Extensive Care Plan For Th Resident

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Extensive Care Plan For Th Resident

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Question:
Discuss about the Extensive Care Plan For Th Resident.

Answer:

Introduction:
Nursing care plan is a fundamental elements of the nursing care scenario which determines the care actions that are going to be taken for the patient and with respect to the care needs and priorities that have been identified for the patient. Along with that, the care plan will also ensure that each of the care needs are addressed by the care providers and each of the wishes and preferences of the patient had been taken into consideration while designing the care program. Hence, care planning and implementation is one of the fundamental professional responsibilities of a nursing professionals and it is crucial for the nursing students to have a clear idea of care planning procedure, its proper documentation and the implementation procedure as well (Nelson et al., 2016). This essay will attempt to outline an extensive care plan for the chosen resident taking the assistance of the patient assessment carried out of the resident.
Providing a brief information of the resident that had been chosen as the patient under consideration of the care plan, the patient is Brenda Wilson. Brenda is a 54 year old Irish woman who is married and had two adult children. Her cognitive assessment revealed the fact that Brenda had been oriented to time and place, aware of the reason to be admitted to the facility as well. The vital signs of the patient revealed the fact that her pulse rate was slightly slow and her respiratory rate has also been lower than normal with risk of being slightly overweight. Further investigation revealed the fact that the patient had recently been diagnosed with hypertension and had been submitted to the facility to undergo a vaginal hysterectomy.
With respect to the biological theory of aging, it has to be mentioned that age derived deterioration of the biological system of the body is eventual and follows a distinctive pattern (Goldsmith, 2014). Considering the aging of the reproductive system of the human body, the aid of modern non programmed aging theory can be taken. According to this particular theory, the evolutionary value of further life and the reproductive power is effectively reduced to zero beyond the species specific age. Hence, there is a significant deterioration and eventual loss of function of the reproductive organs as well which leads to menopause in women. It has to be mentioned that menopause is a very common phenomenon that women begin to experience over the age of 40 when the ovaries no longer release an egg every month and the menstrual cycle of the woman also stops (Mitnitski, Song & Rockwood, 2013). However, it has to be mentioned that although it is a very common phenomenon, there are various complications that arise after the post-menopausal period. Some of this complications are arise includes abnormal uterine bleeding, cervical fibroids, in situ carcinoma, endometrial hyperplasia, and chronic pelvic pain. Although, all of the mentioned diseases have separate etiologic trajectories, all of the diseases are associated menopause or early onset of menopause (Levine et al., 2016). One of the treatment measures that can be used for the above mentioned complications is vaginal hysterectomy, for which the patent in the case study had been admitted to the facility as well.

Care plan:

Nursing issue

Nursing goal

Interventions

Rationale

Incompetent urinary elimination

The patient will be able to vocalize her concerns and discomfort. The patient will also empty her bladder regularly and completely.

The nursing professional will require to note the voiding patterns of the patient and monitor her urinary output.
Palpating the bladder of the patient and investigating whether the patient had any reports of discomfort, fullness, or feeling unable to void.
Providing routine voiding technique such as privacy, normal position, running water in sink, pouring warm water over perineum. Encouraging as well as providing good perianal cleansing and catheter care to Brenda.
Assessing the urine characteristics of Brenda including colour, clarity and odor.
Decompressing the bladder of the patient slowly and providing the aid of catheter as indicated with the aid of the protocol. Frequent and regular cleansing of the catheters used by the patient as well (Sheth, 2014).

Urinary incompetence is a very likely aftermath of the vaginal hysterectomy surgery due to a possible mechanical trauma. Hence, the monitoring the voiding pattern and the urinary output will indicate the presence of urinary retention in the patient as the patient had been voiding frequently and in insufficient amount (Robert et al., 2015).
According to Vorwergk et al. (2014), the perception of the bladder fullness investigated of the patient will indicate urinary retention as well.
The effective voiding techniques will help in promoting relaxation of the perianal muscles and will also help in facilitating successful voiding efforts. The cleansing action will reduce the risk of associated urinary tract infection as well.
Urinary retention, vaginal drainage, and possible presence of intermittent or indwelling catheter increase risk of infection, especially if patient has perineal sutures.

Bladder atony can also be caused due to edema or interference with the nerve supply leading to urinary retention. Indwelling urethral or suprapubic catheter can help in reducing the complications (Yoong et al., 2014).

Rapid bladder decompression releases pressure on pelvic arteries, can promote venous pooling when a large amount of urine has accumulated.

Acute pain in and around the surgical site.

The patient will be free from the pain that she is feeling.

Carry out a pain assessment and documenting pain score for the patient (Relph et al., 2014).

Checking the surgical site of the patient for the presence of surgical site infection.

Administration of mild analgesics for the patient with respect to the pain score that has been identified for the patient.

Administration of non-pharmacological pain management interventions such as providing comfort measures, encouraging deep breathing, emphasizing ordered fluid intake and establishing rapport and communicational comfort to keep the patient engaged (Nelson et al., 2016).

Assessment and determination of the pain score will help in determination of the exact extent of pain that the patient has been feeling which will guide the need for the analgesic intervention.
According to Forsgren et al. (2012), surgical site infection is one of the most plausible reason behind the acute onset of pain.
Administration of the analgesics will help in reducing the impact of the pain and will help the patient feel better.
The non-pharmacological measures will help the patient in increasing her comfort level and diverting her attention from the pain providing momentary relief.

Ineffective tissue perfusion

The patient will demonstrate adequate tissue perfusion evidences by stable vital signs and will be free from edema.

Monitoring the vital signs of the patient, palpating peripheral pulses, and noting the amount of capillary refill.

Investigating the dressings and perineal pads, noting color, amount, and odor of drainage.

Turning the patient and encouraging frequent coughing along with deep breathing exercise. Avoiding the high fowlers position (Robert et al., 2015).

Administration of IV fluids and blood products as per the indication and assisting the patient in foot and leg exercises.

As per Forsgren et al. (2012), these are the most common indicators of the adequate systemic perfusion and any abnormality observed in the same will directly indicate at presence of inadequate perfusion.
The presence of large blood vessels to operative site and/or potential for alteration of the clotting which heightens the chances of postoperative hemorrhage.
This will help in preventing stasis of secretion and avoiding high fowlers will reduce chances of vascular stasis in turn reducing the chances of thrombus formation.

Replacement of blood losses will maintain circulatory volume and tissue perfusion (Yoong et al., 2014).

Constipation

The patient will display active bowel activity.

Ausculating the bowel sounds, noting abdominal distension, nausea and vomiting.

Encouraging adequate fluid intake, including fruit juices, when oral intake is resumed and providing sitz baths (Forsgren et al., 2012).

These are indicators of presence or resolution of ileus that can affect the choice of interventions.
It will promote softer stools that can aid in peristalsis. Sitz bath will promote muscle relaxation.

Risk of lack of oral hygiene

The patient will continue to have a significant oral hygiene.

Checking if the patent has any dental prosthetics and if present adequate cleaning of the prosthetics.
Encouraging the patient to maintain a proper oral hygiene. Aiding the patient in doing so as well (Forsgren et al., 2012).

It will avoid the chances of the patient suffering from oral infection sad tooth decay.
The patient will be free from any secondary oral infection in the post-operative period.

Risk of deficient knowledge due to dementia

The patient will have sufficient knowledge regarding the operation and the care precautions despite her dementia.

Assessing the neurological and cognitive state of the patient. Assess the patient for the presence of dementia in the patient.

Provide adequate patient education and keep the patient informed of her condition and reason for hospice stay (Relph et al., 2014).

Provide necessary medication and therapeutic assistance to help her deal with any behavioral disorders.

Assessment of her cognitive health will help in understanding her condition and will affect the choice of intervention.
The patient education ill help her remain informed and aware of her state.

The interventions both pharmacological and nonpharmacological will help in managing her behavioral disorders if present (Vorwergk et al., 2014).

Conclusion:
On a concluding note, there are certain significant potential and actual problems that can arise for Brenda after her vaginal hysterectomy. The care plan illustrated above has focused on four actual and two potential problems or care needs that may arise in the post-operative period and has provided adequate treatment measures and interventions that can help in managing or avoiding the occurrence of the issues effectively and helping the patient with as comfortable and fast recovery as possible.

References:
Forsgren, C., Lundholm, C., Johansson, A. L., Cnattingius, S., Zetterström, J., & Altman, D. (2012). Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. International urogynecology journal, 23(1), 43-48.
Forsgren, C., Lundholm, C., Johansson, A. L., Cnattingius, S., Zetterström, J., & Altman, D. (2012). Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery. International urogynecology journal, 23(1), 43-48.
Goldsmith, T. C. (2014). Biological Aging Theory.
Levine, M. E., Lu, A. T., Chen, B. H., Hernandez, D. G., Singleton, A. B., Ferrucci, L., … & Kusters, C. D. (2016). Menopause accelerates biological aging. Proceedings of the National Academy of Sciences, 113(33), 9327-9332.
Lipsky, M. S., & King, M. (2015). Biological theories of aging. Dis Mon, 61(11), 460-466.
Mitnitski, A., Song, X., & Rockwood, K. (2013). Assessing biological aging: the origin of deficit accumulation. Biogerontology, 14(6), 709-717.
Nelson, G., Altman, A. D., Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C., … & Acheson, N. (2016). Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations-Part II. Gynecologic oncology.
Relph, S., Bell, A., Sivashanmugarajan, V., Munro, K., Chigwidden, K., Lloyd, S., … & Yoong, W. (2014). Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post?implementation expenditures. The International journal of health planning and management, 29(4), 399-406.
Robert, M., Cenaiko, D., Sepandj, J., & Iwanicki, S. (2015). Success and complications of salpingectomy at the time of vaginal hysterectomy. Journal of minimally invasive gynecology, 22(5), 864-869.
Sheth, S. S. (Ed.). (2014). Vaginal hysterectomy. JP Medical Ltd.
Vorwergk, J., Radosa, M. P., Nicolaus, K., Baus, N., Cruz, J. J., Rengsberger, M., … & Runnebaum, I. B. (2014). Prophylactic bilateral salpingectomy (PBS) to reduce ovarian cancer risk incorporated in standard premenopausal hysterectomy: complications and re-operation rate. Journal of cancer research and clinical oncology, 140(5), 859-865.
Yoong, W., Sivashanmugarajan, V., Relph, S., Bell, A., Fajemirokun, E., Davies, T., … & Lodhi, W. (2014). Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study. Journal of minimally invasive gynecology, 21(1), 83-89.

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