Nursing the Surgical Patient. (Essay Sample)

Introduction
The postoperative period is crucial for patients. During this period, the nursing care provided will help detect, prevent, and treat any complications that may arise due to the surgical operation conducted. George needs to have his pain managed, his blood pressure and heartbeat closely monitored, vital signs, and, airway patency should also be monitored. Furthermore, there should be a maintained fluid and electrolyte balance. This paper touches on the potential clinical issues and appropriate nursing care for George's first 24 hours after the surgery. Furthermore, it focuses on the prioritized clinical issues that may arise after George’s surgery. Besides, it identifies the nursing interventions for the clinical issues identified, and it provides the rationale for each intervention. Lastly, it provides a discharging plan for George after the 24hours under the care of a nurse. The Discharge plan outlays the relevant actions to be followed by the patient as they continue to rest while the postoperative wounds heal.
Part A: Analyse the case to identify potential clinical issues and relevant nursing care
           Since George is a smoker, there are high chances that the smoking habit will impact the healing process. As a nurse, I will ensure that George abstains from smoking since it has an impact on his heart, it will reduce oxygen in the blood, and it may affect the blood pressure, resulting in shock or other life threatening ailments. In the first 24 hours after surgery, there is a need to monitor George's blood pressure, and there is a need to check on his previous myocardial infraction. 
With obstructive sleep apnea (OSA), George's high chances will develop postoperative complications. I will avoid placing the patient in a supine position. Notably, I will ensure that I limit the use of opioids as much as possible. Limiting the use of opioids will be crucial in decreasing the risk of oversedation. Instead of using opioids, I will consider using other medication approaches such as nonsteroidal medications, non-pharmacological methods, and acetaminophen to increase comfort and reduce George's pain. If George will still have problems maintaining the oxygen saturation, I will be constantly checking the oxygen uptake through the nasal prongs.
THREE (3) PRIORITY clinical issues for George
The three priority issues for George include Acute pains that arise from the surgical incision in the abdominal part, which result in irritation in the nerve endings. This is evident in the observation score of 6/10. Acute postoperative pain is normally experienced after operations and could last for days or weeks. Wounds need to heal after surgery and their pains to be managed; ineffective pain management can result in delayed healing hence prolonged hospitalization. Adequate pain relief is crucial since it prevents the pain from persisting. Pain can be a source of discomfort to the patient. Managing pain is one way of ensuring quality care to the patent. George should have the pain that results from laparotomy managed, especially during the bowel movement and the sitting position.
Secondly, the evidence of blood loss as observed to be 400ml and mild oozing from the dressing causes a high risk of hypovolemic shock. It is also known as low volume shock. It is a life-threatening condition that arises from severe blood loss. Furthermore, the evidence of high blood pressure of 96/55mmHg acts as an aligning factor in the causing of hypovolemic shock. It is crucial to restore the blood volume to allow oxygenation and the proper supply of oxygen to vital organs of the body. I will ensure that George increases the amount of blood circulating in the body, in case of a low blood volume, blood transfusion will be necessary after checkups and consultation.
Last but not least, there is a risk of bacterial infections in the open wounds of the surgical incision due to poor skin or muscles integrity and poor aseptic techniques. Aseptic techniques are the use of practices and procedures to help reduce the risks of infections or pathogens. Surgical wound infections may lead to the formation of a purse and severe pains that may cause discomfort or fevers to the patient. Therefore, it will be very important for me to apply competent aseptic techniques when dressing the wound to prevent pathogens or any other forms of infection.
Identify NURSING INTERVENTIONS and RATIONALE for each of the three clinical issues e.g. Encourage deep breathing exercises hourly.
The interventions for reducing acute postoperative pains include administering aspirin at a dosage of 75mg orally. Aspirin helps reduce the patient's pain by preventing prostaglandins production, which regulates pain, among other discomforts. Also, to help reduce the post operation acute pains, I will administer Fentanyl PCA 20mcg bolus. Patient-Controlled Analgesia is an analgesic dose provided to patients after operations to help reduce pains and increase patient satisfaction without causing any adverse effects. In addition, I will administer Paracetamol 1g four times in the first day. Paracetamol helps to inhibit the actions of various pain transmitters in the body. 
Secondly, to help increase blood volumes and reduce risks of hypovolemic shocks, I will administer intravenous infusion of sodium chloride 0.9%(normal saline) of 100ml/hr. to help restore or increase the blood volume. Also, I will consider the administration of fluid sips as ordered after the operation. The administration of fluid sips allows an increase in blood volumes resulting in more and more steady oxygen supply to the body organs. This helps to prevent the shocks and reduce blood pressure.
Lastly, to help reduce the risk of bacterial infections, I will ensure proper and effective aseptic dressing of the surgical wounds. Moreover, I will administer the patient with 2g of IV cefoxitin three times daily. IV cefoxitin is antibiotic that helps prevent infections from attacking the cells in the body.
PART B.
DISCHARGE PLAN
Mr. George Jessen,
April 29 2021
Name of patient: George Jessen
Age: 66 years
Sex: Male
Religion: Christian
Chief complaint reason: Severe Abdominal pain, Diarrhea, Vomiting
Date/ Time of admission:
Accompanied by:
Medical Diagnosis: Obstructing Right Sided Colonic Mass.
Dear Mr. Jessen,
In regards to the diagnosis, the hospital has carried a Laparotomy. Laparotomy is a surgery carried out to a patient through an incision to the abdominal walls to treat abdominal cavities or masses. The surgery that was conducted will have post-operative complications that may vary from mild to severe. You need to take control of your recovery process and ensure that you follow all the instructions given in this discharge plan.
The hospital advises that you take all your medication prescribed by the doctors. Also, avoid carrying or moving heavy objects when undergoing rest and medication. The hospital suggests a rest of six to eight weeks. You are advised to take short walks on flat surfaces, at least daily. Avoid resting for long and allow your muscles to stretch after a wh