Primary Issues in a Scenario of Laparotomy and Right Hemi-Colectomy

Following the clinical reasoning cycle, the first step involves considering the patient situation. In the scenario of Mr. Fraser, who has gone through the Laparotomy and Right Hemi-colectomy, the level of glucose and electrolyte in the body will be considered as the first step of a care plan (Bheemasenachar, 2014). This is because of the due to a post-operative fluid loss that is likely to suffer from a fluid imbalance in the body, and since the operation was done at the Right Hemi-colectomy, the patient is expected to have prepared for the surgery by ceasing from taking solid and colored food for twenty-four hours. The glucose level, therefore, reduced in the body during this period and subsequently after the surgery (Fitzgerald, 2013).

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The second factor to consider for Mr. Fraser scenario is the level of inflammation in the form of pain that he is in after surgery without analgesic drugs. Because of post Laparotomy and Right Hemi-colectomy, the patient must be put under anesthesia and in case the effect of the drug has gone down in the patient's system (Ikeda, Sannohe & Murayama, 2011).

A Cluster of Abnormal Cues in the Laparotomy and Right Hemi-Colectomy Scenario and Pathophysiology Related to the Health Breakdown Occurring

In the process of gathering the patient's cue information, it was realized that preparation of the patient involved emptying bowel. This was one of the requirements to undergo laparotomy and right hemicolectomy. During the preparation, the patient was advised to take only clear liquid for the clearing of the abdominal intestine to be fully accomplished before a surgical operation. This deprives the patient of the particular food that contains glucose nutrients in plenty. As a result of this, the patient is likely to suffer from hypoglycemia because of the low level of glucose. The condition of hypoglycemia occurs when the glucose level drops below 70mg/dl in the patient's blood. The pathophysiology of hypoglycemia relates to the in brain dysfunction and reduction sympathetic activation. The sympathetic activation leads to stimulation of sympathoadrenal nervous system.

The stimulation will subsequently lead to anxiety, tremulousness, palpitation, sweating, and hunger. Similarly, the hypoglycemia leads to a reduction in the cerebral glucose obtainability, the condition that is called, neuroglycopenia, which predisposes the patient to difficulty in concentration, confusion, irritability, focal impairment, that is hemiplegia, hallucinations, and, ultimately, coma and death if it is not well managed in time.

In some cases, when the hypoglycemia is not attended with the correct remedy in time. It may lead to adrenergic symptoms, due to neuroglycopenia. These effects of hypoglycemia are as a result of low catecholamines, which are primarily stimulated by plasma glucose in the body. Due to the adverse impact of low glucose level, there is a requirement to monitor the patient regularly for the symptoms that may suggest low glucose level and also watching the intravenous cannula in the left hand, with 4% Dextrose in 1/5 Normal Saline solution for any possibility of being used up.

Secondly, because of the high pain, Mr. Fraser was subjected to when during laparotomy and right hemicolectomy; the patient must stay under the influence of analgesic drugs. If the pain persists for a long time without remission, it is likely to develop adverse effects on the body's hormonal (endocrine), immune, neurological, musculoskeletal and cardiovascular system. These effects of unremitted pain are likely to result in further complications apart from just pain. The physiological function of any area of the anatomy of the patient that undergoes severe and persistent pain will be deconditioned and loss the function (fuctio-lesser). This result in the following failure in coordinated movement; symmetric and regular service hence the patient is likely to be immobilized and self-splint. The pathological effects will be neuropathies, muscle atrophy, and eventually contractures and death if it is not controlled. The abdominal pain due to later the surgery if not consider in time beget others painful conditions.

To make up for this weak and painful abdomen, other body organs will also attempt to strain to compensate for the pain. Chronic and severe unremitted pain due to Laparotomy and Right Hemi-colectomy may lead to degeneration, hence causing neuropathies, myopathies, and arthropathy (Palmer & Smith, 2016). The other pathophysiological effect of pain is hypertension and tachycardia triggering. Similarly, the results of uncontrolled and persistent pain in any part of the body affect the endocrinal system in the body. This is due to excess production of choline and corticoid hormones such as catecholamine and glucocorticoid respectively due to their neurologic etiology caused by uncontrolled pain. Because of this the cardiovascular disease and even death may occur due to illness as an adverse effect.

Actual Nursing Problem or Diagnosis With a Related to and Evidenced

For a definitive diagnosis of hypoglycemia to be carried out, a systematic approach is used, which call for measurement of glucose, glucose-regulating hormone, ketones and lactates concentration in the body. This measurement is to be performed to the patient he undergoes an IV cannula in the left hand, with 4% Dextrose in 1/5 Normal Saline solution running at 80 ml/hour and when the patient is in the fasting state. To establish the final diagnosis, an enzymatic is performed for the establishment of a diagnosis (Williams, 2017).

Since pain is the subjective and personal experience of the patient who is a victim, the nurses have a problem with measuring the pain. They rely on the patient's explanation of the kind, location, and timing of pain. The patient definespain as sharp, on-and-off, constant, which will be used to give clues on the intensity of the pain.

Goal to Address the Laparotomy and Right Hemi-Colectomy, and Set Outcome Criteria

In the case of managing hypoglycemia, the nurse practitioner is to administer the patient with dextrose, glucose, galactose and another form of carbohydrates through Intravenous way as first-line therapy. This glucose dispensation through the intravenous means should be continued for seven days to allow the intestine healing process to commence, after that, the patient will be subjected to liquid food for a period of another seven days.

For pain, the nurse practitioner will administer the analgesic drugs to the patient, although the use of tranquilizer will as recommended until the patient gets well to manage himself. These will help to soothe the pain as in depressing the nerves on Central Nervous system that are responsible for pain sensation.

Priority Nursing Actions to Achieve the Stated Goal

The administration of dextrose 5% through intravascular is the best action; this involves increasing the rate from 4% to about 5%. This dextrose is administered with 0.225% normal saline. The doctors in charge of the patient should be called immediately so that the IV rate may be increased.

The patient should be monitored closely for the relapse of the condition prevention in 24 hours after the surgery. In case of the shift, the oncoming nurse should be informed of the hypoglycemia condition. The protocol which involves the provision of a notice to deliberate on the possible cause of the hypoglycemia is to be communicated (Kawamura et al. 2016).

In the case of pain, the nurse should administer any form of the analgesic drug. This will be done after reviewing other medications that the patient has been administered to for precaution to be taken interaction that might occur. This will take place when the patient is found responsive. In cases of unresponsiveness, the patient should be a priority should be taken with an assumption that the patient has not taken any antagonistic drug.

The patient can in great pain as well be subjected to sedative drugs such as Amobarbital (Amytal), Aprobarbital (Alurate) Butabarbital (Butisol). Others such as Mephobarbital (Mebaral), Methohexital (Brevital), Pentobarbital (Nembutal), Phenobarbitol (Luminal), Primidone (Mysoline), Secobarbital (Seconal), Thiopental (Penothal) or any other that can be administered through the IV route. This should be administered to the patient at full dose (Haddad, 2015).

Provide a Rationale for Actions

Since the patient has gone through Laparotomy and Right Hemi-colectomy, he cannot be subjected to oral route drugs. Subsequently, the patient there is a need for quick recovery, the patient is to be subjected to intravenous drug route. This makes the drug to be derived from the system of the patient and provide fast-acting, an immediate therapeutic effect.

Provision of 5% dextrose to the patient will fasten the normalization of the glucose level in the patient. Because the patient has undergone surgery, there is blood loss, dehydration fluid result in loss extracellularly (Gordon, 2013). The normal saline 0.225% is isotonic hence will maintain the osmotic pressure, Preventing the cell from crenation and lysis of the cell (Zummo, 2015).

There is a need to monitor the patient for 24 hours after the surgery to respond to any abnormal sign that may develop hence providing the patient's safety. Provision of timely response and recognition of the early clinical problem in the patient is achieved by monitoring (Palmer, & Smith, 2016). The continuous vital sign monitoring is combined with an alarm notification to enable nurses to ensure the patient's safety.

In the case of pain, since analgesic drugs have the capability of depressing the Central Nervous System (CNS), the use of the drug has the capability of lowering the pain sensation in the patient's system (Dowden, 2012). This will make the patient feel comfortable as he stabilized in the ward after the surgery.

Reference to Scientific Best Practice Literature

The analgesic drugs administration should be with consideration the patient's behavioral characteristics and hypersensitive reaction to the drugs. This characteristic includes age, comorbidities, and psychologic rate preoperative response to history to analgesic. Post-operative administered opioids are the mainstay therapy.

The post-operative care unit should consider monitoring of glucose, if the glucose level is below 100 mg/dl, the dextrose is to be administered. Development of hypoglycemia control protocol in patients as a post-operative care unit, and adhering to the protocol strategy.

The intravenous route of drug administration that contains normal saline has side effects, and if the patient has a history of fever, swelling at the injection site, redness or any form of inflammation due to IV, it should be considered. The dosage of the IV should also depend on weight and age of the patient.

The monitoring of the patient should be done continuously with close attention being on the areas that were previously considered to be the origin of their ailment. This should be done will keenness on what are the side effect of the drugs that the patient has been administered.

References

Bheemasenachar, P. (2014). Post-operative critical care. Core Topics in Critical Care Medicine, 3(8), 159-169. doi:10.1017/cbo9780511712289.023

Dowden, S. J. (2012). Pharmacology of Analgesic Drugs. Managing Pain in Theater, 9(12), 39-66. doi:10.1002/9781444322743.ch4

Fitzgerald, R. (2013). Occupational Therapists, Care, and Managerialism.Clinical Reasoning in Occupational Therapy, 3(12), 45-62. doi:10.1002/9781118702833.ch4

Goertz, G., & Mahoney, J. (2017). Causes-of-Effects versus Effects-of-Causes. Princeton University Press, 5(3), 78-80. doi:10.23943/princeton/9780691149707.003.0003

Gordon, G. H. (2013). Dextrose Saline Compared With Normal Sa...