Case Study of Alan Jones for Resection - myassignmenthelp.com

Question: Write about theCase Study of Alan Jonesfor Transurethral Resection. Answer: The case study shows that a patient named Alan was admitted to the ward with a Benign prostrate hyperplasia and had to undergo a surgery called the TURP or Transurethral resection of the prostrate so that his symptoms can be overcome. Benign Prostrate Hyperplasia is mainly associated with the enlargement of prostate gland (Gandaglia et al., 2013). The prostate glands usually surrounds the urethra which is actually a tube that is responsible for carrying urine form the bladder to the exterior of the body. With the occurrence of the disorders, prostrate e gland gets enlarged and as a result they start squeezing or blocking the urethra resulting in problems in urinating. However, he had vital signs which were elevated and hence nurses need to take proper interventions. Moreover, a multidisciplinary team is also required to handle his symptoms properly so that he can get well soon. The essay will be discussing about a patient who is suffering from Benign Prostrate Hyperplasia and undergo es surgery called Transurethral resection of the prostrate and how he should be give nursing care when his vital signs are elevated after surgery. Discuss the aetiology and pathophysiology of the patients presenting condition Critically discuss the underlying pathophysiology of the patients post-operative deterioration. Prioritize, outline and justify the appropriate nursing management of the patient during this time/ It is very important to discuss the etiology and the pathophysiology of Benign Prostatic Hyperplasia in order to understand the severity of the patients condition. The prevalence is higher in aged people. It is not a serious problem and proper management may lead to better quality lives of the patients. Normally in most cases, man develops this symptom due to aging when hormonal changes take place and there is cell growth in the region. Researchers mainly suggest that aging is one of the risk factors that lead to this diorder (Gratzke et al., 2015). Besides, family history and ethnic background can also contribute to the disorder. However, in the case of Alan, we do not get any such information and therefore these cannot be exhibited as the reason of occurrence of the disorder. However diabetes and obesity are the factors that could be the main reason for the occurrence of the symptom. Researchers have suggested that both BPH (Benign Prostrate Hyperplasia) and diabetes share a common pathogenic mechanism where there is alteration of the male hormonal activity that gets influenced by the IGF (Insulin like growth factor) (Oelke et al., 2013). There is presence of insulin like growth factor in the prostatic tissues and therefore there is high chance of these playing the main role in occurrence of the disorders. Lifestyle issues such as lack of exercise, improper food diet often results in obesity which also becomes a risk factor for the disorder (Vignozzi et al., 2014). In the prostate gland there is the type 2 5-alpha reductase enzyme which is responsible for metabolism of the circulating testosterone of patients and thereby converts them into the potent androgen dihydrotestosterone (DHT). This mainly work locally but not systematically and thereby binds with the androgen receptors in the cell nuclei of the prostrate that causes enlargement and thereby result in the disorder. Studies conducted by researchers have shown that large numbers of alpha 1 adrenergic rec eptors are located in the smooth muscle of the stoma as well as in the capsule of the prostrate and also in the bladder neck (Gandaglia et al., 2013). As the receptors get stimulated in this scenario, there is increase of the smooth muscle tone which worsens lower urinary tract symptoms. When these receptors are blocked, it can result in reversible action thereby relaxing the muscles and relieves the patient of any symptoms of lower urinary tract infections. Transurethral resection of the prostrate is a surgery which helps to treat urinary infections. In this surgery, the surgeon use combined visual as well as surgical instruments the resectoscope. They insert it into the tip of the penis into the tube which carries urine form the bladder called the urethra. With the help of the resectoscope, the surgeon trims out excess tissue of the prostrate that surrounds the tube which was actually blocking the urine flow (Grocott et al., 2013). When the same was done to the patient, it was seen that he had some complications associated with it. The nurse had noted that his urine had blood clots which were visible after the patient went through continuous bladder irrigation. After the surgery, it is normal to see some clots in the urine and gradually the wound of the patient starts to heal. As in case of the patient, his bladder was irrigated and was flushed with water, the urine may get red once the irrigation is stopped. The bleeding is normal and the nurse should be careful that the bleeding gets cleared before the patient leaves the hospital. After the surgery, it was noticed that the patients vital signs were not normal. It is indeed important for the nurses to monitor the patients vital signs after surgery in order to monitor the condition of the patients. The body temperature of Alan was 35 degree Celsius which is indeed lower than the normal of 36 or 37 degree Celsius. However Alan showed high pulse rate of about 128 per minute when the normal pulse rate should be 60 to 80 beats per minute. Pulse usually gets higher after operation when there is stress or release of blood and fever (Thiele et al., 2015). Alan is having blood in his urine and might also be stressed after operation and therefore his pulse is quite high. Alans respiratory rate (RR) is also found to be quite high about 30 breathes a minute which is much higher than the normal RR of 15 to 20. This may be due to stress of the operation. Blood pressure is the measure of the pressure which develops when the blood flows through the arteries. High blood pressure or hypertension occurs when the blood pressure gets above 140/90 mm Hg. As Alans blood pressure is higher, for about 160/90 mm Hg, therefore interventions are needed to be taken by the nurse to keep it under control. Often use of anesthetics sometime raise the blood pressure for 20 to 30 mmHg (Johnston et al., 2015). The nurse should provide him with effective medications like Angiotensin converting enzyme inhibitors, calcium channel blockers, beta blockers which will all help by making the heart beat more slowly and thereby make the blood vessels relaxed. Calcium blockers will widen the arteries thereby reducing pressure. Evidently, the pulse rate will also come to normal as the blood vessels and the heart will be relaxed. Stress of the patient should be reduced. The nurse should provide food to patients who will be low in sugar and fat and more on vegetables and fruits with whole grains. The respiratory rate of the patient may be high due to the use of anesthesia side effects. Functional residual capacity drops when anesthetics enter the body. This reduction in Functional residual capacity becomes the main factor for the development of post operative complications. Mechanical ventilation may help the nurse to regain back the stable RR of the patient and keep him out of danger. Identify three (3) members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement. The important members who are needed to be included in the interdisciplinary teams besides the assigned doctors and also the nursing teams are the dietician, the diabetes educator and drug and alcohol abuse counselor. A multi disciplinary team is important to give an overall treatment for the patient so that the different social as well as physical factors affecting his health can be addressed (King et al., 2017). The doctors and the nurses take part in providing the patient relief from his disorder by proper surgery and after care surgery so that she he can get back into his quality life. However, this is not enough, as his other disorders like diabetes type 2, obesity and also drug alcohol habits also need to be properly addressed to ensure him a better quality life. Diabetes type 2 educators will play an important role in making Alan develop health literacy. The dietician should also provide a comprehensive diabetes education, collect information about his blood glucose and help i n surveillance of the outcome measurements. Besides, many of them also provide evidence based hypoglycemia and hyperglycemia management order sets and protocols so that they can track glucose levels and also conduct analysis to prevent any threats. They also provide individualized medication management plan with the hospital settings and also for use after discharge of the patient (Funk et al., 2017). The diabetes educator would also help to facilitate a smooth transition across the care settings. These would help the team to ensure that nutritional needs of the patients are met alongside the provide weight targets (Holescher et al., 2013). As a member of the multidisciplinary teams, they will mainly work with Allan to devise individual, realistic weight loss targets using evidence based practices (Bleisch et al., 2015). The Substance abuse counselor would help the team to provide proper therapies to him to overcome his addiction. They will then create goals and treatment plans for Alan by teaching him appropriate coping mechanisms along with different therapy sessions and progress reports to the teams, refereeing them to support groups, setting up care plans and others (Lewis, Dana Blevins et al., 2014). Therefore, from the above discussion, it is seen that Alan is quite stressed after the entire procedure of TURP surgery. The surgery has taken place after he got affected with benign prostrate hyperplasia. The effect of anesthesia in surgery might have worsened the condition. As his vital signs where mostly increased after the surgery, nurses should develop a care plan which will help in stabilizing the vital signs like with proper medication, right diet, mechanical ventilation and others. A multidisciplinary team is importnat in handling his condition. 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