NRSG370 Assignment Clinical Integration

Question:

Candace Evans is a 42 year woman admitted to the operating theatre at 38 weeks gestation for an elective lower uterine caesarean section (LUCS) under spinal anaesthesia. The patient has been diagnosed with Placenta Previa.

Pre-Operative Nursing Assessment:

  • Current History: Second pregnancy, 38 weeks gestation;
  • Past History: Gestational diabetes with her first pregnancy 5 years ago, which resolved following the birth with no recurrence in this pregnancy, depression, anxiety, post-natal depression.

You are working in the post anaesthetic recovery room (PACU) on a morning shift and will receive Candace following her LUCS. Candace arrives in the PACU, following the uneventful birth of a male infant via LUSC with APGARS of 8 at 1minute and 10 at 5 minutes following birth. Intraoperative blood loss was estimated at 150ml.

PACU Assessment:

  • Dermatome level T3;
  • Pain 0/10;
  • Lower uterine dressing dry and intact;
  • In-dwelling catheter with 100ml of rose coloured urine;
  • Intravenous therapy of Oxytocin in CSL running at 250mL/hour;
  • Vital Signs: HR 88, BP 104/76, SpO297% on RA, Temp 36.9° Celsius.

Answer:

Introduction

Nurses with active clinical reasoning have an affirmative influence on patient results; on the contrary, those with destitute clinical reasoning will frequently flop to discover imminent patient worsening.  Faults in decision making and judgment are recognised to version for more than half of unreceptive clinical actions (Schug, Palmer, Scott, Halliwell & Trinca, 2015).  Clinical reasoning is a learning skill requiring active engagement and determination in deliberate practice as well as reflection, specifically on activities designed to advance performance.  This essay will concentrate on the given case study on Candace Evans, a 42 years old woman with an elective lower uterine caesarean section under spinal anesthesia. The paper will then explore through three care priorities identified in Candace’s scenario: her in-dwelling catheter with 100ml of rose coloured urine, vaginal blood loss and the blood clot. The identified three prime priorities will be examined and justified using Levett-Jones clinical reasoning cycle through executed inventions and to assist nurses to attain those objectives which lead to the finest conceivable results of the patients.

Properly managed recovery steps can avert symptoms associated with the caesarian section (Neal et al., 2010). Candace is presented to the recovery room with vaginal blood loss and some clots as well as an in-dwelling catheter with 100ml of rose coloured urine.  The past history of the patient includes gestational diabetes with her first pregnancy five years down the line, which resolved following the birth with no recurrence in this pregnancy, anxiety, depression or post-natal depression. There is clear evidence that Candace suffered from complications as a result of operations. It is normal for women to lose lochia after birth until the wombs renew its lining.  Following Candace’s caesarean operation, she is given intravenous therapy of oxytocin in CSL running at 250m/L/hour. This will encourage the uterus to contract, assisting it to shrink back to its normal size and reduce blood loss (Baaqeel & Baaqeel, 2013). Blood normally flows quickly and uninterrupted through veins. But, sometimes, the clot can form that either reduce the blood flows or stops it completely. A deep vein thrombosis is a blood clot in vein usually pelvis or leg, and its common cause is immobility during surgery (Stephens & Bruessel, 2012).  Candace shows vaginal blood loss and the patients also display vaginal pad soaked with franks blood and some clots.  Therefore, perioperative and recovery nurses can use their critical reasoning capabilities in executing approaches in managing intricate care and take full advantage of the aids for patients by lessening risks elements connected with multifaceted health concerns.

Perioperative caregivers use evidence-based practice to advance the physical wellbeing and uphold the blood count for the Candace by affecting various tactics and setting desired goals (Pant, Fong & Scavone, 2014). For me to realize those goals, I must work closely with her and midwifery for the best promising results.   Patient life can be upgraded by using patient learning after an operation which will enable the patient and midwifery gain more knowledge and skills in her compelling conditions.  The anesthetic may make one feel sick. Thus, a drip going into her veins will make sure enough fluid when she is not able to drink.  While the patient is drinking enough fluid and no longer feels sick, then, the drip will be removed and I will tell her to start eating.  After two to three days, if the patient will have problems with bowel, I can give medicine to open her bowels. It will be helpful for the patient to drink a lot of fluid, eat a high fibre diet such as fruit, wholemeal or granary bread, cereals and vegetables (Torloni et al., 2011). To improve the blood circulation and prevent further blood clots from developing, I will encourage the patients to walk with the compression boots to improve the circulation. However, the first day, I will encourage sit out of bed in her chair, even if it is for short period. I will encourage resting, however, it is crucial to start exercise as soon as possible. As a result of vagina bleeding, I will advise the patient to use sanitary towels instead of tampons as this may increase the risk of infection.  I will discuss with patients and midwifery on the issues she should check after returning home. If the bleeding becomes heavy or once she notices a smelly discharge, she should see the GP for a check.  Therefore, health care providers can offer means related to diet and education on diet regulation and workout. Realistic goals can be established for vaginal bleeding.  Exercise chart and diet plan could be implemented for the recovery of patients.

It is important to assess the efficacy of the approaches used and to ascertain whether the probable result is realised or not.  For this purposes, will use diverse tools and resources to appraise patient’s improvement.  In Candace’s case, the nurse can use diet controlling plan and discuss it with midwifery and patient herself to see how changing the lifestyle will affect her recovery position. Body mass index is important gears in measuring the body weight before and after recovery to assess the effectiveness of the exercise and diet plan.  Therefore, the above evaluation will back Candace to preserve the dynamic lifestyle and support her to use the idea in further managing of operation in future.

As earlier discussed, Candace was also diagnosed with the vaginal bleeding as a result of the operation.  Literature suggests that it is normal to lose lochia. However following the caesarian one will be given a drug which is a synthetic version of the naturally occurring oxytocin (Butwick, Coleman, Cohen, Riley & Carvalho, 2010).