• Subject Code : NRSG370
  • Subject Name : Nursing

Clinical Integration: Specialty Practice

Introduction to Clinical Integration: Specialty Practice

Post-operative care is one of the important practises that should be formed after the surgery it helps in the early recovery of the patient and help to improve the quality of care. Post-operative complications are associated with deteriorated health status as they increase the hospital stay of the individual that directly increase financial burden over the individual (Bowyer & Royse, 2016). One of the key attributes of the nursing profession is the clinical reasoning cycle that allows the stepwise assessment method of the patient. The clinical reasoning cycle is eight-step cycles that allow nurses to systematically analyze the patient and provide them with accurate intervention to reduce the discomfort (Gummesson, Sundén & Fex, 2018). The case analysis is going to use the clinical reasoning cycle in the patient assessment to understand the current condition of the patient. The clinical reasoning cycle help to analyze the patient current condition that can be used to provide proper intervention to reduce the discomfort of the patient. 

Consider the Person’s Situation

The case study is about a 62-year-old man Peter who is admitted to the surgical ward after the open mesh inguinal hernia repair. After 6 hour history of non-reducible tender, inguinal mass he is presented to the emergency department. The past medical history of the Peter indicates that is a patient of obesity and he was prescribed with medication for hypertension with hyperlipidaemia but his report reveals the presence of mild congestive heart failure. Peter lives with his wife after the retirement and he quitted the smoking 10 years ago. He complains of the pain that is radiating from the surgical site to the calf that is increasing his discomfort after 2 days of surgery. Peters vitals sign reveals that his blood pressure is high that is 170/90, increased respiratory rate and pain score is about 7/10. After the physical assessment of the Peter, it was observed that his post-surgical wound dressing is oozing and inflammation is present around the dressing. The right calf of peter has inflammation in the mid-calf that is warm in touch.

Collect, Process and Present Related Health Information

Relating to Peter case, Peter has recently undergone open mesh inguinal hernia repair to reduce complication associated with inguinal hernia. The individual risk factor that is associated with inguinal hernia includes male with old age and increased body mass index. The external risk factors that are associated with inguinal hernia include smoking and increased weight lifting (Öberg, Andresen & Rosenberg, 2017). The severity of the pain complained by the Peter is the due postoperative complication that is increasing discomfort of the patient as it is about 7/10. There are many reasons for the chronic pain that occurs after the inguinal hernia repair that includes post-operative bleeding and infection, neurotoxic chemotherapy and psychological vulnerability (Berri, 2019). There is evidence that persistent inflammatory reaction due to mesh lead to cause a foreign reaction that increases the post-operative complication like infection, chronic pain and seromas. The inflammatory response for longer duration can increase the chances of infection that lead to increase complication due to increased CRP, neutrophil, lymphocyte and leucocyte (Kokotovic et al., 2017). The investigation done by health care professional reveals that he has a high level of WBC, CRP and neutrophil count that directly indicate the presence of an infection that is associated with infection

Identify Nursing Problems/issues

The first issue that is increasing the discomfort of the individual includes chronic pain that is radiating from the surgical site to the calf of Peter. 20% of the individual encounter chronic pain after the inguinal hernia repair that directly increases the complication of the individual. The postoperative pain can be divided into three sections according to the severity and damage it created. The first section is somatic pain that is most common and it occurs due to a reaction against the prosthetic mesh. The second section includes direct nerve damage or injury that can occur due to the mesh placement lead to negative impact over the genital branch. The last section includes visceral pain that includes intestinal involvement that can cause dysuria. The post-operative pain directly increases the complication of the individual that leads to an increase in the discomfort of the individual (Molegraaf, Lange & Wijsmuller, 2016).

The second issue that needs urgent attention is the increased blood pressure of Peter that is also one of the major complications that increase the complication of the peter. The increase in blood pressure after the surgery can increase complication and it is associates as a risk factor for a multiple of disease like cardiovascular events, renal impairment and cognitive impairment. The classification of hypertension can occur into 4 stages normotensive stage, stage 1, stage2, stage 3 and severe hypertension. The increased blood pressure occurs due to disturbance in the feedback mechanisms that regulate the blood pressure according to the set point. Post-operative blood pressure management is necessary as it can lead to bleeding. The nurses are expected to manage post-operative hypertension that will help to improve the health status of the individual (Nadella & Howell, 2015).

The surgical site infection is evident in Peter as the area around his dressing has inflammation that increased the complication. Surgical site infection is one of the common complications that occur after inguinal hernia repair that increase the complication of the individual. Many aspects are associated to cause the surgical site infection like carelessness during the operative time, decrease skill of the surgeon, carelessness in the mesh fixation and pre-operative antibiotics. The surgical site infection directly increases the complication of the individual that causes the increased hospital stay with the discomfort. Post-operative care is necessary to reduce the complication and provide the quality of care (Cai et al., 2018).

Establish a Goal

The intervention should be planned that aim to reduce the chronic pain of the individual that will help to reduce the discomfort of the patient. The action should be in accordance that it will reduce inflammation and decrease the blood pressure to the set point. The major aim of the intervention is to provide accurate care that helps to improve the health status of the individual.

Nursing Care

  1. One of the interventions that be used to reduce the post-operative pain of the patient includes acupuncture therapy that is associated to reduce the post-operative pain. The acupuncture is involved in insertion or manipulation of the fine needle at the specific point following the body part. The therapy relies on the fact that there is an interrelationship between specify a point and body organ that is directly associated with disorder and dysfunction. The therapy includes mechanical, thermal and electrical stimulation that helps to reduce the post-operative pain. The acupuncture therapy directly involved to heal the issue of the individual with needle and increase self-care capacity of the individual that help to deal with the chronic pain. The acupuncture is one of the promising methods to reduce the post-operative pain and it also decreases the requirement of analgesic that can cause side-effect (Tick et al., 2018).
  2. The lifestyle intervention can help Peter to manage hypertension and reduce the complication associated with the increased blood pressure. The first aspect of the intervention include dietary intervention that helps to maintain the nutrition intake and proper diet plan can help to reduce the complication associated with misbalance of the nutrition. The next part of the intervention includes reducing bodyweight that directly reduces the complication associate with obesity that is also one of the major reasons for hypertension. The last aspect that includes improving the including mild exercise in routine like walking, yoga and meditation that directly help to maintain the blood pressure (Vamvakis et al. 2017).
  3. The educational intervention can be helpful to reduce surgical site infection and it will help to increase the patient understanding toward post-operative care. The educational intervention will help to understand the risk factors that are associated with post-operative inflammation that help them to be aware of the risk factor. The next aspect of the intervention includes increasing awareness about the different wound care technique that helps them to understand the self-care technique. The last aspect of the educational intervention includes increasing awareness about the importance of hand hygiene to reduce the infection and provide the understanding toward proper hand hygiene technique (Tartari et al., 2017).

Evaluate Your Nursing Care Strategies

The nursing care intervention suggested for Peter is non-pharmacological that help to reduce the chances of side effect that can occur due to pharmacological intervention. The nursing care plan will be tailored according to the patient need that helps to increase participation of the patient in the intervention that will lead to positive health status.

Reflection on Clinical Integration: Specialty Practice

This incident helps me to understand the importance of post-operative care and how as a nurse it is important to continuously monitor the patient to reduce the complication. The incident makes me realise that as a nurse I need to be more attentive toward the patient so that proper care can be provided to improve the health status of the patient. I would try to use my learning in future practice to improve patient assessment and reduce the chances of complication. This incident helps me to improve my patient assessment skills that can be used in future to improve the clinical practise skill.

Conclusion on Clinical Integration: Specialty Practice

The case study is about Peter he is a 62-year-old man and he administered to the hospital following the open mesh inguinal hernia repair. The medical history of Peter reflects the presence of obesity, hypertension, hyperlipidaemia and mild congestive heart failure. Peter complains about the chronic pain, his vital indicate increase blood pressure and respiratory rate. The nursing assessment reveals the inflammation at the surgical site that is increasing complication and has a serous discharge from the dressing. The processing of the information revealed that many individual and external factors are associated with an inguinal hernia which is related to Peter. The three important aspects that require urgent attention include chronic pain, hypertension and surgical site infection. The intervention that can help to reduce complication are acupuncture therapy, lifestyle intervention and educational intervention. This incident helps me to increase my understating toward the importance of post-operative care that I can utilize in future to improve my clinical practice.

References for Clinical Integration: Specialty Practice

Berri, T. (2019). Chronic neuropathic pain following inguinal hernia repair. Formos Journal of Surgery, 52(4), 111-21. Available from: http://www.e-fjs.org/text.asp?2019/52/4/111/265487

Bowyer, A., Royse, C. (2016). The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications. Canadian Journal of Anesthesia 63, 176–183. https://doi.org/10.1007/s12630-015-0508-7

Cai, L. Z., Foster, D., Kethman, W. C., Weiser, T. G., & Forrester, J. D. (2018). Surgical site infections after inguinal hernia repairs performed in low- and middle-human development index countries: a systematic review. Surgical Infections, 19(1), 11–20. DOI:10.1089/sur.2017.154

Gummesson, C., Sundén, A., & Fex, A. (2018). Clinical reasoning as a conceptual framework for interprofessional learning: a literature review and a case study. Physical Therapy Reviews, 23(1), 29–34. DOI:10.1080/10833196.2018.1450327

Kokotovic, D., Burcharth, J., Helgstrand, F., & Gögenur, I. (2017). Systemic inflammatory response after hernia repair: a systematic review. Langenbeck’s Archives of Surgery, 402(7), 1023–1037. DOI:10.1007/s00423-017-1618-1

Molegraaf, M., Lange, J., & Wijsmuller, A. (2016). Uniformity of chronic pain assessment after inguinal hernia repair: a critical review of the literature. European Surgical Research, 58(1-2), 1–19. DOI:10.1159/000448706

 Nadella, N. & Howell, S. J. (2015). Hypertension: pathophysiology and perioperative implications. BJA Education, 15(6), 275–279, https://doi.org/10.1093/bjaceaccp/mkv001

Öberg, S., Andresen, K., & Rosenberg, J. (2017). Etiology of inguinal hernias: a comprehensive review. Frontiers in Surgery, 4 (52), 1-8. DOI:10.3389/fsurg.2017.00052

Tartari, E., Weterings, V., Gastmeier, P. (2017). Patient engagement with surgical site infection prevention: an expert panel perspective. Antimicrobial Resist Infect Control, 6(45), 1-9. https://doi.org/10.1186/s13756-017-0202-3

Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R., Simmons, S., Glick, R. & Zador, V. (2018). Evidence-based nonpharmacologic strategies for comprehensive pain care. EXPLORE, 14(3), 177–211. DOI:10.1016/j.explore.2018.02.001

Vamvakis, A., Gkaliagkousi, E., Triantafyllou, A., Gavriilaki, E., & Douma, S. (2017). Beneficial effects of nonpharmacological interventions in the management of essential hypertension. JRSM Cardiovascular Disease, 6, 1-6.

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