Assessment of patient, knowledge of pathophysiology, pharmacology and nursing care Essay Example

Discussion of Initial Medical Treatment and Medical Orders

Briggs (2010) defines a chest x-ray as a non invasive radiography test done to look for abnormalities in the chest, lungs, heart, ribs, diaphragm and large arteries (p. 48). With a history of asthma it is important for Jane to have the X-ray prior to surgery for the surgeon to visualize the status of her chest structures and whether she is fit for surgery to prevent further complications. The results of her results are displayed as bilaterally clear with normal cardiac shadow an indication of no heart enlargements.

Patients with appendicitis require full blood count which examines red blood cells, white blood cells and platelets determining their number per liter of blood (Fergusson, Hitos, & Simpson, 2002). Test results for Jane are expected to give an over 75 percent of WBC in her blood indicating signs of infection due to inflammation of the appendix. The blood tests may also show dehydration or fluid and electrolyte imbalance.

Measurement of the serum urea nitrogen is done together with serum creatinine to assess the renal function. Urea levels in Jane would be above the normal range of 3.0-8.0mmol/ L. This is because of dehydration caused by vomiting (Wyer, 2008).

Creatinine is a produced from metabolism in muscles and its production is independent of fluid intake, exercise or diet. Results for serum creatinine are expected to be slightly elevated due to dehydration caused by vomiting but not due to kidney dysfunction confirming a case of appendicitis (Wyer, 2008).

Jane would be diagnosed with electrolyte imbalance due to vomiting that eliminates fluid from the body thus concentrating electrolytes in the serum. The results will be useful to monitor hydration status and concentration of electrolytes.

An abdominal ultrasound is an imaging procedure that uses high frequency sound waves to give a two-dimensional image of the body’s soft tissues liver, gallbladder, spleen, pancreas and kidney to reveal possible condition like appendicitis or gallstones (Weston, Jackson & Blamey, 2005). In patients with normal appendix, it cannot be visualized sonographically therefore any visualization is an indication of appendicitis (Rosengren, Brown & Chu, 2004).

Abdominal x-ray (AXR) is a test conducted to diagnose abdominal conditions. However, on its own it cannot diagnose appendicitis and that’s why there is need to combine it with abdominal ultrasound (Karkhanis & Medcalf 2009).

Initial medical treatment for Jane required she fast from fluids and foods to reduce the risk of aspiration or regurgitation which can result due to high acid content in the stomach and also the large volume of food content in the stomach. Fasting reduces the risk of vomiting after the operation.

Fluid balance charts are important after the surgery especially because Jane will most likely be receiving intravenous therapy. They are sued to measure intakes of fluids as soup 0or water or intravenous fluids in relation to their output in urine, vomiting or bleeding of the wounds. Keeping these measurements is essential to ensure that Jane is kept at constant hydration to avoid running the risk of electrolyte imbalance.

Intravenous therapy with 1L normal saline solution for 8 hours prior to surgery is meant to provide Jane with treatment of electrolyte imbalance because oral fluid intakes are inhibited to replace fluids that have been lost due to vomiting.

Preparation which will be done on Jane by the nurses prior to surgery include proper documentation of an operative checklist, patient history and medical examinations and results, surgery consent form signed by the patient as well as provision of information concerning the surgery on diagnosis, importance of the surgical procedure an dhow it is going to be conducted, risks and consequences if the surgery is not performed as well as the risks associated if the surgery is performed for Jane to give an informed consent.

Prochloroperazine is a dopamine receptor antagonist. It acts by blocking the D2 somatodendritic autoreceptor ending up in blockage of dopamine receptors that are found in the mesolimbic system and a rise in dopamine turnover (Reddy, 2007). It also blocks anticholinergic and alpha-adrenergic receptors where blockage of alpha adrenergic receptors results into sedation, muscle relaxation and hypotension. Prochloroperazine is prescribed to control severe vomiting and nausea which Jane experienced. Side effects include drowsiness, dizziness, blurred vision, dry mouth, stuffed nose, headache, nausea, constipation, difficulty in urinating, weight gain, agitation, jitteriness, increased appetite, widening or narrowing of the pupils, shuffling walk, drooling and difficulty in falling or staying asleep. The drug is contraindicated for patients with a history of phenothiazine hypersensitivity, it can cause loss of consciousness if combined with desferroxiamine while depressants and alcohol can cause enhanced CNS depression. It can diminish effects of anticoagulants like warfarin.

While administering this drug nurses should advice the patient against driving or operating machinery because it causes drowsiness.

Fentanyl is a potent narcotic pain-reliever with a speedy inception within a short duration of action. It is used commonly as a pain reliever and as an anesthetic when combined with benzodiazepine. Mechanism of action gives some effects through its agonism of the opioid receptors (Sharwood &Babl, 2009). It is highly potent due to its lipophilicity and hence it easily penetrates the CNS. Side effects include diarrhoea, nausea, dry mouth, confusion, dizziness, nervousness, depression, anxiety, flu-like symptoms, indigestion, dyspnea, urinary retention and abdominal pain. It is contraindicated in patients on antidepressants and it can increase absorption of paracetamol. It can result into hypotension especially if administered with other opioids. Care should be taken while being used by patients with respiratory difficulties as it can cause shortness of breath.

The nurses should assess the respiratory rate to ensure that the patient does not suffer collapse of the respiratory system. The patients should be assessed for possible sensitivity to opioids.

Reference list

Briggs, D. 2010. patients with intrapleural drains.of care and management Nursing NursingStandard, Vol. 24 no.21, p47-55,

Fergusson, J. A. E., Hitos, K & Simpson, E. 2002, Utility of white cell count and ultrasound in the diagnosis of acute appendicitis ANZ Journal of Surgery, Vol. 72 Issue 11, p781-785, DOI: 10.1046/j.1445-2197.2002.02548.x

Karkhanis S and Medcalf J2009. Plain abdomen radiographs: the right view?European Journal of Emergency Medicine. vol16, issue 5, p267-70

Reddy, C. & G, K. 2007. GS29P laparoscopic appendicectomy: to do or not to do. ANZ Journal of Surgery, Vol. 77, p32-32, DOI: 10.1111/j.1445-2197.2007.04119_29.x

Rosengren, D., Brown, A F.T and Chu, K. 2004. Radiological imaging to improve the emergency department diagnosis of acute appendicitis Emergency Medicine Australasia, Vol. 16 Issue 5/6, p410-416, 7p; DOI: 10.1111/j.1742-6723.2004.00643.x

Sharwood, L. N. and Babl, F. E. 2009. The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies. Pediatric Anesthesia, Vol. 19 Issue 5, p445-451, DOI: 10.1111/j.1460-9592.2008.02807.x

Weston A, Jackson TJ, and Blamey S, 2005. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: A systematic review and meta-analysis, International Journal of Technology Assessment in Health Care, Vol. 21 No.3, 368-79.

Wyer P.C. 2008. Review: symptoms, signs and lab tests have moderate accuracy for detecting appendicitis in children. Evidence Based Medicine, vol. 13, p.23.