NURS2001 Essentials Of Surgical Nursing

Question 1

The Roper-Logan-Tierney Model can be defined as a nursing theory that is based on the activities of daily living of the patients. The aim of the model is to assess the impact of an accident or illness of the patient on his or her life so that effective planning for appropriate provision of care can be done for increasing independence as well as the quality of life (Holland & Jenkins, 2019).  The model highlights 5 major factors that influence the activities of living of the patient. It includes biological, psychosocial, environmental, spiritual, and cultural factors.

When it comes to psychological factors, In case of Hanna, the sudden accident has shocked the patient and poses the potential to lead to anxiety, depression as well as a feeling of hopelessness. Hanna is likely to undergo an effect of shock immediately after the accident (CHRONIC, 2022). This is true for her family as well. Given the fact that she has a loving family, her sufferings and pain are resulting in grief, anxiety and depression for her husband. Hanna’s son is only 3 years old. As a result of her accident, he is unable to see her mother for a prolonged period of time. This in turn is imposing a negative impact on his psychology. As per Shen (2020), the sudden absence of a mother for a prolonged time period damages the ability of the child to process emotion. 

The cultural factor can be defined as the impact of society and culture on the patient. The culture of a family imposes an impact on the perception of health, illness, death as well as beliefs (McCluskey, 2021). In case of Hanna, it has been found that Hanna’s family is not at all superstitious in nature and there exists a healthy culture in her family. However, Hanna’s husband is supportive in nature which ensures stability in the patient’s life as well as the life of her family members post her accident.

When it comes to biological factors, it addresses the impact of overall health, current injury as well as illness along with the scope of anatomy and physiology of the patient on him or her as well as the family members. As being stated in the case study, since Hanna has undergone a fracture in her pelvis, she is undergoing severe pain and shock. Pain may be in from pelvis, groin, back and abdomen region (Holland & Jenkins, 2019). On the other hand, since she is suffering from right-sided cerebral contusions, there is a risk of bleeding and swelling in the brain. As for her family members, no biological change has been experienced.

Finally, when it comes to spiritual factors, Hanna is most likely undergoing spiritual distress which is associated with increased pain as well as depression. Given the fact that the accident has happened all of a sudden, Hanna is likely to lose trust in her spirituality (Indra, 2018). The same is true for her family. All these factors can result in hopelessness for both Hanna and her family members.

Question 2

The term Doctrine of Necessity can be defined as a term that is used for describing the basis on which administrative actions are designed for resting orders. By the administrative authority, are found to be constitutional. In healthcare, medical necessity can be defined as a legal doctrine required in the United States which is related to activities that may be justified as necessary, reasonable as well as appropriate based on the evidenced-based clinical standards of care (Gbobo & Oke-Chinda, 2018).

The legal concept of enduring guardianship includes, legally providing someone with the ability and right to make a decision on behalf of another individual, in case the latter fails to decide for himself or herself. His takes place chiefly when the patient is in end of life care and may lose the ability to make his or her decision for himself or herself in the advanced stages (Nittari et al., 2020).

In this case, the legal considerations do get applied. Since Hanna needs to be operated on and due to her Right sided Cerebral contusions, may lose the ability to make her own decision by herself, on her belief, the decision must be taken by her husband (McQuoid-Mason, 2020). In this case, the legal factors of the doctrine of necessity and enduring guardianship need to be considered.

Question 3

The first and highly important nursing intervention that requires to be conducted for Hanna includes patient and family education. Given the fact that Hanna is getting operated on, it is normal for her to undergo anxiety and tension (Lamont, Stewart & Chiarella, 2020). In order to reduce her anxiety and make her aware of what exactly her body will be going through, the nurse must transparently provide her with the details of the operation procedure, the benefits of the operation and expected outcome. As per Perissotto et al. (2019), positive expected outcomes encourages patients and reduce the fear of the operation procedure which in turn impose a positive impact on the patient’s health. On the other hand, it is the responsibility of the nurses to make the patient aware of the possible risks. This will ensure a transparency. Along with Hanna, her family members should also be educated about the procedure to be followed and the benefits as well as risks of the operation.

The next preoperative action includes gathering the consent letters and other required documents before preparing the patient for the operation theatre. A consent letter that states that the patient is aware of all the procedure of the operation and is willingly opting for the operation need to be gathered. Along with this, her medical history, medications and other documents also need to be organized before she is to be operated on.

The third preoperative action includes getting the patient ready for the operation. Hanna should be informed that she cannot consume any solid or liquid 4 hours before the operation is performed (Neiva, R. O, Nogueira & Pereira, 2020). She should be bathed and the area of her body that is to be operated on should be cleaned. A series of blood tests, X rats, and other procedures required for the pelvis surgery needs to be conducted. Finally, she should be made to wear the apron in which she will be operated.

Question 4

A major abnormal cue includes the Capillary Refill time of Hanna. The Capillary refill time can be defined as the time that is taken for a distal capillary bed for regaining the colour after the pressure has been applied for blanching to take place. As per (), the normal Cap Refill Time (CRT), post pelvis operation is 1 to 2 second. This is consistent with the normal blood volume as well as perfusion.  A CRT that is longer than 2 second indicates poor perfusion as a result of peripheral vasoconstriction. This indicates that Hanna is suffering from the complication of a blood clot.  As per Moik et al. (2021), blood clots, plague build up as well as borrowed blood vessels can often lead to poor perfusion of blood. Low circulated blood volume as well as decreased oxygen supply to important tissues cause peripheral vasoconstriction, which is a natural reaction. Peripheral vasoconstriction must be predicted in hypovolemic as well as cardiogenic shock patients. As per Gervaso, Dave and Khorana, (2021), peripheral vasoconstriction diminishes the volume as well as space inside the affected blood vessels. While the blood vessel volume has been lowered, there occur a reduction in blood flow. At the same time, the resistance is raised resulting in high blood pressure.

Cool limbs are often coupled with peripheral vasoconstriction, which can be detected by palpating the distal limbs. Vasoconstriction is also a result of severe hypothermia (Etkin et al., 2021). A CRT of the less than 1 second indicates a hyper dynamic condition with increased vasodilation. The Hyper dynamic states are associated with distributive shock, hyperthermia and systematic inflammation. 

The second abnormal cue includes bilaterary cold feet. As per Bhat et al. (2018), there exist no direct connection between a successful pelvis surgery and bilaterally cold feets.  Cold feet signify blood clotting. According to Grilz et al. (2019), a symptom associated with blood clotting is highly dependent on its location within the body. Some blood clots produce no symptoms until and unless they rupture and become dislodged. This clots tend to travel through the circularity system to other sites. Both the first and second cue together highlights the occurrence of Arterial thromboembolism.

The third complication includes slightly pale skin colour. Generally, pelvis surgery does not result in pale skin colour. Hence this is a major abnormal cue. All the three cues indicates Arterial thromboembolism (Mulder et al., 2021). This indicates obstructive flow of blood in the lower extremities. This abnormality can take place after surgery of the fractured pelvis.

An arterial embolism occurs when one or more    limiting circulation of the blood ischemia, which can lead to infarction as well as tissue death (necrosis). Collateral circulation develops in people with arterial thrombosis or embolism to cover the loss of arterial flow. However, adequate collateral circulation takes longer to establish, rendering damaged regions more prone to rapid embolization than, say, progressive blockage as in atherosclerosis. A blood clot refers to a fragment of plaque which acts like a clot can be defined as an “embolus.” The term “emboli” can be defined as several clots or plaque pieces (Grilz et al., 2018). Arterial embolism can be result of one or more blood clots. Clots possess the tendency to lodge in an artery while preventing blood flow. Tissues gets deprived of oxygen as well as blood resulting in obstruction. This can result in tissue death or injury (necrosis). Arterial emboli commonly takes place in legs and feet. They often are the result of brain stroke. A heart attack is the result of embolism that occurs in the heart. The eyeballs, kidneys as well as intestines can be considered to be some of the less usual locations. Atherosclerosis-related artery deterioration is the most common cause of arterial thromboembolism (Dinger, Möhner & Heinemann, 2020). Atherosclerosis is a condition in which plaque builds up on the inside walls of arteries. The vessels then constrict and stiffen, increasing the risk of arterial thrombosis.

Cold feet of Hanna along with lower ability to bend her knees also indicates Postoperative femoral neuropathy. After pelvic surgery, postoperative femoral neuropathy is an unusual complication. Neuropathy is caused by two basic mechanisms: improper elongation as well as chronic nerve pressure. We present two cases of femur neuropathy that developed after pelvic surgery (Grilz et al., 2019). There had been no prior arterial or peripheral nerve illness in either case. After operation, they had left hip flexion as well as knee stretching weakness, as well as visual impairments in the left lower limb. Left femoral neuropathy was established by electromyography and nerve conduction tests.


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