• Subject Name : Nursing

Prevention of Postoperative Wound Infections

Introduction to Demelza Smith Case Study

The postoperative care is considered to be an integral part of the care as the patient is most susceptible to acquire certain infection or complication that will directly deteriorate the health status of the patient. Different units come under the post-operative care includes ICU, Post-anaesthesia care, integrated care and high dependency unit (Zakhary et al., 2017). The case study is about a 56-year-old woman Demelza Smith and she has undergone laparoscopic cholecystectomy. After the surgery, she has returned to the ward with 125mls/hr Hartmans solution with two additional medications other than her usual medication. The report is going to discuss the different aspect of the post-operative care that need to utilize to address the patient post-operative health status. The last section of the report will discuss the important aspects that need to be considered while the discharge plan of the patient.

Preparation of The Ward for The Post-Operative Patient

The nurses are expected to play a vital role in post-operative care and they are expected to frame the care in a patient-centric way. The first aspect that needs to be included in the post-operative care is undergoing the preoperative information of the patient to understand the health status before the surgery. The postoperative information helps the nurse to understand the patient medical history and current status to identify patient-centric care (Bowyer & Royse, 2015). The preoperative information help to identify the medical history of the patient includes Gastro-oesophageal reflux disease, hypertension and migraines. The information about the medication of the patient is also important to maintain the dose and monitoring of the patient. The study presented by Chong et al. (2016) indicates those nurses are expected to prepare all the equipment’s and assessment following the aseptic condition to reduce the chances of the healthcare-associated infection. The preparation of the ward and the types of equipment are necessary to deals with any post-operative complication that can deteriorate the health of the patient. The preparation of the assessment and equipment’s will help to deliver the right care in the first four hours after the patient surgery.

First Four Hour of The Patient Post-Operative Care

The first four-hour care for the patient is considered to be very important to improve the health status of the patient by decreasing the chances of complication that can due to the surgery (Fletcher & Engelman, 2020). 

Patient assessment:

The patient assessment is important to understand the patient current health status that is important to understand the fluctuation in the patient condition after surgery. The ABCDE assessment includes airways, breathing, circulating, disability and exposure analysis to identify the patient condition (Fernández-Méndez et al., 2019). Pain assessment is also important to understand the patient discomfort that will be utilized to plan for the treatment. Pain assessment scale will help the patient to self-report the intensity of the pain so that health care professional can assist the patient (Booker & Herr, 2016). The wound assessment is also important after the surgery to understand the current condition of the wound by analysing the margins, surrounding skin and drainage. The wound assessment is important to decrease the chances of the infection that will increase the surgical site complication for the patient (Hsu et al., 2019). These assessments will help to evaluate Smith health status after the surgery to understand the health condition.

Patient Health Complications

One of the major complications that are associated with the post-operative condition of the patient is the surgical site infection that usually occurs due to the healthcare-associated infection. The surgical site infection occurs due to the invasion of the infectious agent from the surgical site that leads to local and systemic responses. The infection can be superficial and involve the tissue under the skin that increases the complication for the patient. The surgical site infections are considered to increase the compilation of the patient by increasing the hospital stay and increased recovery time that directly increase economic burden (Carvalho et al., 2017).

The nurses are expected to engage at three levels to improve the condition of the surgical site infection of the patient. The first is at a personal level they can perform the hand hygiene and provide proper dressing to the patient as per the results of the wound assessment. At the ward, the level nurse is expected to coordinate with the team to provide hygienic and safe condition to reduce the chances of further infection by addressing the risk in the care. At the departmental level, the nurse should improve the guidelines for the surgical and hygienic procedure conduction to reduce surgical site infection. The nurses are expected to form a surveillance team to check the ward condition concerning the guidelines (Andersen, 2018). This intervention will help to prevent surgical site infection by improving personal and organization procedure.

The Hartman’s solution infusion is considered to be important to improve the electrolyte balance in the patient after the surgery but an overdose can lead to over-hydration. The increase Hartman’s solution leads to the dilution of the serum electrolyte concentration which leads to pulmonary congestion and oedema that will have a negative impact over the health of the patient. Many complications occur due to the overdose of the Hartmann’s solution that includes allergic reaction, increase level of blood potassium and high blood calcium level. It is also responsible to increase the blood pressure level that can lead to the hypertensive emergency state (Santi et al., 2015). The nurses are expected to continuously monitor the patient to track the electrolyte balance and it will reduce the overdose that has a negative impact over the health of the patient. The hyperkalaemia state that occurs as a complication of the Hartmann’s solution overdose can be addressed by the dietary intervention that will help to balance the electrolyte misbalance. The dietary intervention includes calories intake management concerning the expenditure that will help to improve the electrolyte balance. The nurses are expected to work with the dietician to improve the understanding of the patient concerning the right dietary pattern to decrease electrolyte concentration (St-Jules et al., 2016). The dietary intervention is important to address the increased level of the electrolyte that patient faced due to the Hartmann’s solution overdose leading to increase health-related complication. These two are the major complication that can occur to the patient concerning the health of the patient thus nurses are expected to address the issue with the right intervention to improve the health of the patient.

Discharge Education

The discharge education of the patient after the surgery will include different aspect like lifestyle education, surgical site education and medication education. The lifestyle education of the patient will include the balance between the rest and activities that are important to maintain health. The dietary intervention information will also be included to improve the calories intake so that the patient can follow its daily routine (Adugbire & Aziato, 2018). The discharge will also include the self-management technique for the wound management that will include hand hygiene information, dressing information and wound inspection. It will also include the information concerning the referrals that can be utilized if the patient found any unusual wound condition. The self-management session will include educating the patient about the right method for the dressing so that there are no chances of the infection. The educational session will also improve patient skills for the wound assessment so that early detection of the infection can be done which can be addressed by the right treatment process (Cook et al., 2014). The last will be helping the patient to understand the medication importance and the doses as per the prescription so that medication adherence can be maintained. The proper medication information for the patient will also be included in the discharge plan so that patient can refer in case of any confusion. The educational session will also include the side effect that patient cab encounter after the medication administration so that the patient do not panic and can self-manage the minor fluctuation in the health (Prochnow et al., 2018). The discharges plan will help the patient to improve the skills that are necessary to continue the care without hampering the health status which will improve the recovery.

Conclusion on Demelza Smith Case Study

The report can be concluded by adding that post-operative care is considered to be complex as patients require extra care because of their increase susceptibility. The nurses are expected to understand the patient preoperative condition and the clinical practice should be following the aseptic technique to decrease chances of infection. The different assessment that can be done for the patient includes ABCDE, pain and wound assessment to understand the current status of the patient. The two health complication that can be encountered by the patient includes surgical site infection and Hartmann’s solution overdose that can be addressed by infection control and dietary intervention. The education during the discharge planning includes session concerning the lifestyle improvement, surgical site care and medicine doses to improve patient skills to manage the health.

References for Demelza Smith Case Study

Adugbire, B. & Aziato, L. (2018). Surgical patients’ perspectives on nurses’ education on post-operative care and follow up in Northern Ghana. BMC Nursing, 17(29), 1-9. DOI: 10.1186/s12912-018-0299-6 

Andersen B. M. (2018). Prevention of postoperative wound infections. Prevention and Control of Infections in Hospitals: Practice and Theory, 377–437. DOI: 10.1007/978-3-319-99921-0_33

Booker, S. Q. & Herr, K. A. (2016). Assessment and measurement of pain in adults in later life. Clinics in Geriatric Medicine32(4), 677–692. DOI: 10.1016/j.cger.2016.06.012

Bowyer, A. & Royse, C. (2015). The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 63(2), 176–183. DOI: 10.1007/s12630-015-0508-7 

Carvalho, R., Campos, C. C., Franco, L., Rocha, A. M. & Ercole, F. F. (2017). Incidence and risk factors for surgical site infection in general surgeries. Revista Latino-Americana de Enfermagem25, 1-18. DOI: 10.1590/1518-8345.1502.2848

Chong, J. U., Lee, J. H., Yoon, Y. C., Kwon, K. H., Cho, J. Y., Kim, S. J., Kim, J. K., Kim, S. H., Choi, S. B. & Kim, K. S. (2016). Influencing factors on postoperative hospital stay after laparoscopic cholecystectomy. Korean Journal of Hepato-Biliary-Pancreatic Surgery20(1), 12–16. DOI: 10.14701/kjhbps.2016.20.1.12

Cook, D. J., Moradkhani, A., Douglas, K. S., Prinsen, S. K., Fischer, E. N. & Schroeder, D. R. (2014). Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system. Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association20(4), 312–317. DOI: 10.1089/tmj.2013.0219

Fernández-Méndez, F., Otero-Agra, M., Abelairas-Gómez, C., Sáez-Gallego, N. M., Rodríguez-Núñez, A. & Barcala-Furelos, R. (2019). ABCDE approach to victims by lifeguards: How do they manage a critical patient? A cross sectional simulation study. PloS One14(4), 1-12. DOI: 10.1371/journal.pone.0212080

Fletcher, N. & Engelman, D. T. (2020). Postoperative care: who should look after patients following surgery? Anaesthesia, 75(S1), 5-9. DOI: 10.1111/anae.14887 

Hsu, J. T., Chen, Y.-W., Ho, T.-W., Tai, H.-C., Wu, J.-M., Sun, H.-Y. & Lai, F. (2019). Chronic wound assessment and infection detection method. BMC Medical Informatics and Decision Making, 19(99), 1-20. DOI: 10.1186/s12911-019-0813-0 

Prochnow, J. A., Meiers, S. J. & Scheckel, M. M. (2018). Improving patient and caregiver new medication education using an innovative teach-back toolkit. Journal of Nursing Care Quality, 1, 101-106. DOI: 10.1097/ncq.0000000000000342 

Santi, M., Lava, S. A., Camozzi, P., Giannini, O., Milani, G. P., Simonetti, G. D., Fossali, E. F., Bianchetti, M. G. & Faré, P. B. (2015). The great fluid debate: saline or so-called "balanced" salt solutions? Italian Journal of Pediatrics41(47), 1-5. DOI: 10.1186/s13052-015-0154-2

St-Jules, D. E., Goldfarb, D. S. & Sevick, M. A. (2016). Nutrient non-equivalence: does restricting high-potassium plant foods help to prevent hyperkalemia in hemodialysis patients? Journal of Renal Nutrition: The Official Journal of the Council on Renal Nutrition of the National Kidney Foundation26(5), 282–287. DOI: 10.1053/j.jrn.2016.02.005

Zakhary, W. Z. A., Turton, E. W. & Ender, J. K. (2017). Post-operative patient care and hospital implications of fast track. European Heart Journal Supplements, 19(suppl A), A18–A22. DOI:10.1093/eurheartj/suw055 

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