Assignment- Clinical case study
The patient in the given clinical scenario can be observed to be returning to the post-operative care ward, after undergoing his surgery of open cholecystectomy. During the surgery the patient was managed on three main general anesthetic drugs. These included Rocuronium, Fentanyl and Propofol. The drug Rocuronium is mainly used to cease the functioning of the muscles of the body. It brings about a paralytic effect in the body the means of blocking the secretion of the neurotransmitters. Whereas, the other two drugs viz. Fentanyl and Propofol are two of the most common choice of drug given during surgical procedures, in order to attain an unconscious state for the person, throughout the procedure. This state of unconsciousness is very crucial to be maintained in order to keep the patient relaxed and free from any suffering during major surgical interventions. The administration of general anesthesia is usually given in high doses in complicated surgeries. While it is an imperative step of the surgical procedure, it might leave the patient with some commonly observed complication post- administration. During surgery the patient is kept on artificial ventilation in order to provide them with respiratory support. However, during major surgeries like cholecystectomy, the patient might be kept on ventilation a little longer than anticipated. This could have been possible in our given case study as well. After surgery these patients might experience respiratory depression or might not be able to have a normal respiratory pattern all together. The administration of Rocuronium is mainly done as a neuromuscular block form. This can have several detrimental effect on the individual such as insufficient lung expansion, inefficient working of respiratory muscles and so on. This can lead to accumulation of secretions in the chest cavity after surgery and also due to underlying respiratory insufficiency as well. This neuromuscular block can also bring about a partial loss of the involuntary movement in the body and thus, reduced expiration as well. The cumulative effect of the same, tagged along with impaired respiratory muscle functioning can bring about an impaired airway clearance. This is also difficult for the patient to manage on his own in voluntary manner, as he might be having a severe pain due to surgery, restricting his overall functioning. The other main complication that can be observed in this case scenario is patient having hypertension as well as gastric oesophageal reflux. This can also be attributed to his life style choices such as sedentary life style, smoking, drinking and him having a high BMI of obese category. Obesity in itself is a major risk factor that might give rise to not only many other complications but might also be a hindrance in managing the clinical condition of the patient. The patient is at a risk of developing multiple complications such as deep vein thrombosis, due to prolonged bed rest, reduced urine output leading to acute kidney injury, developing atelectasis due to reduced and inefficient airway clearance. The paper will focus on goals setting and nursing interventions for managing the patient’s condition in a holistic manner.
The main goal is to ensure patient’s comfort and help him in maintaining an efficient airway conduction. This can be attained through the following methods:
The interventions suggested for the Darren’s case have to be evaluated as well, to examine whether they are apt for the given case scenario or not. The interventions plan for Darren can be evaluated as follow:
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