violet COPD has been moderate for the past ten years although managed through medication. Taking her history relating to chest infections will also enhance in giving her particular attention. It is indicative that her chest complications occur during the winter. It is thus an indication that cold environmental conditions cause these difficulties. Maintaining the warmth in her room will enhance in avoiding chest complications. The problems resulting from COPD amount to airflow obstruction, continuous infections as well as mucus hyper secretion (Eliopoulos, 2010, pg. 213). Diagnosis process to curb COPD will be achieved through administering of Beclametasonediproprionate 400mcg 12 hourly through a nebulizer as opposed to an earlier approach of using an inhaler. The second aspect of prioritised care need relates to pain management during postoperative care. In order to understand pain management, a focus on the whole lobectomy process will prove essential as it serves as a guidance to pain origin. Performing a lobectomy occurs through a process referred to as thoracotomy (Tarhan, 2009, pg. 184). It relates to a process whose aim is to access the chest cavity with an aim of doing an operation that is mainly complex. The process involves an incision mostly four to six inches long under the armpit or in some cases behind the scapula. The incision enhances in creating an opening that enhances the surgeon to get access to the inside chest as well as creating space for using special instruments for removing the lobe from the lungs. The process takes a complex structure as the surgeon does not only create an incision, but also removes some nodes stemming from other areas of the inner chest in order to stage the lung cancer. Knowing the stage of lung cancer plays a significant role in determining chemotherapy, as well as radiotherapy for the future (Vance and Corrigan, 2011, pg. 223). The process is thus complicated and can only happen under anaesthesia. Although anaesthesia is used during the surgery process to eliminate severe pain that may cause death under normal operation in its absence, pain is evident after the process. In Mrs Violet case, pain does not only result from the surgery itself, but also from the chest tubes inserted to help in draining the chest. Pain and discomfort will, therefore, affect Mrs Violet during the recovery period. Pain control is, therefore, essential in ensuring that she wakes up and even walks a few times in a day. Where ineffective pain control measures plays in, the patient fails to recover after the surgery (Rosdahl and Kowalski, 2012, pg. 79). In pain management, the nurse has a role of engaging Mrs Violet letting her communicate whenever pain occurs during postoperative care. Whenever Mrs Violet complains of pain, administering painkillers on her will enhance in reducing the pain. However, since pain is inevitable after an operation, inducing Paracetamol 650mg 4 hourly as the doctor prescribed will enhance in relieving the pain. Consequently, Paracetamol 1g 4-6 hourly through oral means will improve in relieving her pain. Monitoring the level of intravenous pain relieve given after the surgery before she gets into her room will also improve in pain relieving. In her room connecting the intravenous pain relief with an electronic pump, will assist in giving her a continuous dose of painkiller. Controlling level of pain killers a patient also takes remains essential to avoid overuse of pain killers (Gallagher, 2001, pg. 314). Mrs. Violet has a patient-controlled analgesia (PCA) that will require pressing whenever she feels sore. Taking her through the process will ensure that she controls her pain condition whenever left on her own. The IV infusion in her possession comprises of Hartmanns 1 litre solution while the PCA comprises of Bolus dose: 10mcg lockout 6 minutes and 10mcg Fentanyl per ml in 120ml Normal Saline. The PCA and IV infusion consists of high-level pain killers that relieve pain instantly. Taking Mrs Violet through the process of administering the painkillers will ensure her stains pain-free in the absence of a medical officer. The PCA will not cause overdose, therefore, advising her to press the button once the pain exceeds will aid in pain reduction. Another pain management aspect employed to help Mrs Violet reduce pain during postoperative care period will be to encourage her to remain comfortable as she can at her room. Staying in a comfortable manner will ensure that she breathes in the right way in return reducing chest infections that may develop (Dudrick, 1996, pg. 65). The last aspect under consideration refers to Chest Drain Monitoring and Care. Chest drain is a method that is used by inserting a thin plastic tube into the pleural space. The plastic tube is used as a suction device that is used to remove excess fluid or air from the lungs especially after the lobectomy procedure. The fluid drained from the lungs can be blood pus or a pleural effusion. The process allows for the re-expansion of the underlying lung while also preventing any entry of air drained air or fluid back into the chest (Beaman, 2011, pg. 176). It is, therefore, essential for a chest drain to have an unobstructed chest drain, a collecting container that is placed on the chest level and a one-way mechanism such as a water seal. The chest drainage is essential for the lung cancer post-surgery patients that might need the procedure due to the accumulation of air or Blood in the thoracic cavity. In the case Violet is a cancer patient that has recently had a lobectomy performed and therefore needs time to recover. She has a chest drain that is on-going, and there is blood in the collection bottle for Violet meaning that the blood had accumulated in the chest cavity of Violet. After the lobectomy procedure doctors recommend that a patient undergo a long-term fluid drainage through placing a catheter under the chest skin. The catheter acts as a drainage path where the excess air and fluid are collected from the lungs (Hsu, 2013, pg. 92). The process is important in ensuring that repeated drains to remove the accumulation of the air and fluids in the lungs. Due to the technical and delicate nature of the procedure it is important for the nurses to take good care and monitor the patient regularly to ensure that they are well catered. The PICU and NNU patients should be in continuous monitoring before and after the procedures. The nurse should observe for signs of infection and the inflammation of the patient and document the findings for future reference on the same. There is also need to check the dressing where the nurse should ensure that it is clean and intact to ensure that the patient does not suffer from the effects of having the dressing unclean and give rise to other complications. There is also a need to observe the sutures ensure that they remain intact and secure. Since the long-term drains after the surgical procedures take time, the sutures may erode over time and, as a result, there is need to ensure that they are adequately monitored to ensure that they are intact and secure (Quigley, 2003, pg. 341). Chest tube assessment and system tubing that should occur at the while starting the shift and every hour throughout the shift to ensure that the chest tube is in place. One of the most important aspects that a nurse should remember is that they should never lift the drain above the chest level. It could have catastrophic effects on the health of the patient since instead of removing the air and liquid from the lungs it increases the amount making it impossible for the patient to breath (Sun, 2007, pg. 258). The nurse needs to ensure that the connections between the chest tubes and drainage units are tight and secure for the procedure. The nurse is also required to monitor the catheter on the patients skin to ensure that the patient does not pull the drain thereby ensuring that the catheter is correctly anchored. There is also need to monitor the volume of water for the procedure that should be maintained at 2cm at all times. Drainage is a procedure that can only be recommended by the doctors, and the nurse should ensure that they keep an hourly record of the amount of fluid in the chamber. The nurse in the process of recording the volumes calculate and documents total hourly output for multiple drains and also calculate the cumulative total output for the procedure (Taylor and McGehee, 2004, pg. 253). It is important in assessing the quantities and comparing with other previous volumes previously recorded and to monitor increase in amount of drainage the nurse should report to the relevant medical staff. If a nurse notices that there is bubbling, it indicates air leak that can only be assessed to evaluate the severity of the situation. It is important, therefore, for the nurse to check the chamber and if they notice any notable changes notify the relevant medical staff to repeat the procedure either or look for an alternative way to tackle the problem. In the drainage of the lungs for patients that have undergone a surgical procedure to the lung t is important to ensure proper monitoring and care of the different dynamics of the process thereby ensuring patients health. In conclusion, postoperative care is a long process that requires keen observations to ensure a patient recovers smoothly from surgery. The process requires providing extra care needs to the patient. Before postoperative care process begins, a nurse or a medical officer needs to equip themselves with the patient’s history so as to ensure that the right diagnosis is given (Vance and Corrigan, 2011, pg. 39). Comparing the recorded history of a patient on admission and after the surgery proves essential to understanding any developments the patient gains. Deviations of medical history of the patient from time of admission and after surgery also help in determining any adverse effects that may become detrimental to the patient’s health. The three primary postoperative cares needs include respiration, chest drain monitoring as well as pain management. Effective monitoring and control of these processes ensures that the patient recovers with less or no complications at all (Wilmore, 1999, pg. 289). A nurse or a medical officer performing postoperative care needs to understand the patient so as to enhance cooperation from the patient. Relieving tension from close relatives of the patient will also enhance in providing joy for the patient and in return leading to an efficient recovery process. 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Care of the surgical patient: A publication of the Committee on Pre and Postoperative Care. New York: Scientific American. Read More