Wednesday, May 6, 2020
Cholecystitis and Laparoscopic Cholecystectomy
Question: Discuss about the Cholecystitis and Laparoscopic Cholecystectomy. Answer: Introduction: Acute Cholecystitis is a disease that occurs due to severe inflammation of gall bladder and is also called as Gallstone disease. Sedentary lifestyle incorporating no physical activities, unhealthy diet and lifestyle oriented diseases such as morbid obesity, diabetes and others has led to the extreme prevalence of acute cholecystitis. Furthermore, Laparoscopic Cholecystectomy is a surgical treatment that is prevailing worldwide for the treatment of cholecystitis. The treatment is undertaken with optimal patient-oriented nursing care and formulation of condition oriented multidisciplinary team for the regulation of the treatment. This multidisciplinary team consist of different healthcare professional working all together for the regulation of effective treatment of the patient (Tornqvist et al., 2016). The topic of this report is a case study on acute cholecystitis and the effects of laparoscopic cholecystectomy targeting its merits and demerits. This report is an analysis the case of Joan Middleton who is suffering from acute cholecystitis, targeting the health alterations from the predetermined results, appropriate nursing methodologies and multidisciplinary team required for the treatment of the prevailing condition. Health condition: Cholecystitis is a medical condition which occurs due to the inflammation of gall bladder that is a profound resource of bile. The bile and its products are responsible for the digestion and absorption of fats and lipids such as triglycerides or phospholipids in small intestine. Medical condition cholecystitis hardens this bile blocking the passage and causing the inflammation of the gall bladder (Gurusamy et al., 2013). This condition is medically treated with the help of surgery called as laparoscopic cholecystectomy that undertakes removal of gall bladder with non-invasive technique with lesser post-operative pain. This surgery allows the patients to get discharged from the hospital same day of the operation or the very next day. Joan Middleton is a middle aged woman who is living a sedentary lifestyle and is suffering from lifestyle related diseases such as obesity and diabetes type 2. Furthermore, she has been diagnosed with acute cholecystitis and has undergone laparoscopic cho lecystectomy for the treatment. This surgery allows the patient to get discharged same day as of surgery or the very next day. But in her case, she has again developed same symptoms prior her surgery. Explanation of such health alteration could be the post-operative complications of the laparoscopic cholecystectomy surgery. This is considered to be one of the safest remedial treatment for cholecystitis but contains certain complications depending upon different conditions of the patients. In case of Joan Middleton, the signs and symptoms occurring in her post operation that are high pulse rate, high blood pressure, high fever and high respiration rate has led to the predetermination of certain possible complications such as bile leakage, severe anaesthetic implications, bile duct injury during surgery and post-cholecystectomy syndrome (Bickel et al., 2016). Bile leakage occurs when the bile leaks into the abdomen of the body passing through the tube which is blocked by certain clips required to seal the tube from one end after the removal of the gall bladder. Furthermore, another possible condition is bile duct injury that may happen during the laparoscopic cholecystectomy that leads to the leakage of the bile into abdomen or injury to other adjacent organs, arteries and capillaries. Besides this, complications can also arise from the anaesthesia provided to the patient during the surgery. The general anaesthesia leads to respiratory complications such as high respiration rate, high pulse rate, and high heart beat along with increased body temperature. Lastly, post-cholecystectomy syndrome can also be a possible reason of the altered signs and symptoms shown by Joan Middleton. This complication mainly occurs due to leakage of bile and persist for many days and months. One or more of these complications are the possible reasons of the ha phazard signs and symptoms shown by Joan Middleton after the conduction of laparoscopic cholecystectomy (Brooke et al., 2015). Nursing Settings: Effective patient-oriented nursing is required in case of Joan Middleton along with optimal implementation of pharmacological and non-pharmacological interventions. Nursing interventions priorities include balancing the equilibrium in respiration activity, prevention of any complications, optimal reporting on the existing condition, treatment and procedures and effective discussion with other healthcare professionals (Ignatavicius Workman, 2015). The safeguard interventions to be provided by nurse must be in accordance with optimal assessment of pain, promotion of comfort and rest, relaxing the patient, frequent communication, restricting and maintenance of dietary intake by restructuring the food consumption and analysing the laboratory results for future interventions. Different nursing care plan on the analysis on ineffective breathing pattern, acute pain and risk of infection are required for the optimal imparting of the treatment to Joan Middleton. Ineffective breathing pattern will undertake observation on respiration process and assistance on effective breathing (Lawrence, 2015). Acute pain will undertake optimal dispensation of medication and monitoring of the pain with the help of signs and symptoms. Furthermore, optimal implementation and regulation of non-pharmacological interventions such as massages, therapies and other to provide relief to the severity. Lastly, risk of infection will undertake the determination of infection and other conditions that leads to alteration in the predetermined results of laparoscopic cholecystectomy. This analysis is conducted with the help of personal protective equipment (PPE) (Dunphy et al., 2015). The analysis is required to be conducted on the probable source of the complications such as infection due to medication, bile leakage, anaesthesia and others. In addition to this, optimal reporting is an essential measure required to be undertaken for the consideration by other healthcare professionals. Furthermore, di scharge measures such as maintenance of the oxygen requirement, creating awareness on post-operative care to be undertaken by patient and his family and minimization of complications must be undertaken within two days of the discharge as prescribed. Oxygen requirement determines the rate of respiration, pulse rate, heartbeat of Joan Middleton and will help in undertaking optimal measures to lower it down. Awareness must be instilled on the post-operative care to be maintained after getting discharged from hospital at home by the patient and the family of the patient. Furthermore, balancing and maintaining of the prevalent signs and symptoms is essential in the hospital and as well as at home in order to minimize any sort of degrading implications to the patient (Doenges, Moorhouse Murr, 2014). Multidisciplinary Team: A multidisciplinary team or multiagency team is a group of different healthcare professionals working together for the remedial treatment of the patient. The multidisciplinary team approach the disease or illness by determining different possible solutions for the prevailing condition and planning a possible treatment that must be non-invasive and patient oriented. These two factors determines the extent of pharmacological and non-pharmacological interventions to be delivered by different healthcare professionals. Such team must consist of different patient-oriented professionals for targeting the severe condition (Weaver, Dy Rosen, 2014). Optimal treatment is conducted through the regulation of effective communication among all healthcare professionals with the help of reporting and change of shift report (cosr). Furthermore, the multidisciplinary team containing healthcare professionals must be accessible to all medications and non-pharmacological interventions and are required to be trained and experienced in their respective field for the effective imparting of the safeguard intervention. Besides this, they must be able to provide intervention in accordance with the laws and legislation of the specific country. Lastly, involvement of the patient and the family of the patient must be undertaken at the every step of the intervention as it will help in better response to the imparted treatment by the healthcare professionals to the patient (Santiago et al., 2014). In case of Joan Middleton, different healthcare professional can be radiologists, nurses, pharmacists, general physician, gastroenterologist, and physiotherapist. Radiologist is required for the undertaking of x-rays, computerized tomography scan, ultrasound and other essential scans required by the condition of Joan Middleton for the analysis of the existing issue. Nurses are pivot for the regulation of the treatment as they assist all other healthcare professionals and regulates the pharmacological and non-pharmacological interventions required by Joan Middleton. Pharmacists will provide medication as per the prescription on the haphazard signs and symptoms shown by Joan Middleton post operation (Basta et al., 2016). Gastroenterologists and general physician will assist the disease of Joan Middleton by undertaking detailed analysis on the organs present in the abdomen further determining possible remedial solutions to the altered signs and symptoms. Physiotherapist will help reduci ng the fat in Joan Middleton leading to reduction and maintenance of obesity and diabetes mellitus type 2. Furthermore, physiotherapist may help in reducing the pain occurring in the body (Karavias et al., 2015). Conclusion: This case study determines that sedentary lifestyle leads to many other critical and severe conditions such as cholecystitis besides obesity and diabetes mellitus. Cholecystitis can treated with the help of laparoscopic cholecystectomy which is a non-invasive surgical method of remedial treatment of cholecystitis. This surgical method is extremely effective and allows the discharge of the patient same day but carries certain complications such as bile leakage, injury to adjacent organs in abdomen, anaesthetic implications and post-cholecystectomy syndrome. These complications are required to be effectively treated within short period of time as repercussions can be devastating leading to ultimate death. Besides this, patient-oriented multidisciplinary team is required for the treatment of Joan Middleton. This team is required to contain different healthcare professionals from different sectors such as physiologist, general physician, gastroenterologist, nurses and pharmacist for the optimal regulation of the remedial treatment of the condition of Joan Middleton. The optimal formulation, implementation and regulation of concoction of pharmacological and non-pharmacological interventions as prescribed by the multidisciplinary team will lead to the discharge of Joan Middleton within two days. References: Basta, Y. L., Baur, O. L., van Dieren, S., Klinkenbijl, J. H., Fockens, P., Tytgat, K. M. (2016). Is there a Benefit of Multidisciplinary Cancer Team Meetings for Patients with Gastrointestinal Malignancies?.Annals of surgical oncology,23(8), 2430-2437. Bickel, A., Hoffman, R. S., Loberant, N., Weiss, M., Eitan, A. (2016). Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis.Surgical endoscopy,30(3), 1028-1033. Brooke?Smith, M., Figueras, J., Ullah, S., Rees, M., Vauthey, J. N., Hugh, T. J., ... Yokoyama, Y. (2015). Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study.HPB,17(1), 46-51. Doenges, M. E., Moorhouse, M. F., Murr, A. C. (2014).Nursing care plans: Guidelines for individualizing client care across the life span. FA Davis. Dunphy, L. M., Winland-Brown, J., Porter, B., Thomas, D. (2015).Primary Care: Art and Science of Advanced Practice Nursing. FA Davis. Gurusamy, K. S., Davidson, C., Gluud, C., Davidson, B. R. (2013). Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis.Cochrane Database Syst Rev,6. Ignatavicius, D. D., Workman, M. L. (2015).Medical-surgical nursing: Patient-centered collaborative care. Elsevier Health Sciences. Karavias, D., Kourea, H., Sotiriadi, A., Karnabatidis, D., Karavias, D. (2015). Gangrenous cholecystitis related to transcatheter arterial chemoembolization (TACE) treatment for hepatocellular carcinoma.Journal of Gastrointestinal Surgery,19(11), 2093-2095. Lawrence, R. (2015).Acute Cholecystitis. S. R. Eachempati, L. Reed (Eds.). Springer International Publishing. Santiago, C., Lazar, L., Jiang, D., Burns, K. E. (2014). A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit.Intensive and Critical Care Nursing,30(1), 13-21. Trnqvist, B., Waage, A., Zheng, Z., Ye, W., Nilsson, M. (2016). Severity of Acute Cholecystitis and Risk of Iatrogenic Bile Duct Injury During Cholecystectomy, a Population-Based CaseControl Study.World journal of surgery,40(5), 1060-1067. Weaver, S. J., Dy, S. M., Rosen, M. A. (2014). Team-training in healthcare: a narrative synthesis of the literature.BMJ quality safety, bmjqs-2013.