Introduction

Sonia has suffered from a motor car accident and undergone laparotomy. She is 36 years of age and has been shifted to the ward immediately after the operation. Her vital signs appear normal but there are events that suggest internal bleeding and this could be fatal. Also, post-operative nursing management for Sonia requires care for her body movements while she is asleep in order to keep a check that she does not hurt her operated regions. Along with this, proper flow of chest drains requires intensive care throughout the night. The paper is an assessment of a post-operative nursing management immediately when the patient is shifted to the ward at 10 PM. The essay will look into each specific criticality of the operation and treatment to highlight the care management that is necessary immediately after the laparotomy.

Assessment and Care for L Pneumothorax (ICC inserted)

For ICC insertion, postoperative care would require in positioning of the patient. Conversion to a portable system of flutter valve like a pnemostat would be helpful in facilitating positioning of the patient if the requirement for chest drains is long. The patient also needs to be assisted for regular shifts in position throughout the night so that drainage is facilitated. Also, the nurse has to be careful with dressing and should maintain it dry and intact for preventing infection (Evans, 2012).

Assessment and Care for Lacerated spleen

The postoperative care of a lacerated spleen lasts for about 5 to 14 days depending upon the treatment of other injuries. The first 24 to 48 hours of the patient is extremely important after operation. The nurse has to take care for evidences of recurrent bleeding if the case has been for splenorrhaphy and should also check for areas of new bleeding for vascular structures that have been inadequately litigated or missed out. He nurse has to maintain a nasogastric tube for the next 48 hours after operation on a low level of intermittent suction to reduce risks associated with failure of litigation owing to short gastric along with a distended stomach (Bjerke and Geibel, 2014).

Laparotomy care requires that post operation, patients are monitored continually for vital signs, output and intake and CVP. Record of properties of drain darai has to be maintained regularly to take a note of amount and colour of drainage. For pain management, the nurses should provide with analgesia at regular intervals all day. Diazeparn has to be used for muscle spasms. Suspected case of internal bleeding is a critical case and need a regular check for vital signs along with an examination of history.

Assessment and Care for # L shaft of femur

It is recommended that septic work ups are not undertaken at temperatures that fall less that 38 degree centigrade. The therapy after operation has to be focussed on mobility and transfer management. Postoperative care of femur rehabilitation requires beginning of physical therapy from the very first day after the operation. This includes a range of gentle motion activities and weight bearing exercises towards the ambulation program. The patient can be allowed to use the bilateral crutches almost immediately after the surgery (Paterno et. al, 2015).

Assessment and Care for Suspected internal bleeding not identified during surgery

The case of Sonia, historical records do not suggest any evidences and so the care has to undertake a physical examination for evidences. Blood tests can be conducted to see if the count for RBC is low. For Sonia, the information on operation suggests that internal bleeding might occur in the gastrointestinal region. Nursing care requires that regular checks for blood pressure and consciousness are conducted in order to determine any emergency cases of internal bleeding that might need immediate attention. The nurse also has to make sure that the patent is breathing and the airway is open. Pulse rate detections have to be done at regular intervals to ensure that the circulation is adequate (Wedro, 2015).

A CVP line is essential to detect the balance loss and replacement as opposed to normal blood pressure check. Oxygen should be provided regularly. Access to venous has to be secured at early stages. In case of complication in ICC and hypovolemic shock, it is possible that replacement of fluid prior to occurrence of haemorrhage might just cause further internal bleeding.

In order to prevent the worst case of internal bleeding, any evidence of loss in circulating volume has to be diagnosed quickly to avoid before condition becomes critical. Areas of chest drain have to be observed for HR, BP, RR and SaO2 in every 15 minutes to one hour. Patients who are kept under ventilation face higher risk of lung collapse. Nursing care requires a constant check of drain clamping or presence of air leakage.

Moving and organization of the patient needs to be done with extreme care so that the drain does not get uprooted. Diet care would require that sufficient amounts of protein and vitamin C are infused in the patient to avoid infections and allow faster healing. Since Sonia has been just released from the OR, the anaesthesia must be quite strong and this has removed any voluntary control on the urinary function. It is also important to check for the colour, consistency and amount of stomach contents to test gastro intestinal function at every 6 to 8 hours (Sarjunipadang, 2013).

Literature Review

There are three main regions that need post-operative attention critically in the case of Sonia. The first is internal bleeding and lung function where air passage through a one way valve enters the pleural space but finds no way to leave. This might lead to decrease in the venous returns and thereby cause lung collapse causing a life threatening case of cardiovascular and respiratory compromise (Wedro, 2015). The second is care for trauma where overnight care of the patient would also include diagnosis for other signs of shock because the patient has undergone a case of trauma and there is an immense risk that she might just bleed to death (Cirocchi et al, 2013). The third is management of post anesthesia patients where resuscitation should be accompanies with crystalloid like normal saline. In the event of internal bleeding, blood has to be provided as soon as possible through fast devices of infusion and this has to be quick in case of excessive blood loss (Kaplow, 2010).

Conclusion

Nursing management requires care for patient movement after operation for laparotomy and regular checks for blood pressure and consciousness are conducted in order to determine any emergency cases of internal bleeding that might need immediate attention. Laparotomy also requires regular check for vital signs for any evidence of internal bleeding. Lastly, nursing management requires that the urinary catheter is checked from time to time during the night to ensure that there is no event of infection.

 

 

References

Bjerke, H. S. and Geibel, J. (2014). Splenic Rupture Treatment and Management. Retrieved from: http://emedicine.medscape.com/article/432823-treatment

Evans, J. (2012). Chest Drain Management – Clinical Guidelines. Retrieved from: http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_Drain_Management/#management

Paterno, M. V., Archdeacon, M. T., Ford, K. R., Galvin, D. and Hewett, T. E. (2015). Early Rehabilitation Following Surgical Fixation of a Femoral Shaft. Physical Therapy, 95, 558-572.

Cirocchi, R., Montedori, A., Farinella, E., Bonacini, I., Tagliabue, L., Abraha, I. A. (2013). Damage control surgery for abdominal trauma (Review). Cochrane Database of Systematic Reviews, 3. Art. No.: CD007438. DOI: 10.1002/14651858.CD007438.pub3.

Kaplow, R. (2010). Damage control surgery for abdominal trauma (Review). Critical Car Nurse, 30(1), 60-63.

Sarjunipadang, A. (2013). Nursing Care post op Laparotomy. Retrieved from: http://alisarjunipadan.blogspot.in/2013/03/nursing-care-post-op-laparotomy.html

Wedro, B. (2015). Internal Bleeding. Retrieved from: http://www.medicinenet.com/internal_bleeding/page4.htm