Case Study with Short Answer Questions
Case Study with Short Answer Questions
Attached Files:
• READING SHORT ANSWER ASSESSMENT Determining the Use of Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain Management and the Influencing Professional Factors.pdf READING SHORT ANSWER ASSESSMENT Determining the Use of Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain Management and the Influencing Professional Factors.pdf – Alternative Formats (255.041 KB)
• READING SHORT ANSWER ASSESSMENT Role of the nurse in supporting the safe use of opioids.pdf READING SHORT ANSWER ASSESSMENT Role of the nurse in supporting the safe use of opioids.pdf – Alternative Formats (220.111 KB READING SHORT ANSWER ASSESSMENT Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery_
Aim of assessment
The aim of this assessment is to enable students to complete the short answer questions using evidence based information from relevant literature.
Due Date
Word Count
There is a word limit of 1200 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10% word count. If you exceed the word limit by more than 10% the marker will stop marking at 1200 words plus 10%
Assessment Marking Criteria
The marking criteria for this assessment can be found in the Learning Guide. It is important that you read this PRIOR to commencing this assessment so that you are fully aware of the criteria and marks for each section of this assessment.
Case Study
Mr John Hemsley, 56 years old, presented to his general practitioner (GP) with a three-month history of constipation and abdominal discomfort. More recently he has felt very fatigued and has been experiencing lower abdominal pain. In the weeks prior consulting the GP, Mr Hemsley noticed his stools were long and narrow with small amounts of bright blood on the toilet paper. He ignored these signs and symptoms as he was too embarrassed to talk about them. The GP performed a digital rectal examination to rule out the haemorrhoids. The findings were a firm irregular non capsulated mass in John’s rectum. The GP arranged a consultation with a gastrointestinal specialist. The specialist scheduled a colonoscopy for John the following week. During the colonoscopy, a biopsy was taken of the large sessile lesion located in the proximal third of John’s rectum. Three polyps were also removed from John’s colon. The biopsy results confirmed a stage IIA rectal adenocarcinoma. Following these findings John was scheduled for surgery the following day to have an abdominal-perineal resection and the formation of a sigmoid colostomy. There were no complications reported during John’s surgical procedure. Postoperatively John has been commenced on analgesia of I.V. Morphine 2.5mg – 5mg PRN 2-4 hourly and I.V. 4mg-8mg Ondansetron PRN 8 hourly for nausea.
Additional Medical/Social background:
John states that his father died from bowel cancer at the age of 84 years old and his younger brother was diagnosed with Crohn’s disease when he was 18 years old. John states he was quite active as a “young manâ€but over the last 10 years does not do any form of regular exercise and has gained 20kgs. He did admit to the “occasionalâ€cigarette on the weekends but did say how he was proud to have now “given upâ€regular smoking of cigarettes for the last 5 years. John’s current weight is 107kgs.
Three (3) Short Answer Questions
In addressing the Australian National Health Priority Area of bowel cancer prevention and treatment use a person centred care approach to respond to the following:
Question 1: Postoperatively, Mr. Hemsley has been ordered PRN I.V. 2.5mg to 5mg Morphine for his pain relief. Discuss one (1) nursing care consideration for the safe administration of this medication.
Question 2: Discuss one (1) non-pharmacological nursing comfort measure you can undertake to help manage Mr. Hemsley’s postoperative pain.
Question 3: A sigmoid colostomy was performed on Mr. Hemsley during surgery. Discuss one (1) nursing consideration when caring for the patient with a colostomy during the postoperative period.
References
A minimum of 5 references are to be used for this assessment that include the three (3) mandatory references that are provided. The three (3) mandatory references are located on the Subject vUWS site under the Assessment section for this assessment.
Mandatory three (3) references
Gumus,K., Musuroglu, S., Ozlu, Z.K., & Tasci, O. (2020). Determining the Use of Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain Management and the Influencing Professional Factors: A Multicenter Study. Journal of PeriAnesthesia Nursing, 35, 75-79. https://doi.org/10.1016/j.jopan.2019.04.011
Telford, A. (2020). Role of the nurse in supporting the safe use of opioids. Nursing Standard, 35(9), 77-82.
Zelga, P., Kluska, P., Zelga, M., Piasecka-Zelga, J., & Dziki, A. (2021). Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery. J Wound Ostomy Continence Nursing, 48(5):415-430.
Submission
Electronic copy only. Students are to submit an electronic copy of the assessment.
Submit your assessment electronically through the Turnitin link
Students are to upload the assessment with the following title; Surname_Firstname_assessment title 4. Your assessment must be submitted in .doc, docx format
Pain Management
Student’s Name
Institutional Affiliations
Pain Management
Bowel cancer is among the chronic diseases that are causing deaths and poor health quality among populations worldwide, including in Australia. One of the Australian National Health Priority Areas is to reduce deaths due to bowel cancer through timely diagnosis, effective treatment, and proper pain management (Australian Institute of Health & Welfare, 2022). When employing a patient-centered care approach in practice, nurses must use evidence-based strategies for postoperative pain management. In the given case study, Mr. John Hemsley has just had an abdominal-perineal resection and the formation of a sigmoid colostomy. The purpose of this assignment is to provide short answers to questions related to the case study using evidence-based strategies to support the presented claims.
Question 1: Postoperatively, Mr. Hemsley has been ordered PRN I.V. 2.5mg to 5mg Morphine for his pain relief. Discuss one (1) nursing care consideration for the safe administration of this medication.
Opioids such as Morphine are a group of drugs that are widely used in healthcare settings to manage different types of pain including cancer pain, postoperative pain, and acute pain. To ensure the safe administration and use of opioids, nurses must understand their pharmacology, benefits, risks, and side effects (Telford, 2020). Mr. Hemsley is under postoperative care following a sigmoid colostomy. He has been ordered PRN I.V. 2.5mg to 5mg Morphine for his pain relief. One nursing care consideration for the safe administration of this medication is the slow injection of the drug at the time of administration and utilizing controlled infusion rates of 5 mg after every 4 hours or 2.5 mg hourly (National Health Services, n.d.). Slow injection and intermittent administration of morphine prevent the occurrence of adverse events and enhance the medical effectiveness of the drug.
Evidence-based research supports the effectiveness of slow injection and intermittent administration of morphine in ensuring patient safety. For instance, Arthur et al. (2019) conducted an anonymous cross-sectional survey to understand the perceptions and practices of oncology nurses regarding intravenous infusion of opioids for the management of cancer-related pain. The researchers found that an infusion speed of more than 120 seconds is considered to be safe while a speed less than that is considered too fast. They also found that most nurses use a timing device to prevent speedy infusion rates. Evidence from the study advocates for intermittent administration of intravenous opioids for pain management. Guided by this evidence, the nurse involved in the care of Mr. Hemsley should be careful to administer the drug slowly and intermittently based on the chosen dose: 2.5 mg hourly or 5 mg after every four hours.
Question 2: Discuss one (1) non-pharmacological nursing comfort measure you can undertake to help manage Mr. Hemsley’s postoperative pain.
Nurses usually implement both pharmacological and non-pharmacological strategies for postoperative pain management. Gumus et al. (2020) reported a number of non-pharmacological approaches commonly used by nurses in clinical practice settings to promote postoperative pain management. A proposed non-pharmacological nursing comfort measure that the nurse can undertake to help manage Mr. Hemsley’s postoperative pain is the use of distraction. Distraction entails turning the attention of the patient towards something pleasant or engaging him or her in storytelling to prevent them from feeling pain. A survey that was conducted in Turkey to understand the non-pharmacological pain management approaches used in postoperative care rated the use of distractions at 42.2% which was a sign of increased use (Gumus et al., 2020). Nurses will be influenced to use distraction for postoperative pain management in Mr. Hemsley’s case when they adequately understand how to implement it with patients.
Distractions have proven effective in reducing pain in patients who have undergone surgery. In their study, Komann et al. (2019) assess the frequency with which 15 non-pharmacological approaches were used to manage postoperative pain in operative patients and their effectiveness in relieving pain. The researchers collected data from an international acute postoperative pain management registry. Findings from the study revealed that the most frequently used non-pharmacological pain management strategies with post-surgical patients include the use of cold packs and distraction. Both approached were effective in relieving pain and this influenced their increased use. The researcher recommended the complementary use of these non-pharmacological strategies with pharmacological approaches for effective management of pain in post-surgical patients (Komann et al., 2019). For nurses to effectively use distraction to help manage Mr. Hemsley’s postoperative pain, they need to be trained on how to implement the approach and clear guidelines should be developed to direct their practice.
Question 3: A sigmoid colostomy was performed on Mr. Hemsley during surgery. Discuss one (1) nursing consideration when caring for the patient with a colostomy during the postoperative period.
The goal of the nurse who is caring for post-surgical patients should be to prevent all forms of complications that might hinder speedy recovery and contribute to poor quality outcomes. To achieve this goal, the nurse needs to consider and address factors that are associated with postoperative complications (Zelga et al., 2021). A colostomy is a surgical procedure that is conducted to divert one end of a colon to an opening usually in the tummy. A nursing consideration that the nurse should make when caring for a patient with a colostomy during the postoperative period is to observe the patient for any allergies or sensitivities that might occur on the skin around or at the stoma site (American Cancer Society, 2022). The patient’s skin might react to the adhesives, pouch, skin barrier, pouch material, or tape in the operated part. The nurse can work with colleagues to ensure that the materials are replaced to prevent the patient from developing complications.
It is worthwhile noting that another way to prevent sensitivities and allergies around the stoma is to keep the area clean at all times. The nurse should be careful to use an appropriate pouch size. Additionally, the skin barrier opening should neither be too large nor too small to prevent skin irritation. Moreover, the nurse should change the pouch regularly to avoid skin irritation and leaking. Developing a clear schedule to change the pouch can be helpful in this case. The nurse should not wait for the patient to complain of problematic signs such as burning and itching before changing the pouch. Again, the nurse should be extra careful when changing the pouching system. The American Cancer Society (2022) warns against removing the pouch system or the skin barrier more than once a day. It is also advisable that the nurse cleans the skin around the stoma thoroughly with water and dry it completely before placing the pouch or skin barrier. Taking these precautions will prevent Mr. Hemsley from developing complications during the postoperative period.
References
American Cancer Society. (2022). Caring for a colostomy: Protecting the skin around the stoma. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/surgery/ostomies/colostomy/management.html
Australian Institute of Health & Welfare. (2022). Cancer control: National Health Priority Areas. https://www.aihw.gov.au/getmedia/8100375f-0f50-4d29-8c9d-71735a24e7ab/nhpacc97.pdf.aspx?inline=true
Arthur, J. A., Reddy, A., Smith, U., Hui, D., Park, M., Liu, D., Vaughan-Adams, N., Haider, A., Williams, J., & Bruera, E. (2019). Practices and perceptions regarding intravenous opioid infusion and cancer pain management. Cancer, 125(21):3882-3889. doi: 10.1002/cncr.32380.
Gumus,K., Musuroglu, S., Ozlu, Z.K., & Tasci, O. (2020). Determining the use of nonpharmacologic methods by surgical nurses for postoperative pain management and the influencing professional factors: a multicenter study. Journal of PeriAnesthesia Nursing, 35, 75-79. https://doi.org/10.1016/j.jopan.2019.04.011.
Komann, M., Weinmann, C., Schwenkglenks, M., & Meissner, W. (2019). Non-pharmacological methods and post-operative pain relief: an observational study. Anesthesiology and Pain Medicine, 9(2), e84674. https://doi.org/10.5812/aapm.84674
National Health Services. (n.d.). Pain management. Clinical guideline. https://mm.wirral.nhs.uk/document_uploads/guidelines/Pain_Management_clinical_guidelinesv2.pdf
Telford, A. (2020). Role of the nurse in supporting the safe use of opioids. Nursing Standard, 35(9), 77-82
Zelga, P., Kluska, P., Zelga, M., Piasecka-Zelga, J., & Dziki, A. (2021). Patient-related factors associated with stoma and peristomal complications following fecal ostomy surgery. Journal of Wound Ostomy Continence Nursing, 48(5):415-430.