Health Evaluation of Post-Operation Infection

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Table of Contents

Introduction
Consideration of Cues
Process Information
Nursing Action
Conclusion
References

Introduction

Health evaluation is a critical role in nursing practice. The process entails assessing how the patient is fairing in terms of their health by performing health examinations and intervening when necessary to ensure quality health care for the patient. The case scenario entails the patient Mabel Davis who has experienced changes in her condition, where she confirms that she is suffering from abdominal pains. This case study entails the assessment carried out to identify the problem. Cues and areas of concern are checked to identify aspects of her health that shows signs of illnesses. The paper discusses the post-operation infection she might suffer from and the dangers of developing sepsis. Finally, the importance of communication and the mode of communication with the surgeon is addressed. The general goal is to provide maximum quality care for the patient.

Consideration of Cues

A nurse’s assessment aims to identify the assessment parameters needed to deliver and plan the appropriate individualized patient care. Clinical cues are used to recognize changes in the patient’s medical status that may occur due to acute illness or treatment. The patient’s clinical states are expected to fluctuate between improvement and deterioration during the patient’s hospitalization or the response to treatment. Effective clinical care relies on the proactive approach to assessing the patient and early recognition of changes to protect the patient from the adverse event and promote recovery. There have been changes in the patient’s condition where she confirms she is suffering from abdominal pains, which necessitated me, to perform an A-G assessment to check the problem. After the assessment, I identify several cues and areas of concern about her health.

On the assessment of the temperature of the patient, I note that she has a low-grade fever. This form of adult fever is when your body temperature is slightly above normal temperature between 98.8°F (37.1°C) and 100.3°F (38°C) (Zhou et al., 2020). The patient’s temperature is 37.3 degrees and considering her current status, it is clear that she has a low-grade fever. Checking the respiratory rate was significant to assess if the patient was having difficulty breathing. The normal respiratory rate for adults at rest ranges from 12 to 16 breathes per minute (Hill & Annesley, 2020). Respiratory rate may increase in individuals with fever, illnesses, or other medical conditions. On the assessment, the patient’s respiratory rate is 24pmb which is an elevated rate from the normal rate, indicating that the patient is facing some difficulties in breathing.

Assessment of the patient’s heart rate was significant to check the member of times her heartbeats in a minute. The usual range for resting heart rate for an adult ranges from 60 to 90 beats (Natarajan et al., 2020). The heart rate tends to increase during illnesses, exercise, emotions, and injury. The patient’s heart rate is 92, which is slightly high, making it a cue of concern about the patient’s health. Pain is a crucial indicator of the patient’s wellness, and she has reported that her abdomen area is painful, which has affected her ability to move well. The patient has been declining PRN Endone tablets earlier, yet she requested them. The assessment indicates a pain rate of 7/10 in her epigastric region. Level seven of pain is an area of concern that indicates that she is suffering from moderate pain (Lazaridou et al., 2018). This pain may affect her senses and significantly limit her from performing daily life activities.

On wound assessment, I realize that the laparoscopy surgical sites have redness. The skin surrounding the areas is warm and red, and Mabel complains that she has stomach cramps. Other assessments should collect more information about the patient’s problem. I would perform a medical review of the wound, such as performing a wound swab test that involves cells or pus from the site to check on the type of organism causing the infection. An abdominal ultrasound would be essential to assess the organs and the structures within the patient’s abdomen to help evaluate the cause of pain. A C – reactive protein test would be essential to check the inflammation due to an infection (Anis et al., 2019). Additionally, a lactate test would be important to find out if enough blood is reaching the blood tissues, which is a life-threatening reaction to a bacterial infection.

Process Information

Pathophysiology of post-operation infection is conducted by the pre-triggered host immune-inflammatory response to the pathogens in surgical patients. The first step in developing the infection is microbial contamination of the site and wound from the surgery. The microbial contamination may be from an exogenous or endogenous source. The Endogenous flora includes the patient’s mucous membrane, hollow viscera, and skin. The most common causative organisms are Enterococcus, S. aureus, Escherichia coli, and coagulase-negative staphylococci (Anis et al., 2019). In abdominal surgeries, anaerobes and Gram-negative bacilli are more common. The theatre room may have exogenous flora, including instruments, air, staff members, and materials.

The most common exogenous organisms are streptococci and staphylococci. The number of virulence may be a major risk factor. There is a high rate of virulence isolated from post-operative wound infections such as Methicillin-resistant Staphylococcus aureus, especially due to the more use of broad-spectrum antibiotics (Anis et al., 2019). Every wound can withstand some local host damage and some bacterial inoculum without manifestation of the infection. However, if the factors exceed the tolerable threshold, infection is manifested, and uncontrollable proliferation of bacteria occurs. The level of breaking point is affected by certain factors such as age, immunodeficiency, obesity, and diabetic conditions.

Unthreatened bacterial infections risk the patient developing a life-threatening condition called sepsis. Sepsis occurs when an infection results in an extreme reaction in the body. Sepsis may lead to widespread inflammation in the patient’s body. People with chronic medical conditions such as cancer, diabetes, kidney disease, and lung disease have higher risks of acquiring sepsis (Komorowski et al., 2018). Sepsis signs and symptoms may include fever, shivering, high heart rates, low blood pressure, shortness of breath, disorientation, confusion, sweaty skin, and extreme pain or discomfort.

Sepsis may progress to a septic shock, a severe drop in blood pressure. If this happens, it may result in highly abnormal problems with the functioning of the body cells and energy production. Bacteria are released into the bloodstream, resulting in tissue and organ damage. Septic shock is a medical emergency, and the patient is cared for in the intensive care unit (Komorowski et al., 2018). Complications occur as the sepsis worsens, impairing blood flow in vital organs such as the heart, brain, and kidney. It may result in the patients’ blood clots or bursting a blood vessel, destroying and damaging the body tissues. Severe septic may result in the death of the patient.

For the assessment, sepsis should be considered in patients with proven or suspected bacterial infection and other states such as altered conscious state, including irritability, lethargy, and floppiness. Assessments should be carried out on patients with non-blanching rash, cardiovascular dysfunction, hypoxia, tachypnea, hypothermia, and unexplained pain. The red lag features include clinical deterioration despite treatment, representation within 48 hours, and recent surgery or burns (Australian Sepsis Network, n.d.). Temperature levels and lactate levels should be assessed.

Patients who show signs of sepsis should be treated immediately and aggressively. Prevention of sepsis entails the prevention of infection, especially with consistent and good hygiene. Prevention begins by ensuring that all wounds are cleaned as quickly as possible during surgery and kept clean throughout the healing process (Australian Sepsis Network, n.d.). Hands should be washed all the time while handling wounds and maintaining the right conditions. Any noticed infection should be treated immediately to prevent it from progressing to sepsis.

Nursing Action

Being the fore line workers in the healthcare sector, nurses rely critically on communication in all aspects of their work. Strong verbal and written communication skills are key to the improvement of health outcomes for the patient. Communication fosters good relationships with co-workers and helps in navigating complex situations (Potter et al., 2009). Communication between health care professionals is the basis for care, monitoring, treatment, and revision. The communications can be verbal or written interactions at the end of the shift, reports, electronic records or notes, or interpersonal interactions between nurses and other professionals. Concise communication ensures the continuity of patient information throughout the healthcare system, affecting the quality of care the patient receives. Nurses are at times stressed, overworked, or exposed to dangerous situations. Communication allows the nurses, even in the presence of constraining to be effective in their roles and improve the efficacy of the care provided to patient experience and the nurse’s well-being.

The evidence-based method of communication I would use to communicate with the surgeon is ISBAR. The abbreviation stands for identity, situation, background, assessment, and recommendation (Brust-Sisti et al., 2019). I would identify by stating who I am, my role, and location in the institution, then identify the patient by giving details such as name, age, gender, and department. I would state the situation by giving information about what has been observed. I would then provide a relevant clinical history of the patient, such as admission date and diagnosis, previous illnesses, allergies and relevant problems, treatments, and interventions. The next step would be working through the assessment by stating the A-G physical assessment, showing my clinical observations of my areas of concern, and stating what I think the problem might be. Finally, I would provide recommendations for what I wish the surgeon to do. I would state what I have done about the situation and be clear about what is requested, including timeframe.

According to Brust-Sisti (2019), ISBAR communication tool was formulated to enhance communication and provide structure. The tool is essential in improving safety in the transfer of critical information. The tool can be used for all types of handovers and prioritizes important information for both parties. The tool will increase my confidence as it decreases the chances of forgetting any relevant information. I would be able to decrease assumptions and make the reason for the call or communication obvious at the outset. The tool not only improves my relationship with the surgeon but also significantly enhances the patient’s overall health.

Conclusion

In conclusion, post-operation infection is a common challenge in the medical setting. The assessment and analysis of cues show that the patient suffers from a post-operation infection. More assessment is needed to provide additional data for the diagnosis. The lack of treatment for the infection may result in sepsis, a life-threatening condition that may lead to damage to tissues or even death. Proper communication with the surgeon is essential, and evidence-based communication methods come in handy to help provide the best care for the patient.

References

Anis, H. K., Sodhi, N., Klika, A. K., Mont, M. A., Barsoum, W. K., Higuera, C. A., & Molloy, R. M. (2019). Is operative time a predictor for post-operative infection in primary total knee arthroplasty?. The Journal of Arthroplasty, 34(7), S331-S336. Web.

Australian Sepsis Network. healthdirect. (n.d.). Web.

Brust-Sisti, L. A., Sturgill, M., & Volino, L. R. (2019). Situation, background, assessment, recommendation (SBAR) technique education enhances pharmacy student communication ability and confidence.Currents in Pharmacy Teaching and Learning, 11(4), 409-416. Web.

Hill, B., & Annesley, S. H. (2020). Monitoring respiratory rate in adults.British Journal of Nursing, 29(1), 12-16. Web.

Komorowski, M., Celi, L. A., Badawi, O., Gordon, A. C., & Faisal, A. A. (2018). The artificial intelligence clinician learns optimal treatment strategies for sepsis in intensive care.Nature Medicine, 24(11), 1716-1720. Web.

Lazaridou, A., Elbaridi, N., Edwards, R. R., & Berde, C. B. (2018). Pain assessment. In Essentials of Pain Medicine (pp. 39-46). Elsevier. Web.

Natarajan, A., Pantelopoulos, A., Emir-Farinas, H., & Natarajan, P. (2020). Heart rate variability with photoplethysmography in 8 million individuals: a cross-sectional study.The Lancet Digital Health, 2(12), e650-e657. Web.

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing. Mosby.

Zhou, Y., Ghassemi, P., Chen, M., McBride, D., Casamento, J. P., Pfefer, T. J., & Wang, Q. (2020). Clinical evaluation of fever-screening thermography: Impact of consensus guidelines and facial measurement location.Journal of Biomedical Optics, 25(9), 097002. Web.

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