Need help with post-op care and intervention

[west37]

I have got this case study below

Mrs. Sally Hilton, a 32 year old mother of 3, is admitted to the hospital for an open small bowel resection this afternoon. Mrs. Hilton's first language is English and she is awake and alert but anxious about her surgery. Mrs Hilton has a history of Crohn's disease and presents with acute upper abdominal pain, fatigue, loss of appetite, weight loss and a history of diarrhoea.

Post operative

Mrs Hilton's surgery was performed while she was under general anaesthesia and proceeded as planned. She was admitted to the surgical ward after spending 1 hour in the recovery ward.

You are the nurse caring for Mrs Hilton on the surgical ward. She arrives on to your ward with, a peripheral IV cannula, a nasogastric tube, and she has TED stockings on. Her post operative orders were;

* vital signs as per post operative protocol

* 0.9% sodium chloride at 100 mL/h

* Morphine via patient-controlled analgesia 1 mg at 5 minute intervals for pain

* Clear fluids as tolerated

* Nasogastric tube on free drainage

1, What are the potential post anaesthetic/surgery problems that the nurse might expect Mrs Hilton to encounter?

2, What nursing interventions would be appropriate to prevent these complications from occurring? Please provide a rationale for your interventions.

Now, I ve come up with several aspects for the first question: potential alteration in respiratory function, cardiovascular function, urinary function, gastrointestinal and integument; and body temp, pain, and psychological function. Anyone care to elaborate a bit with reference to the patient's condition? Thanks in advance! :)

[loriangel14, RN]

YOU need to elaborate a little bit more. We aren't going to do your homework for you.Hint: when you are thinking about complications think about the kind of surgery she had and what system it involved. What would be an obvious complication? What bodily function will be affected the most?

For the complications you listed what would be some interventions that would be appropriate? What are you going to do as her nurse to address and prevent these possible complications? When you say "alteration" to these functions what kind of alterations? How do you reduce the likelihood of them happening?

[west37]

advice taken. I have come across tons of resources in this regard, but couldn't manage to link them up in a way. now i ve realized i could categorize them into anesthesia complication and surgical complication in relation to the small bowel resection. I just don't quite get it how Crohn's disease could contribute to the post-op surgical complication of small bowel resection.

[loriangel14, RN]

If you research Crohn's you will see how it affects the bowel and how in turn that will affect this patient postoperatively.Once you learn what Crohn's is you will see why it would affect a person that has had bowel surgery.

But, Crohn's aside, the assignment is asking you what complications could come up post op and what you are going to do about them? You have come up with some possible problems so what are you going to do to manage them? The possible complications for her can be the same as for any patient that has had a similar operation, whether they have Crohn's or not.You don't need to focus solely on the fact that she has Crohn's.

So tell us what you have come up with for the complications you would expect. These are the two basic questions being asked. What are the complications and what are you going to do about it?

[west37]

Thanks for the reply. So far, i ve got complications that might arise from surgical aspect - ileus, anastomosis leakage, enterotomies, electrolyte imbalance due to blood/fluid loss which impairs cardiovascular function (K+ loss i suppose), lowered urine output resulted from stress of surgery, abdominal distention, and again GI issues that leads to ineffective nutrition absorption resulting in slow integumental recovery at incision site and so on. For anesthesia, I ve got nausea and vomit, potential pulmonary aspiration, drowsiness, sore throat, cognitive dysfunction and etc. I ve put down few interventions to tackle the aforesaid complications, just need a little more time to get them organized. i know that's not all of them, but i guess those would suffice?

[loriangel14, RN]

You are over thinking this way too much.Your possible complications don't have to be that complicated.

Inefffective nutrition absorption is rather long term.She's on clear fluids so there isn't much nutrition to be absorbed at this point. What would be an immediate post op GI effect? Fluid imbalance/lowered urine output could be a possibility as well. So what would you do about that? Ileus is a good choice. What interventions have you come up with? The N&V could be a result of what other thing rather than anesthesia?

She's got TEDS on. What else should be looking at?

[Esme12, ASN, BSN, RN]

Go simple.....what would you look for for any post op patient. http://www.siumed.edu/surgery/clerkship/colorectal_pdfs/SB crohns_surgery.pdf

First what is crohns? Crohn's Disease — UVA Health

What is a risk for any open abdominal surgical patient? think pain, infection, obstruction, nausea vomiting, ileushttp://www.ajronline.org/doi/full/10.2214/ajr.185.3.01850671

This patient had an open small bowel resection (SBR)

What is a SBR? Small bowel resection

Small Bowel Resection With End-to-End Anastomosis Using the Gambee Technique

http://uvahealth.com/services/digestive-health/conditions-and-treatments/14864W

What are the complications of the surgery?

Small Bowel Resection - procedure, recovery, blood, tube, removal, pain, complications, time, infection, operation, medication, cells, types, risk, cancer, nausea, rate, Definition

Department of Surgery

look up nursing care of the bowel surgery patient....http://wps.prenhall.com/wps/media/objects/737/755395/bowel_surgery.pdf

Now make a list and we will further discuss what interventions they might need

[Fiona59]

And don't forget the mental health issues. Crohn's patients are different, often very needy and very demanding in their care.

altered body image,

[Heart2015FNP]

Advice, the patient's abdominal cavity is exposed and a portion of the "small" colon is removed during surgery. After the cavity is sutured, think about the complications of the surgical wound and your patient's body in response to the surgery. Good luck!