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NURSING 7145 Introduction To Perioperative Nursing

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NURSING 7145 Introduction To Perioperative Nursing

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NURSING 7145 Introduction To Perioperative Nursing

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Course Code: NURSING7145
University: The University Of Adelaide

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Country: Australia

Question: 
1. Should this man be booked for elective hernia repair at the current time? Justify your answer.  

2. How could he be optimised for elective surgery?
3. One week later, he presents with an acute abdomen and suspected appendicitis. Describe a perioperative plan.

Answer: 
1: The case study represents the case of a 72 year old patient who had been admitted to the facility with the complaints of limited exercise tolerance due to hip pain. The patient had also been complaining of occasional angina which in turn is also associated with the myocardial infarction that the patient suffered 8 months ago. The patient had been admitted in the facility for an elective inguinal hernia repair, which can be considered the wrong decision for the patient. Exploring the existing health adversities for the patient includes obesity with a BMI of 41, diabetes, low haemoglobin, and extremely high blood sugar levels with HbA1C of 95.

From the vitals and the subjective and objective data that has been shared regarding the patient, the patient is suffering from a number of different complications which has the potential to deteriorate the homeostatic stability. As a result, if the patient in case study is proceeded for the surgery without his existing complications such as the high blood sugar, low haemoglobin and cardiac complication will create many complications in the surgery. As mentioned by Kotagal et al. (2015), high blood sugar enhances the risk of blood clots and deep vein thrombosis. On the other hand, the impact of preoperative anaemia can enhance the risk of perioperative blood transfusion, leading to high possibility of morbidity. Hence, the complications of the patient, especially the high blood sugar and low haemoglobin will need to be addressed before proceeding with the surgery (Froessler et al., 2016). Hence, not optimizing the pre-existing complications before commencing with the surgery will lead to bad outcome for his inguinal surgery, and as a result he should not be proceeded for the surgery immediately.
2:  A surgical intervention has an array of significant impacts on the health and wellbeing of the patients. The fear and anxiety of an impending surgery affects the psychological stability of the patient affects the physical health status of the patient as well. Hence, even in case of an elective surgery, adequate preoperative planning and management for the patient is required. First and foremost, a thorough patient education before the surgery will be required for the patient. It has to be mentioned in this context that consent sharing information with the patient is one of the key integral part of the patient centred care in surgical setting (Mier et al., 2018).
As the patient is obese, has high blood sugar levels and low haemoglobin levels, necessary action to stabilize his conditions will also be needed to be taken to ensure minimal risk after the surgery. The patient will need to be continued on blood sugar minimizing medication, in this case the insulin dose should be adjusted to half of what is generally given to him as hyperglycaemia and hypoglycaemia are common post-surgical complications (Mendez et al., 2018). For the low haemoglobin, the patient will need to be given iron supplements, preferably ferrous sulphate 325 mg thrice a day. In case the patient has hypersensitive reaction to it, 325 mg dosage of ferrous gluconate can be given daily (Froessler et al., 2016). Lastly, as a cardiac patient, it is crucial for the health care professionals to discontinue anticoagulant medication before proceeding with the surgery to reduce the chances of internal bleeding. These steps will optimize his conditions before commencement of the surgery and will help him avail optimal outcomes of the surgery when carried out. Along with that, dietary restrictions will need to be followed as general anaesthesia is going to be used for the surgery including fasting before the surgery (Kumar, Salzman & Colburn 2018).
3: Acute abdomen can be defined as the health adversity where the intra- abdominal organs are inflamed due to a possible infection leading to acute pain. In this case, the infection of the patient led to appendicitis which can be aggravated by the infection that the patient acquired after the surgery (Davidson et al., 2017). In this case, the most plausible complaints that the patient might have includes acute pain and the risk of perforated appendix in case the infection in the appendix is not given any immediate medical attention. Hence, first and foremost, the perioperative plan for the patient will focus on pain management and comfort. In this case, the patient can be given both pharmacological and non-pharmacological pain management intervention; patient controlled analgesia can be an option until the patient is readied for an appendectomy (Davidson et al., 2017).
It has to be mentioned that the patient had been suffering from both post-surgical complication and appendicitis, hence the second surgery that is going to be performed will need to be with certain precaution. In this case, laparoscopy can be opted due to his existing surgical wound. However, before proceeding with the surgery stooping the spread of the infection will be imperative (Kaoutzanis et al., 2015). Based on the present conditions, the patient should be given intravenous antibiotics for maximum effect. After 24 hours of intravenous antibiotic and analgesia treatment, the patient should be proceeded for appendectomy.
References: 
Davidson, G. H., Flum, D. R., Talan, D. A., Kessler, L. G., Lavallee, D. C., Bizzell, B. J., … & Wolff, E. M. (2017). Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment. BMJ open, 7(11), e016117.
Froessler, B., Palm, P., Weber, I., Hodyl, N. A., Singh, R., & Murphy, E. M. (2016). The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Annals of surgery, 264(1), 41.
Kaoutzanis, C., Leichtle, S. W., Mouawad, N. J., Welch, K. B., Lampman, R. M., Wahl, W. L., & Cleary, R. K. (2015). Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia, 19(1), 113-123.
Kotagal, M., Symons, R. G., Hirsch, I. B., Umpierrez, G. E., Dellinger, E. P., Farrokhi, E. T., & Flum, D. R. (2015). Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Annals of surgery, 261(1), 97.
Kumar, C., Salzman, B., & Colburn, J. L. (2018). Preoperative Assessment in Older Adults: A Comprehensive Approach. American family physician, 98(4).
Mendez, C. E., Wainaina, N., Walker, R. J., Montagne, W., Livingston, A., Slawski, B., & Egede, L. E. (2018). Preoperative Diabetes Optimization Program. Clinical Diabetes, 36(1), 68-71.
Mier, N., Helm, M., Kastenmeier, A. S., Gould, J. C., & Goldblatt, M. I. (2018). Preoperative pain in patient with an inguinal hernia predicts long-term quality of life. Surgery, 163(3), 578-581.

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