National Survey and Secondary Data Analysis †MyAssignmenthelp.com

Question: Discuss about the National Survey and Secondary Data Analysis. Answer: Introduction: The current assignment deals with post-operative nursing care practices. Here, the patient Kathleen Johnson is a 45 years old lady who had been admitted to the hospital for sleeve gastrectomy surgery. Kathleen has morbid obesity with a BMI index of 40kg/m2 along with type 2 diabetes. She is also the sole carer of her father who has been suffering from dementia and suffers from low self esteem due to her negative body image. Kathleen has been dependent upon addictives such as alcohol, cigarettes and coffee for dealing with the stress in her life. Therefore, after the gastrectomy surgery the patient has been transferred to the general ward where a nursing professional has been employed for looking after her care concerns. The patient here is a 45 years old lady suffering from type 2 diabetes and is morbidly obese. Therefore, she had been suggested sleeve gastrectomy surgery by the doctor. However, it is necessary to understand the aetiology and the pathophsyiology of the condition of the patient. The aetiology and pathophysiology of type 2 diabetes and obesity has been linked over here. It helps in understanding the effect of obesity on the overall health and well being in people. Obesity is a hetergenous group of conditions with multiple causes each of which is expressed as an obese phenotype (Berman et al., 2014). As commented by Bryant Knights (2014), the influence of genotype on the aetiology of obesity is either attenuated or exacerbated by non-genetic factors. There are a number of aetiological determinants of obesity which are endocrine and hypothalamic disorders, heritability, eating and energy storing patterns. Additionally, obesity has been strongly related to the development of type 2 diab etes. The BMI is strongly related to diabetes and insulin resistance as in obese individuals the amount of non-esterified fatty acids, glycerol, hormones, cytokines, pro-inflammatory markers are increased. Serum free fatty acids (FFA) are frequently high in obese individuals which are the one of the major contributors to peripheral insulin resistance. Elevated levels of FFA in the blood have been seen to promote gluconeogenesis inducing hepatic and muscle insulin resistance. FFAS also enhances the accumulation of triglycerides in liver and skeletal muscle, which could be correlated with insulin resistance (Hoogervorst-Schilp et al., 2016). BMI equal to or greater than 40 kg/m2 has been categorised under class III obesity which increases the risk for illness and death manifold times (Broyles, Smith, Coon Bonawitz, 2016). The obese condition of Kathleen could be attributed to her lifestyle and eating habits. In order to cope up with her life stress Kathleen had been overtly dependent upon alcohol, smoking. Kathleen has been drinking upto four bottles of beer on a single night. Therefore, excessive alcohol uptake results in increased amount of calories. Therefore excess amount of stored energy whereas less expenditure can result in increased body weight. As commented by Bullock Hales (2012), the psychosocial factors have also been seen to trigger binge drinking in people. Thus, binge drinking with long intermittent gaps have been seen to enhance weight gain by disturbing the facultative thermogenesis cycle. Underlying pathophysiology of the patients post-operative deterioration The patient had been suggested a sleeve gastrectomy surgery in order to facilitate weight loss. In the following procedure most of the stomach is removed except a small sleeve shaped pouch. It restricts the amount of food which could be consumed by the patient improving metabolic s syndrome. It acts by changing hormonal signal between stomach, liver and brain by establishing lower set points. As supported by Broyles, Smith, Coon Bonawitz (2016), undertaking sleeve gastrectomy surgery helped in controlling type 2 diabetes in 58% of the cases. However, there are a number of complications associated with the conduct of sleeve gastrectomy surgery in patients. Some of the most common side effects which could be noted after the conduct of the sleeve gastrectomy surgery are feelings of nausea and vomiting. Some more serious complications can be seen in the patient are blood clots in the lungs (pulmonary embolism) or legs (deep vein thrombosis) (Chou et al., 2016). Some other symptoms which could be seen over here are chest pain, shortness of breath. The leaking and bleeding around the stomach have been seen to cause abdominal pain and fever. In this respect, a number of post-operative complications were noticed in the patient such as shortness of breath or panting, high blood pressure, whereas the urine output has been recorded to be around 5 ml which is very less. The shortness of breath could be due to clotting of blood in the lungs during the surgery. Therefore, a post-operative follows up needs to be conducted on the patient. One of the most serious which needs to be addressed in the patient immediately is less urine output. It could be attributed to acute kidney injury (AKI) which may develop as a complication within the patient in post-aneasthasia care unit (PACU). It is important to recognise AKI in the early developmental stages as it could further progress into chronic kidney disease (Hamlin, Davies, Richardson-Tench Sutherland-Fraser, 2016). Additionally, use of antiarrythmic drug during surgery can also effect the normal urine output in the patient considerably. As commented by Forrester Griffiths (2014), ad equate resuscitation needs to implemented before application of the diagnostic criteria for decreased urine output. Appropriate nursing management of the patient Post-operative care process is crucial for the management of patients with gastric surgeries. Patients with a number of co-morbid conditions need to be kept inside the intensive care unit for few days before shifting to the general ward. Kathleen had type 2 diabetes, which required that a number of clinical assessments be completed before shifting her to the general ward. An A-E assessment needs to be conducted in order to analyse the overall condition of the patient. In this context, Kathleen was suffering from shortness of breath. Hence, the nursing professional needs to employ a proper airway management for looking after the respiratory complications developed in the patient. As commented by martin and Bartholomew (2018), residual anaesthesia have been seen to develop respiratory depression in the patient. Under such conditions, the nurse needs to make adjustments in endotracheal intubation. The patients could be placed in a reverse trendelenburg position which limits the push of abdominal contents over the diaphragm, facilitating the rate of respiration (Hamlin, Davies, Richardson-Tench Sutherland-Fraser, 2016). The expertise of aneasthelogist is required for the management of patients who are difficult to intubate. In order to improve tidal volume the head of the bed needs to be elevated from an angle of 30 to 45 degrees. Some of the additional steps which could be taken by the nursing professional over here are using intensify scale to access the pain in the patient. In this respect, the nurse should record pain as the 5th vital sign. The bleeding patterns of the patients needs to be monitored. The nurse should observe the puncture sites or the sites of insertion of the catherer tube closely as entry of any form of pathogen though those sites can result in the occurrence of central line associated bloodstream infection (CLABI) (Forrester Griffiths, 2014). Justification for involvement of three members of the interdisciplinary healthcare team The support care and participation of the interdisciplinary healthcare team can enhance the quality of the healthcare services. In this respect, part from the primary medical and nursing team three other allied healthcare professional could be involved who are dietician, critical care pharmacist, and respiratory therapist. Since Kathleen had undergone sleeve gastrectomy surgery therefore she needs to be particularly careful about her diet. Therefore, the involvement of a dietician can help in guiding the patient regarding the right food which needs to be taken after the pot-operative surgery. As mentioned by Craft, Hudson, Plenderleith Gordon (2017), the involvement of a dietician can help in providing effective diabetes management education to the patient. The involvement of clinical care pharmacist in disease state management has been found to be fruitful as they can keep a tab on the prescribed medication pattern of the patients. The interdisciplinary team can work closely with the doctors for effectively monitoring the changes in doses and their effects over the body of the patient in the long term (Nursing and Midwifery Board of Australia, 2013). The involvement of the respiratory therapists is crucial during the post-operative as they can help in restoring the normal breathing patterns of the patient. As mentioned by Gan et al. (2014), the involvement of the interdisciplinary care team can make the process of post operative support care easy and much more effective. However as argued by Bullock Hales (20121), the involvement of a number of medical channels can make the healthcare setting more slow and complicated. Therefore, an effective collaboration is needed between the different healthcare channels. Additionally, implementation of effective peri-operative nursing standards can help in improving the quality of care in an intensive care unit. Conclusion The current assignment focuses upon the nursing care and management strategies for patients who just had an immediate surgery. In this respect, the patient Kathleen is a 45 year old lady who had undergone a sleeve gastrectomy surgery due to morbid obesity. The patient depicted a number of complications immediately after the surgery such as the shortness of breath, high blood pressure and low urine output. Some of the most serious concerns surrounding the patient were low urine output along with shortness of breath. The low urine production could be due to acute kidney injury. Therefore, an effective postoperative follow up needs to be conducted which could help in accessing and monitoring the current health condition of the patient. Additionally, support from a number of health care channels along with interdisciplinary healthcare teams can help in improving the overall health condition of the patient. References Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., ... Parker, B. (2014).Kozier Erb's Fundamentals of Nursing Australian Edition(Vol. 3). London: Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?hl=enlr=id=wMWaBQAAQBAJoi=fndpg=PP1dq=Kozier+%26+Erb%E2%80%99s+fundamentals+of+nursing+(3rd+ed.).+Australia:+Pearson.+ots=FEk6kCa1nnsig=OOOkHrwLlTkR_hoCq565ovg88c8#v=onepageq=Kozier%20%26%20Erb%E2%80%99s%20fundamentals%20of%20nursing%20(3rd%20ed.).%20Australia%3A%20Pearson.f=false Broyles, J. M., Smith, M., Coon, D., Bonawitz, S. C. (2016). 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