GL 2007: Nursing and/or Collaborative Interventions Used

Project Case Study
Student Name:
Professor:
Course title:
Date:
1.0 Introduction of the Case Study and its Significance
The case study is about pre-operative care of a patient who is going through bowel resection for colon cancer. The patient is male aged 74, Mr. Arthur Barrett, who has a history of change in bowel habit. He decided to seek medical attention after noticing rectal bleeding. He also reported occasional constipation and diarrhoea as well as changes in bowel habits and. The general practitioner (GP) referred Mr. Barrett for colonoscopy after finding out that this patient was anaemic. Results of the colonoscopy indicated that the patient has left-sided colon cancer and a bowel resection was scheduled afterward.
Mr. Barrett has co-morbidities such as Type 2 diabetes which is diet-controlled and osteoarthritis. He also has chronic obstructive pulmonary disease (COPD) since the past fifteen years. The son of the patient died last year in a farming accident and his wife died 3 years prior due to cancer of the breast. He has one daughter although she resides away from him. He is a grieving elderly man who lacks social support. He has anxiety and possibly depression that is related to loneliness and recent loss of son and wife, his cancer diagnosis, living with a colostomy, as well as capacity to care for himself after discharge. Even so, he is not so much as anxious as he is sad for the loss of wife and son, and daughter who is away.
This case is significant since fighting cancer is generally a very hard experience for any patient to undergo. The case is particularly of note given that it focuses an elderly patient with several co-morbidities that include osteoarthritis, type 2 diabetes, as well as chronic obstructive pulmonary disease (COPD) all of which are not uncommon conditions amongst patients aged 65 years and above. Adding cancer to these already existing conditions is very difficult for Mr. Barrett, and this combination is by and large common. It is quite demanding to provide care to a patient with such intricate health issues as Mr Barrett.
Complex cases can be difficult for new graduate nurses. If a nurse focuses on the reason for the patient’s admission, for instance surgical operation, he or she can easily overlook important factors that will affect the patient’s risk for complications and recovery. Mr Barrett’s case is complicated by his co-morbidities and his psychosocial history. This case allows one to consider the importance of looking past the “reason for admission” and addressing these factors in an effective and appropriate manner.
2.0 Nursing and/or Collaborative Interventions Used
A number of nursing and/or collaborative pre-op interventions were used. The patient met with anaesthetist, surgeon, and stoma therapy nurse pre-operatively to be provided with information with regard to his upcoming surgical operation. The physiotherapist provided the patient with information and exercises related to coughing, breathing and mobilising post-operatively. This was reinforced and the patient was encouraged to practice these every hour.
Enoxaparin sodium was administered to protect him from thromboembolism. Information regarding leg exercises was reinforced. The patient was then educated regarding how to prepare for the colectomy. He was advised to follow a diet that comprises clear liquid. He was informed that beginning from midnight of the day prior to the surgical operation, he should withhold from drinking fluid or eating foods. The patient was given 2 PicoPreps to remove bowel contents in preparing him for the colectomy. In addition, the patient was administered prescribed prophylactic antibiotics for the purpose of protecting him from the risk of infection. Mr. Barrett was also prepared for postoperative outcomes like pain and necessity for pain management, IV lines, drains, and incisions. Lastly, a discussion was made with the patient regarding his pain management post-operatively, including how to operate his PCA.
While some of the aforementioned interventions were effective, others were not. The use of PicoPreps was not effective since this is not suitable to elderly patients aged 65 years and above (Fearon, Jenkins & Carli, 2013). PicoPrep is an excellent bowel cleansing agent. However, it is not appropriate for use with elderly patients by reason of the high prevalence of renal insufficiency among these people as well as their intolerance to drinking a large volume of bowel preparation like PicoPrep (Hart, Hoyt & Diefenbach, 2012).
Even so, the other interventions were largely effective. Meeting with stoma therapy nurse pre-operatively was particularly effective. According to Fearon, Jenkins and Carli (2013), any patient who undergoes surgical operation for colon or rectal cancer, or colorectal cancer, might require a stoma and therefore the surgeon should warn every patient of the relative possibility of this likelihood. The patient has to be seen pre-operatively by the stomal therapy nurse if there is a likelihood of a stoma. This visit has several purposes such as: identification of the stomal therapy nurse’s role; evaluation of cultural, psychological, social and physical factors; commencement of patient teaching; selection of stomal locations; as well as reassurance of the patient (Fearon, Jenkins & Carli, 2013).
Protecting the patient from thromboembolism by administering enoxaparin sodium and administering prescribed prophylactic antibiotics to protect from antibiotic infections was also an effective intervention. Cancer is a major risk factor for the development of thromboembolism (Fearon, Jenkins & Carli, 2013). Prophylactic use of subcutaneous unfractionated heparin has been shown to reduce the risk thromboembolism (Manda et al., 2011). As such, every patient who undergoes surgical operation for colon cancer such as Mr. Barrett has to be administered prophylaxis for thromboembolic disease. Prophylactic administration of antibiotics is effective in reducing morbidity, shortening patient’s stay in hospital, and reducing infection-related costs (Manda et al., 2011).
Alternate interventions
COPD and Respiratory Complications
The main clinical priorities for Mr Barrett are COPD/ respiratory complications and low mood/low motivation/anxiety. Mr. Barrett has COPD which is a major risk factor for intra-operative and post-operative pulmonary complications. COPD is typified by persistent airflow limitation and is linked to increased mortality and morbidity (Kim et al., 2016). It also causes pneumonia, exacerbation, increase length of recovery, increase length of stay, decrease healing, as well as increase wound complication. This is important since it would affect the patient’s comfort post-operatively (Kim et al., 2016).
With regard to the type as well as the degree of surgery, patients who have chronic obstructive pulmonary disease face the risk of worsening pulmonary function that brings about complicated peri-operative course. To decrease peri-operative complications, Mandra et al. (2011) pointed out that pre-operative patient preparation and pre-operative evaluation are crucial. In patients who have COPD, the goals of pre-operative preparation and anaesthesia include maintaining ventilation-perfusion ratio, stopping the development of hypoxemia, pneumothorax, intra-operative brochopasm, as well as disturbances of cardiovascular system (Manda et al., 2011).
Other interventions that can be used to prevent complications associated with COPD are as follows: drug therapy optimization: most patients who have COPD usually benefit from taking at least one dosage of a nebulized bronchodilator prior to their surgery (Licker et al., 2012). Chest physiotherapy is also crucial for COPD patients awaiting surgery. Before the surgical operation, draining mucus helps in removing the excess, which might bring about post-operative plugging and/or pneumonitis (Salpeter, Ormiston & Salpeter, 2010). During patient preparation, it is also important to educate him in lung expansion manoeuvres as this greatly decreases pulmonary complications (Alvisi, Romanello & Badet, 2011). Moreover, re-nutrition and muscular endurance training might improve respiratory muscle strength and facilitate weaning from the ventilator after the surgery (Kim, Lee & Park, 2016).
Prehabilitation is also an appropriate alternate intervention for the patient. It is essential for an elderly patient such as Mr. Barrett before he undergoes the operation. Prehabilitation is mainly utilized in anticipation of a forthcoming stressor like a surgical operation (Hulzebos & Meeteren, 2015). It comprises psychological and physical evaluations that determine a baseline functional level, recognizes any impairment, and offers appropriate targeted preventive interventions which improve the health and...