Question No. 1:
Use stage one of the clinical reasoning cycle (CRC) ‘Consider the patient situation’ to identify the biopsychosocial, spiritual and cultural impacts of Ted’s surgery for him and his family
The clinical reasoning cycle (CRC) is the process that guides nurses and medical specialists to have information about the patient. It helps in processing the data so that one can identify the problem. The cycle has different stages leading to various useful factors about the patient. It considers the situation and processes the information. In so doing, one may decide actions and evaluate outcomes. The life span of a patient can help understand different factors, including the bio-psychosocial, spiritual, and cultural impacts of the patients. In the given case study, the analysis helps takes account of Edward Ted William. The following factors reflect on his situation:
Biological Aspects:
In the case of Edward Williams, the present and past health history of the patient is worth considering. It also includes that there is colostomy present along with his present health situation after going through laparotomy. These aspects help understand the situation faced by him.
Psychological and Spiritual Aspects:
Understanding psychological aspects are important because they reflect on emotions, cognition, and spiritual beliefs of the patient. It is a point of comfort that he has the company of his partner Gwen, but he is alone in his life. The spiritual aspects flourish when a person enters the old age. So, this factor is satisfactory for Ted.
Socio-cultural Aspects:
Cultural aspects are related to social issues. Ted is receiving care, and the receiver of care feels things differently. He can feel well about his place in society. He is a widower and seems to have a low level of independence and cognition. These aspects make his personality and the way he fights against the situation.
Question No. 2:
The information for stage two of the CRC collect cues and information has been provided for you in the case study. Use this information to provide responses to CRC stages three ‘Process the information’ and stage four ‘Identify Problems.’ Please link to pathophysiology and provide evidence from the literature to support your thinking.
CRC Stage 3: Process the Information
The third state of CRC is about processing the information. This step includes activities of interpretation, discrimination, making relations, inference, matching, and prediction. Ted’s situation in light of CRC has provided plenty of information that has to go through these steps of processing. These steps let analyze data so that signs and symptoms may be understandable. For this purpose, a comparison of normal and abnormal is valuable and is the step worth focusing. Typical signs include colostomy bag that is at its right place, presence of pinkish stoma, and the discharge is of minimal level with clear dressing. Abnormal symptoms include the right side with coarse crackles, nausea, sluggish abdominal sounds, and distended abdomen. There are gaps in collected cues, and the patient has severe psychological health as well.
In the information processing stage, one step is called discrimination. It is useful to process relevant information so that irrelevant information may not waste time and energy. Then, the process calls for relating different aspects and parts of information. It leads to marching the current situation with the prior health status of the patient. It helps to predict after processing the most suitable and relevant information. The relevant information of Ted, according to the case study, is about his vital signs. The above information is worth including in the analysis and processing information. An essential aspect of the information and processing is that it leads to note problems faced by the patient. The steps in this stage are complex, and they must be integrated. Their integration and synthesis lead to find and identify the problem faced by the patient. As a result, prediction becomes possible. The following step is going to look into the future perspective by identifying the problems and issues presented in the case study.
CRC Stage 4: Identify Problems
The fourth stage of CRC goes to identify the problems and issues faced by the patient. The information is that it is in the case study. This stage of CRC includes facts and inferences of points so that patient’s problem can be diagnosed. It requires a comprehensive review of the condition and situation of the patient. In the case study, the patient has a set of relevant information that may help find the real problem. Moreover, it should also relate to pathophysiology so that the actual condition of the patient can be known. The following has the diagnosed problem and pathophysiology of the patient.
The problem diagnosed is the excessive coughing that causes acute pain. Coughing can be bearable to some extent, but it becomes troublesome when it is excessive and consistent. The patient has just experienced surgery and operation that has its implications. Operation or surgery has certain complications that must be solved and addressed. Even excessive coughing can hurt and make the situation extreme for the patient. Another diagnosed problem is the pneumonia relapse and depression because of being alone. These symptoms and problems give rise to different other problems and issues for the patient. The pathophysiology related to the patient identifies more problems and complications.
The pathophysiology includes malignant mass and planning for the temporary colostomy. Many risk factors are affecting the health of the patient. The patient is experiencing pneumonia and gout, along with the past history of heart disease. He has undergone heart failure in the past while he also has diabetes as the disease. The obesity problem is also there that may make the situation intense. It is the reality that obese patients with diabetes can get complications about their health-related to heart. However, some symptoms are functional, like the stoma is pinkish. However, it is necessary to keep monitoring the patient so that operations resulting in complications may not bring the patient to an extreme level (Craft and Gordon, 2019).
Question No. 3:
Using stage five of the CRC Establish goals outline and justify (5) nursing care interventions/strategies the registered nurse would implement to provide care for Ted. Justify your thinking with links to current peer reviewed evidence and literature
The case study also explains the situation faced by the patient, but it can be explained further. For this purpose, stage five can be helpful, that is, to establish goals outline and makes a case for nursing care interventions. Ted should be provided with the required interventions and strategies so that he may not get further problems with his health.
Caring for Colostomy:
It is useful to take care of the skin around the stoma. The skin color and outlook should be similar to the one that is elsewhere on the patient’s abdomen. If it is not identical or does not match, it is an indication of the problem. Therefore, the patient-caregiver should take some proper steps to keep the skin healthy.
Water can help clean the skin around the stoma. Then, the caregiver should not forget to dry the skin even though the change in the color and skin type can be the result of any sensitivity or allergy. Therefore, it is useful to look into this factor. It should be made sure that the skin barrier, adhesives, or other material may not cause allergy to the skin of the patient around the stoma (Bullock and Manias, 2017).
Nursing Interventions:
Research notes that the nursing staff has some serious and fundamental steps to take for the health of the patient. The type of colostomy should be in the knowledge of nurses so that they can know the real location of it. The location helps determine the possibility of further steps for the health of patients. It can predict the fecal drainage to be examined. One of the ways to increase the frequency of inspection is there so that any change or deterioration to health may be examined instantly. It is also important to position the collection bag on the stoma (Martini, Nath and Bartholomew, 2018). The decisions are considered important for the colostomy irrigation and drainable pouch. The use of a caulking agent can be a good solution and a nursing intervention. These agents can be Stomahesive and any kind of paste. Nursing interventions should know that there should be a needle that has a position above the colostomy pouch. It would permit the flatus to move away.
Along with these interventions, nursing or caregiver staff should know the complexities of the patient that are the result of mixed reasons. Surgery and health symptoms need to be examined for the patient so that he cannot deteriorate his existing health. Nursing staff should not be alone in understanding these steps, but the family and the patient should also be aware of some instructions (Farrell, 2017).
Instructions for the Family and the Patient:
The patient must know the situation and the required steps needed for his health. It is also essential to take the family along the process so that the health of the patient can remain on track. For this purpose, written and verbal guidance and psycho-motor guidance on the subject of colostomy care can be useful. More areas of consideration are skincare and irrigation concerning the health of the patient. It must be in knowledge of both parties that proper care is possible when everyone knows the right procedures and actions. Practicing changing the pouch and psycho-motor skills are fundamentally important for the improvement of knowledge and information of the patient and family members. In the case of Ted, his partner should be along this learning process. He has children, and they should also know it (Levett-Jones, 2018).
Useful Foods:
Medicines are not useful alone, but the patient should know suitable and healthy foods. In the case of Ted, he should know foods suitable for thickness and odor of stool. Pasta, Pretzels, Cheese, Yogurt, butter, and rice are ideal for increasing the gas in the intestines. Some foods thicken the stools, and some loosen it. The caregiver, nursing staff, and Ted should know about these properties of different foods.
Question No. 4:
Select two classes of drugs that would be used to manage Ted’s post operative condition. Please provide a rationale for why that drug class would be suitable for Ted. Provide a detailed description of the pharmaco-dynamics of each of the selected class of drug as well as the potential side effects and the nursing implications for administration
Ted is having bowel obstruction after the operation has ended. For the conditions of the patient, two kinds of drugs are helpful for his health. They are Metoclopramide and Erythromycin.
Metoclopramide is considered as D2 antagonist. It acts as the antagonist for the 5HT3 receptors and against the 5HT4 receptors. They help treat a patient with gastroparesis, hiccups, and postoperative ileus. There are some side effects of the drug include Akathasia, galactorrhea, hypertension, disorder, and some other adverse effects. Nursing staff should consider monitoring and examining the vital signs of the patient. Timing for tablets and timely food should be the consideration. Besides, they should monitor the bowel movement as well. As a result, the drug may make Ted healthy and well.
So far as Erythromycin is concerned, it is an antibiotic that is a macrolide. It functions by preventing translocation. The drug is mainly bacteriostatic, but in case of a high dose, it may be bactericidal. It tends to stimulate receptors in the intestinal tract, and it also promotes GI motility. It has side effects, including QT prolongation, diarrhea, hypertrophic pyloric stenosis, and some other signs. However, nursing interventions should work towards making the drug a perfect dose for the patient. Nursing staff should consider the allergy of patients so that it cannot lead to more complications. If the patient has a history of liver impairment and heart disease, care should be taken. It should not be given in pregnancy, and bowel sounds should be tracked on a routine basis.
References
Bullock, S. and Manias, E. (2017) Fundamentals of pharmacology, 8th edition, Pearson Australia.
Craft, J.A. and Gordon, C.J. (2019) Understanding pathophysiology, 3rd edition, Elsevier.
Farrell, M. (2017) Smeltzer & Bare’s Textbooks of Medical-Surgical Nursing, 4th edition, Wolters Kluwer.
Levett-Jones, T. (2018) Clinical Reasoning: Learning to think like a nurse, 2nd edition, Pearson.
Martini, F.H., Nath, J.L. and Bartholomew, E.F. (2018) Fundamentals of anatomy & physiology, 11th edition, Pearson.
