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Complex Nursing Care of Clients: Hysterectomy

Code: HLT51612

Part One

The information sheet must cover the following criteria –

-  Description of the surgery

-  Expectation pre and post operatively

-  Expected outcomes

-  Recovery times

-  Rehabilitation options within South Australia

-  Pain and management of this surgery.  

Part Two

The learner is to create a comprehensive holistic nursing care plan in relation to  the chosen scenario. The care plan must cover the following criteria -

-  Physical (medical, ADL’S ability/inability, interventions),  

-  Emotional (fears, apprehensions),  

-  Intellectual (maintaining interest),  

-  Cultural (including spiritual & religious)  

-  Social (financial, family)

-  Pain management

-  Wound care

-  Catheter/Drain/Colostomy care

Part Three  

Answer the following questions.  

1.  The patient arrives for admission to the ward for surgery what nursing interventions must be carried out?  

2.  What is consent and why is this needed?  

3.  The doctor has requested a pre op ECG.  What is an ECG and why would this be required prior to surgery?  

4.  The patient request to see a priest prior to going to surgery? Do we have to accommodate this due to the time constraints, and why?  

5.  The patient has requested no male nurses to provide care due to cultural reasons.  What is cultural nursing and do we have to comply with this request?

6.  How would you communicate this request to all who would care for this patient?  

7.  How would you set up the room for your patients return post-surgery?  

8.  What equipment would you need to assist you to care for this patient post operatively?

9.  Provide an explanation of an ISOBAR handover and what is the purpose of handover?  

10.  Provide an explanation of what a catheter is and how this is managed?  

11.  Provide and explanation on how to remove the catheter and post IDC removal?

12.  Provide details on how to manage and monitor intravenous therapy.    

13.  Provide an explanation of how to removal an IV cannula once no longer required?

14. Name and describe two pain scales that can be used post-surgery and what the best choice would be for your patient within the scenario.  

15. What methods other than medications could we use to assist in pain management?

16.  Its Day 2 post op and you are assisting your patient to get up and have a shower.  Your patient complains of chest pain, SOB and feeling lightheaded on sitting up.  Explain what would you do and why?  

17.  After the chest pain and incident from the morning has resolved and on follow up assessment in the afternoon you note that your patient is complaining of a sore L) calf.  On further exploration the L) calf is very swollen compared the right, it is hot too touch and sore.  What action would you take?  What could be the cause?  

18.  It’s Day 4 and the client is getting ready for discharge, when does discharge start?

19.  The patient is packing their back and you note they are flushed in the face.  They are clutching at their wound site.  What would you do?  

20.  You take your patients clinical observations and note that the patients PR is 110, Temp 38.9, BP 100/70.  You examine the wound and there is copious yellow ooze from external staples, there are parts where the staples are bursting and the odour is offensive.  What do these results mean?    

21. What nursing interventions will you undertake and why?

22.  A heart rate of 110bpm is referred to as what?  

23.  A temperature of greater than 38 degrees is referred to as what?  

24. When the results from the wound swabs return the infection is identified as MRSA. Define what MRSA is and what actions will you need to implement to manage?

25. What information will you provide to the client to educate them on what has happened and the requirements for management of hospital acquired infections?

26.  The patient develops during the hospital stay a urinary tract infection.  How would this be diagnosed and what clinical manifestations would the patient complain of?  

27. Define what would be found in the urine when doing a urinalysis?  

28.  The patient was due to discharge on DAY 5, but due to post-operative complications the discharge was delayed a further 5 days.  This has now resulted in further social and economic burdens.  What can you do to support this patient with the issues that have arisen? 

29.  The patient is clear for discharge what is required for this?  

30.  Provide a list of services that could provide your patient with community support whilst they are home recuperating.  


Answer

Task 1

A Description of the surgery:

Hysterectomy refers to a surgery or operation that conducts the removal of the uterus of a female body. In scenario one, Mrs. Gay McMann who is fifty six years old, needs to undergo the surgery of total hysterectomy. Organs in the female body such as fallopian tubes, ovaries and cervix are removed in the case of elective surgery of hysterectomy (Yurteri et al. 2015). The hysterectomy surgery is referred to as the most common and usual type of phenomenon relevant in Australia. It causes heavy bleeding and pain. It is used to treat like vaginal bleeding, certain types of cancer.


b.Expectation pre and post operatively:

The preparation of hysterectomy needs to identify the overall health of Mrs. Gay McMann and conduct urine and blood tests. The most important of pre-operative hysterectomy surgery is to conduct pelvic exam (Corona et al. 2015). Preoperative meeting with the associate surgeon and the nurses in relation to the discussion of the procedures following the surgery and which type anesthesia is to be given to the patient post operation are the two major pre-operative measures as instructed by the surgeon.


It is expected that after the surgery Mrs. Gay McMann needs to be taken and cared in the recovery room for few hours. She is expected to give medicines for post operative pain and required relief. For prevention of any infection, care needs to be taken and anti-infective medicines needs to be prescribed. If any bleeding occurs then sanitary pads, cotton pads or cotton cloths needs to be used by the nurse in the management and control of bleeding and any discharge, therefore, Mrs. Gay McMann needs to be kept in the hospital for required care and hospitality for at least five days as post operation, the patients has difficulty in dealing with pain and discharge (Kim et al. 2015)


c.Expected outcomes:

The surgery conducted under proper care is generally at low risk for the patient. The surgery is generally associated with low risks as the surgeon does perform the surgery on a regular basis, because hysterectomy is common in present times resulting in favorable outcomes in Mrs. Gay McMann. As analyzed the patients under the elective surgery of hysterectomy are often healthy that helps in reducing risks and limitations pre and post the operation. However the minor risks associated with the surgery are bleeding, rare injuries to adjacent organs such as intestines and bladder, need to shift from vaginal incision to abdominal incision, the patients face issues of urination and discharge (Siedhoff et al. 2015). The major issues address sterility that is no possibility of giving birth post elective surgery and menopause. As she is overweight therefore she has difficulty in exercises and in managing time with her full time work, she needs to schedule her medications and therapy including exercises timely.


d.Recovery times:

In Mrs. Gay McMann post the operation needs to face several difficulties, and the recovery process needs to be handled carefully as without uterus following the symptoms that result in the bleeding, pelvic and abdominal pain post hysterectomy surgery. It is important for the patient in understanding of the loss and not to grieve post the loss of uterus as that allows no child birth. Mrs. Gay McMann needs to consult therapist if needed for expressing one’s own feeling and pacify her own mental health. The medicines has been recommended in accordance with her breathing issues, obesity and arthritis-mobic 15mg daily,omega 3 fish oils 2 daily,glucosamine 2 daily, panadol prn (Ahmed et al. 2014).


e.Rehabilitation options within South Australia:

Rehabilitation depends on the different types of surgeries conducted in patients. In case of Mrs. Gay McMann the therapist needs to undergo exercises and floor exercises in relation to abdominal and lower part of the body. Normal diet and increase intake of fruits and vegetables are recommended for improvement of health and healing. Rehabilitation includes visits to the therapist post three weeks of the operation and monthly weekly visits for regular exercise program that’s he had earlier avoided due to her weight gain of 40 kgs. She needs to undergo weight loss exercises in maintaining health body post operation.


f.Pain and management of this surgery:

Pain management in hospital:

The pain management system in hospital has provided Mrs. Gay McMann the ON-Q that is a local anesthesia resulting in the numbness of the area post operation. Along with this morphine pump is attached to the IV that helps Mrs. Gay McMann in controlling pain and restrains overdosing of pain medication. Another major pain relief is Toradol that has been reported by many patients as a better alternative to morphine or Demoral (Siedhoff et al. 2015).


Pain management at home:

Post hysterectomy surgery, Mrs. Gay McMann has been sent home after one day with prescribed medication and instructions in maintaining healthy patient’s body. As she is a working woman, working as a full timer in customer service industry,most of the time she has to undergo pain.  It is important to schedule the medicines timely as often patients forget the intake of medications on time that triggers bodily discomfort. In order to relive the pain, the patient can use the antibiotics prescribed in Australia. 


Task 2:

Three actual nursing diagnosis:

Physical: abdominal and vaginal examination needed pre operation, which anesthesia needs to be given under the conditions of patient’s health. Pre operation needs to undergo urine and blood and pelvic examination. Post operative care needs weight loss for Mrs. Gay McMann andprevent pain and infection through the medicines prescribed-mobic 15mg daily, omega 3 fish oils 2 daily,glucosamine 2 daily, panadol prn. The nurse being the crucial agent of acre giving in case of hysterectomy needs to provide annual report of temperature, respiratory rate, and abnormality if any (Wang et al. 2014). The nurse needs to maintain healthy hygiene in and around the patient in restraining infections. The nurse needs to train Mrs. Gay McMann the ways in which she will address her bleeding, urinary symptoms, tiredness, discharge, infections and healing of wound post operation. The nurses need to recommend several forms of exercises that will help maintain healthy body and loss of the ability of not bearing in children in future (Huang et al. 2016)


Emotional:as Mrs. Gay McMann is already overweight, she fears the surgery of hysterectomy. As post hysterectomy the patient tends to gain weight that in case of Mrs. Gay McMann will be more harmful, therefore, she needs to be recommended exercises of weight control. Proper diet needs to be tabled for maintaining healthy diet. The emotional grief of the inability of bearing a child need to be taken care by a therapist; therefore constant counseling is recommended and resulting in grief discharge. 


Intellectual:as Mrs. Gay McMann is a worker at customer service industry, she needs to be headstrong in balancing her domestic interest and work hours. She needs to schedule her interests in accordance to her medication and therapies. 


Cultural:it is culturally important in taking proper health of one’s own health,as culturally in many places, hysterectomy causing inability of child birth leads to cultural disgrace. Therefore, it is important for the psychiatrist, family members, and therapists in providing proper emotional stability.


Social:the diagnosis of hysterectomy leaves one with the feeling of isolation. The patient might feel subjugated and aloof of the social world. She needs to positively approach her social surroundings in maintaining healthy mental structure, needs social therapy and express grief to family members and continue work strongly. 


Management:Mrs. Gay McMann needs to manage and control her bleeding, wound infection and healing, urinary symptoms and continue her medication properly and timely. 


Wound care:Mrs. Gay McMann needs to wash the wound gently with foamless gel using clean water, and should remember not to scrub or rub the areas around. Use of harsh chemicals needs to be prohibited, needs to follow the prescribed ones. After wash the area needs to be dried gently by patting cotton pads and clean cloth that will help soak in the excess water (Lynch and LeFort, 2016).


Catheter/Drain/Colostomy care:

A urinary catheter in case of Mrs. Gay McMann needs a flexible plastic tube that will help in draining the urine from the bladder. It is important in maintain hygiene before and after the process of catheter. The urine needs to be collected in a bag that needs to be set according to the level of the bladder.


b.Three potential nursing diagnosis:

Physical:the potential diagnosis of hysterectomy needs effective pelvic examination, and exploratory surgery process for instance laparoscopy and sample urine in case of excess bleeding and discharge (Gilmour et al. 2016). The nurse needs to plan and accordingly train the patient the ways of dressing that will help her in managing her own issues at home; needs to manage pain and excess bleeding; maintain hygiene by proper cleaning; grief controlling management, balance of work field and domestic needs. 


Emotional:Mrs. Gay McMann needs to control her emotions as she is a service worker and needs to control her fears and apprehensions in regards to her obesity, proper weight loss exercises and yoga and meditation will help her in relieving. 


Intellectual:the patient should not be emotionally drained and control her emotions through her intellectual freedom. Intellectually strong people will be able to handle her grief and emotions carefully. She can undergo intellectual relief by reading good books, journals and magazines. In case, of work field, she needs to engross herself in maintaining her mental health and balance. 


Cultural:culturally the patient is made weak as she needs to face the after operation symptoms. Culturally, she needs to be strong maintaining her social, domestic and individual life.


Social:the nurses need to make the patient socially active, the nurse needs to train the patient in being socially active by not suppressing herself in isolation and taking leaves from office. in order to be socially acceptable she needs to be strong and lead a normal life (Singh et al. 2017).


Management: it is important for her in keeping up with the domestic and work life. The balance life will give her a self satisfaction and not make her grief of such a lossMrs. Gay McMann needs to undergo medical therapy in managing related pelvic, abdominal, and urine issues.


Wound care:proper management of wounds is important both at hospital and home. The wound needs to be washed and cleaned every now and then, in case of excess bleeding, patient needs to consult doctor. It is important in consulting with the doctor for the proper care and treatment and follow the interventions as recommended and trained by the nurses. 


Catheter/Drain/Colostomy care:the potential care will include proper urinary catheter, emptying the urinary bags timely, washing hands before and after catheter, Mrs. Gay McMann needs to take care of her diet as she has diabetic issues.


c.Goals:

The nursing goals include supportingthe patient physically, culturally, socially and emotionally, as the surgery process weakness the female mind and body excessively that ahs impacts for a longer period of time; prevent complications and risks; train the patients in dealing with surgery management post operation that includes process of urination and control of excess bleeding and discharge etc; support effective adaptation to change.


d.Three implementation of a rationale:

It is important in identifying the effective measures in conducting the surgery; necessary consequences; adaptation; benefits along with disadvantages. It helps in building positive attitudes among women. It is important in dealing with the decisions of re-intervention. Rational use of medication and control management needs to be implemented (Marcarelli et al. 2017). The use of robotically assisted hysterectomy in keeping control with disorders in relation to gynecologic issues has compared increase. 


e. Evaluation of each implementation:

The use of robotically assisted in maintaining disorder is helpful for short-term benefits. Hysterectomy is originally active through the use of laparotomy, laparoscopically, or vaginally therefore, robotically assisted hysterectomy is established as an alternative resulting as a minimal approach (Goderstad et al. 2016). With the identification of proper anesthetic in accordance to the overall health condition of the patient helps in preventing excess pain post operation. 


Task 3:

  1. The patient arrives for admission to the ward for surgery what nursing interventions must be carried out?

The patients need to be addressed on the basis of her overall bodily functions. She needs to be given positive vibes and attitudes towards facing such surgical operations with future security. Her mind and body should be relaxed through verbal and motivational acts of nurses. 


  •   What is consent and why is this needed?

Consent refers to the advice and acceptance of a known and reputed doctor who recommends the patients in state of confusion. It is important as it grants advice, permission, and helps in understanding of the surgical scenario and analyzes the pros and cons of such surgery.


  • The doctor has requested a pre op ECG. What is an ECG and why would this be required prior to surgery?

ECG is referred to an electrocardiogram that helps in checking problems within the body by analyzing the activities of the heart. This is an important test required before conducting a surgery that helps the doctor in tracking the activities within heart and the movement of muscles and contraction.


  • The patient request to see a priest prior to going to surgery? Do we have to accommodate this due to the time constraints, and why?

The world has people with diverse religion, culture and beliefs. Mrs. Gay visits the priest before the performance of the surgery as it makes her feel positive of the outcomes. It helps in gaining consent from the priest and blessings in regards to the treatment and procedures undertaken by the doctors and finally the well being of the patient.


  • The patient has requested no male nurses to provide care due to cultural reasons. What is cultural nursing and do we have to comply with this request?

Women need to be respected in relation to their modesty. Therefore, culturally male nurses are not provided to women undergoing the elective surgery of hysterectomy. In addition, culturally women prefer female nurses over male nurses in case of gynecological surgeries and issues. Since, post operation, women needs intense and intimate care which can comfortable be endowed by the female care givers and nurses. Male nurses are restricted as they provide a sense of discomfort for the patient. 


  • How would you communicate this request to all who would care for this patient?

It is important in spreading awareness and discuss among the hospitality team in managing the female nurses in giving proper care and control of illness post operation. 


  • How would you set up the room for your patients return post-surgery?

Post surgery weakness the patient by mind and soul. Therefore, it is suggested that the patient’s recovery room be well decorated, kept neat and clean that will help her feel homely and comfortable and provide her a sense of relief and allow the thoughts of positivity and happiness. In addition, presence of family always is welcomed, as their presence will warm the patient and makes her feel available and joyous. 


8 What equipment would you need to assist you to care for this patient post operatively?

The equipments mostly needed for the nurse in need of the care for Mrs. Gay are thermometer, pulse oximeter, blood pressure machine, dressingkit, crutches, cane and walker.


9 Provide an explanation of an ISOBAR handover and what is the purpose of handover?

           ISOBAR refers toidentify-situation-observations-background-agreedplan-readback. These are the essential components that are evaluated post the surgery of a patient. The purpose of ISOBAR handover helps in improving favorable outcomes; and safety and management of the patient.


  1. Provide an explanation of what a catheter is and how this is managed?

Catheter is referred to a tube that is flexible and has a narrow passage through which the fluid or urine passes through the bladder to the bag in a female body post surgery.


  1. Provide and explanation on how to remove the catheter and post IDC removal?

It is important in removing the urinary catheter in preventing any complications for instance, bleeding and infections. Under the consent of the doctor and trained nurse the patient needs to understand and learn the process of removing the catheter. It is important in cleaning the meatus and remove the gloves carefully and document the details including date and time in relation to the catheter removal. Post IDC removal involves the placing of waterproof sheet between the patient’s legsthat will receive the catheter.Following the attachment of the syringe to the catheter value that will deflate the balloon. It is important in recording the details of urine output and observes any signs of difficulties.


  1. Provide details on how to manage and monitor intravenous therapy.

Intravenous device are referred to as catheters in hospitals for therapeutic purposes. The general procedure for the insertion of the device is to use administer fluids and medications; allow the understanding of the procedure to patient’s family; prevent any traumatic experience while insertion.


  1. Provide an explanation of how to removal an IV cannula once no longer required?

 In the process of the removal of IV removal cannula, it is important to wash the hands and wear non sterile gloves and carefully remove the dressing following the application of cotton or gauge over the site without any application of pressure that might result in bleeding. Finally, carefully the cannula needs to be withdrawn marinating a proper angel.


  1. Name and describe two pain scales that can be used post-surgery and what the best choice would be for your patient within the scenario.

The two pain scales post the surgery of Mrs. Gay are 8 and 10 within the scale of 1-10.


  1. What methods other than medications could we use to assist in pain management?

Pain can be managed in place of medication through interactions, and sleep. The patient needs to be diverted with family interactions and proper sleep for hours. The nurse and care givers can calm her by providing massage to the area s under pain sensitively.


  1. Its Day 2 post op and you are assisting your patient to get up and have a shower. Your patient complains of chest pain, SOB and feeling lightheaded on sitting up. Explain what would you do and why?

She needs to be given rest for some while and allow to have food and fluids that will provide her strength and then slowly take her and make her walk n restraining one from tiredness and chest pain. 


17. Swelling in left calf occurs due to the retention of fluid in the tissues of leg. The cure to such causes are intake of potassium content foods, and exercise for better blood circulation and massaging of the lymph nodes. Leg swelling is caused due to fluid growth that is caused mainly due to the retention of fluids that gets clotted in the part of the leg. Besides, it is important to do proper exercises, have plenty amount of water, limit salt intake consumer enough calcium and carbohydrate. 


  1. It’s Day 4 and the client is getting ready for discharge, when does discharge start?

The discharge starts towards early morning. The packing of the essentials of the patient is done. The initial step of discharge is to clean the patient and give her proper food and it is important in the part of the nurses to explain her medications and the ways she would conduct self care. According to the prescription, the nurse needs to systematically write down the intake of the medicines. 


The patient is packing their back and you note they are flushed in the face. They are clutching at their wound site. What would you do?

It would be better if one would take care of the wound site carefully post discharge. It is important to take appropriate measures in order to heal the wound. It is important to clean the area and use proper dressing. It is important for the patient to understand the demonstration of dressing, laceration, suturing techniques so that during the self care the patient will be able assist herself.

You take your patients clinical observations and note that the patients PR is 110, Temp 38.9, BP 100/70. You examine the wound and there is copious yellow ooze from external staples, there are parts where the staples are bursting and the odour is offensive. What do these results mean?

It means that there has been an occurrence of infection due to swelling that is leading on to yellow ooze and bad odor. The infection needs medication and cleaning therefore, the nurse needs to dress the wound and wash and dress it sensitively. 


  1. What nursing interventions will you undertake and why?

The nurses need to counsel the patients or provide them psychotherapy in support of emotional crisis; the proper management of wounds, infection and discharge needs to be taken care of; proper implementation of catheter and needs to have full knowledge about the prescribed medicines and therapies post the elective surgery of hysterectomy.


  1. A heart rate of 110bpm is referred to as what?

110 bpm heart rate is referred to as above normal heart rate.  As observed, normal heart rate in adult range within that of 60-100 bpm. Therefore, 110 bpmis considered is above  normal that is caused due to major reasons like anemia, hypoglycemic, hypothyroidism , heavy exercises, reparatory issues and respiratory blockage. 


  1. A temperature of greater than 38 degrees is referred to as what?

A temperature of greater than 38 degrees is referred to as pyrexia or febrile response.


  1. When the results from the wound swabs return the infection is identified as MRSA. Define what MRSA is and what actions will you need to implement to manage?

MRSA is referred to as Methicillin-Resistant Staphylococcus Aureus that is the form of bacteria causing infections in a person’s body. It can’t be treated with any sort of antibiotics therefore; it needs to be effectively managed. It shelters in the skin, nose of the person without causing any severe diseases or outcomes but can be managed by keeping oneself clean and hygienic. But in rare cases, if severe infection occur, the individual cab use intravenous antibiotics in order to resist it. 


  1. What information will you provide to the client to educate them on what has happened and the requirements for management of hospital acquired infections?

 It is important in taking appropriate medical care for bloodstream removal, urinary tract infection, surgical site infection and other health care infections. The patients need to be made aware of the management process of infections.Besides, it is important for the organizations to train the staff and the care givers towards maintaining a clean environment and use gloves in treating patients. The patients need to wash their hands and use air masks in order to prevent one-self from the germs and air borne diseases. In addition, personal protective equipments needs to be sued by the care givers that will help them in protecting the service users or the patients and themselves from health hazards and risks. The equipments’ involve gloves, eye protection, clean and hygienic clothing and safety harnesses. 

  1. The patient develops during the hospital stay a urinary tract infection. How would this be diagnosed and what clinical manifestations would the patient complain of?In dwelling catheters needs to be removed in prevention of the infection. Use of empiric antibiotic and antifungal therapy can help in reducing any complication.Besides, it is important to clean one’s urinal tract during the occurrence of any infection. It is essential to drink plenty of water that will help in draining out any internal infection. If there is UTI pain, it can be treated with heat under clinical guidance; to reduce consumption of food that irritates the bladder. People often adhere to the herbal remedies that soothe the pain. 


  1. Define what would be found in the urine when doing a urinalysis?

The urine analysis helps in detecting any common disease occurring in the body of a female. The urine analysis is done both before and after the case of hysterectomy. It helps in analyzing abnormal findings. In case of Mrs. Gay the urine test will help in screening tract infections, disorders in kidney and liver and diabetes.


  1. The patient was due to discharge on DAY 5, but due to post-operative complications the discharge was delayed a further 5 days. This has now resulted in further social and economic burdens. What can you do to support this patient with the issues that have arisen?

It is important for the patient to address the complications and inform the authority of the social and economic burdens. The nurses need to freely talk to the patient regarding the complications and provide her with adequate information. The patient needs to beware of the protection act that will help her state her rights. 


  1. The patient is clear for discharge what is required for this?

In order to discharge the patients, the nurse and the care gives need to assure that the patient’s valuable things, materials and medicines are packed.. It is important for the patient to be clean and have proper food. 


30. Provide a list of services that could provide your patient with community support whilst they are home recuperating.

 The patient needs to undergo rehabilitation community circle, social circle, psychotherapies and counseling and involve oneself in social activities that will help in diverting her stress and help in achieving relief. She needs to visit the exercise mentors for proper exercise plan that will improve the health condition. The service providers need to support the patients with protection and guidance under professionals. Besides it is important for the providers to maintain occupational health and safety and foster effective communication in delivering proper care and treatment.

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