Question:

To Be Addressed with Peter Harris

* Discuss the aetiology as well as the pathophysiology of your patient’s condition.

* Critically discuss and justify the underlying cause of the patient’s post-operative deterioration.

This time, prioritize, explain and justify the proper nursing management of the patient

* Identify three (3) of the members of the interdisciplinary health team (apart from the primary medical/nursing team) that you would consider involving in the care of the patient prior to their discharge. Provide justification for their participation.

Answer to Question: NRSG258 Principles Of Nursing Surgical

The correct and complete analysis of the disease process, how it developed and the underlying aetiological factors is essential for PARU care planning.

It is important that nurses understand the pathophysiology of post-operative complications. They can then identify and treat the root cause.

This essay will analyze and explain the aetiology of the disease, the pathophysiology and the specific nature of the post-operative deteriorations in order for nurses to provide safe and appropriate patient-centred care.

Peter Harris, a 72 year-old man with benign prostate hyperplasia had to have his surgery.

Histologically, benign prostatic hyperplasia means that there is unregulated proliferation of connective tissue and glandular epithelium.

It is a more frequent health condition that affects older men. (Nayak and colleagues, 2017).

BPH is a progressive condition that causes prostate enlargement and lower urinary tract symptoms.

BPH can be found in the peri- and transitional areas of the prostate glands. Many experts believe BPH, along with its associated lower urinary system symptoms, is a common symptom for an ageing population.

BPH is reported by 75% of males over the age 50. In addition, 20-30% reported BPH in men aged 70-80.

Although this is a common condition, much remains to be known about the pathogenesis and underlying causes. (Roper 2017).

Many theories have been put forward to help understand the causes of BPH. These include hormone alteration, inflammation, metabolic syndrome, and other factors.

First and foremost, the most important risk factor in this disease is ageing. Many studies have been conducted to determine the relationship between BPH progression and the physiological processes of ageing.

Goren (2018) and Gat (2018) both support the claim that tissue remodelling occurs in ageing males, in particular in transition zones.

Further exploration revealed that there is also an interference with the stability growth factor signalling pathways, which alters divisible cells’ fate, especially basal ones.

These basal cell changes cause a change in intracellular metabolic pathways, resulting in hypertrophic and larger basal cells. The benign volume increase of the prostate is also caused by changes in the stromal Epithelial interactions.

The disease’s etiology is also affected by changes to male hormone levels.

Peter suffered from LUTS (complete emptying of the bladder), nocturia, urinary urgency, pain urination, haematuria, and strain while urinating.

BPH may also be associated with type 2 diabetes. This link is facilitated by the link between prostate enlargement and glycaemic regulation. However, the effects of dynamic glycaemic monitoring are more directly linked to LUTS symptoms than the BPH symptoms (Roper 2017.

Peter had a transurethral procedure to remove the prostate. This was done in an attempt to relieve his BPH symptoms.

The patient has been able to recover quickly, but the vital signs that he has recorded in the PARU device indicate that he has suffered from some anomalies.

First, his respiratory rate of 30 breaths/minute is alarming. This indicates that he has experienced significant post-operative deterioration.

Novosad (2016) says that an adult’s respiratory rate should be between 12 and 16 breaths each minute.

This means that the patient’s post-operative respiratory rate is almost twice what it should be.

High respiratory rates following surgery can often indicate a major medical emergency, such as cardiac arrhythmia and even sepsis.

Nakahira et. al. discuss the reasons for respiratory distress.

Nakahira et. al. (2017) stated that post-surgical conditions can lead to respiratory distress due to an increased resistance of the airway flow and tissue resistance.

Additionally, the patient may have had COPD. This indicates that there is a possibility of bronchial restrictions or collapse. The surgery can further complicate the situation.

Next, the blood pressure or pulse rate is a sign of further deterioration.

Normal blood pressure levels for an adult are 120/80 mmHg, and the average pulse rate is 100 beats each minute (Novosad 2016).

The patient’s blood pressure was 120/60 mmHg. This is hypotension. A pulse rate of 128 beats per minute indicates arrhythmia. As per Nag et al.

(2018). The impact of anaesthesia is often the biggest contributing factor that has significant impact on blood pressure. However, septichock or the chance of severe surgical site infections could also be major reasons behind the drop in blood pressure.

To avoid myocardial damage, an elevated heart rate (or tachycardia) can be a sign of cardiac risk.

Anaesthesia and oxygen therapy used during surgery are likely to be the main contributors to the elevated heart rate.

Peter had COPD history, so heavy oxygen therapy may increase the heart rate.

The patient’s temperature was 35 degrees. This is indicative of the risk of perioperative hyperthermia. It is usually caused by reduced peripheral blood circulation due to anaesthesia. Also, the patient didn’t feel any pain. High anaesthesia block can also cause this.

The patient also had blood clots and bruising in her urine. These are signs of perioperative hypothermia.

If the patient’s post-operative symptoms are not taken into account, she could be at increased risk for sepsis.

If the patient already has high pulse and RR, then a blood test is required to determine whether her WBC count is high or low. This will confirm the risk of developing septic shock (Rhodes. et. al., 2017).

As the first priority, sepsis management is the primary concern. In the meantime, nurses will need to administer fluids by vein and antibiotics with oxygen.

Next, the nurse should administer bronchodilators for the patient to lower the respiratory rate. External oxygen therapy is also recommended if the issue does not resolve.

Following this, the nurse should give anti-hypotension medication to the patient and medication for Tachycardia. Electrolyte therapy is also recommended to help restore hemodynamic stability.

Peter’s nursing care will include bladder irrigation to remove any blood clots remaining so there is no chance of infection or blockage.

The nurse will also need to encourage the patient’s fluid intake to flush any remaining blood.

The nursing management will provide warmth blankets and electrolytes for the patient to bring the body back to normal. They also check the levels of anaesthesia (Haese, Sotelo, 2018).

Peter will need the help of three other members of an inter-disciplinary health care team.

Peter is a type-2 diabetic. This condition is one that can cause a wide variety of dietary restrictions.

Understanding the patient’s dietary intake is crucial after discharge will help him not only to recover, but also to meet his nutritional needs.

It is crucial that the patient’s care plan include a dietician and/or a nutritional expert. This will allow him to create a diet chart together with his team to aid in his recovery.

Peter is an individual and cannot be cared for by anyone else. Therefore, he needs a community support nursing member.

Peter will need the assistance of a community health- and social care support group to provide him with 24*7 assistance. (Deek, et al. 2016).

Peter also has an alcohol addiction that can cause serious problems post-discharge. This can affect his recovery as well as have severe consequences.

As such, Peter will have an addiction psychotherapist involved in his care. They will help him with post-surgical restrictions and help him recover from his alcohol addiction. (Yokell et. al., 2014).

A conclusion note: Post-operative treatment delivery depends upon many factors.

The nurses must do a thorough assessment of the patient, including his symptoms, in order to plan and deliver safe and patient-centered care.

This essay identified the main post-operative deterioration Peter was suffering from and recommended appropriate priority-based interventions.

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