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Nursing care is a formal process that correctly identifies existential needs and recognises the client’s potential risk or needs. It is a way of communication between the nurses, their patients and other healthcare providers (Chaboyer et al. 2021). In this assessment, the care plan for patient Michael Abernethy will be discussed which is providing the relevant solution for the illness. Michael (Mike) presented with a history of abdominal pain for the past 72 hours. Medical history, left-sided Cerebral vascular accident (CVA) 6 years ago. Limited movement in arm and leg, facing difficulty in swallowing and saying.
Potential problems constipation, ankle edema, and macular degeneration that are progressively worsening and impacting the vision. Physical observation; underweight, breathless, choking, on a pureed diet and requires assistance for activities like showering poor eyesight and hearing. He is not sleeping well, refuses to drink fluids and has pressure ulcers in his buttocks. The assessment will discuss the care plan for selected care needs (abdominal pain) that results in informed nursing care. It will take the intervention and outcomes of the provided care needs (Asmirajanti et al. 2019). The nursing care is going to be supported with evidence that promotes the recovery of Mike.
Selected care need in the case study
Abdominal pain is very common in the elderly population due to chronic constipation that is linked with comorbidities and negative implications on quality of life. The main causes of abdominal pain will consist of physical inactivity, polypharmacy, chronic medical condition and defecatory disorders. It plays a major role in constipation. In elders suffering from constipation, the issues will be seen with prolonged abdominal pressure during defecation and the sensation of obstruction at an outlet that impacts the stools.
To make the identification of abdominal pain, an evaluation is carried out that takes the idea about the medical history of the patient. For instance, in the case of Mike, the change in bowel movements and weight loss has been reported. It is important to perform various medical examinations that will reveal the possible chances of chronic constipation and its impacts on quality of life (Mari et al. 2020).
Relating abdominal pain to the case of Mike, it is due to constipation and eating habits that are leading to the impact on faeces. The condition is quite common and leads to distressing symptoms that will result in bowel disturbances. In addition, bowel disturbance is also seen due to less physical activity, low dietary fibre intake and other causes that lead to faecal incontinence.
As reported in the case of Mike, severely impacted faeces were traced in the emergency department. It is causing discomfort in the body due to the pressure over the gastrointestinal tract. The waste buildup in the system creates discomfort in the abdomen and the lower back and makes an individual feel swollen(bloated) (Deb et al. 2020).
Gut microbiota is also considered a key player in the abdominal and gastrointestinal function that is hampered due to ageing and underlying medical conditions. Factors like dysbiosis, particular diseases or drugs, and medical conditions will be a cause that is impacting abdominal functions and will be resulting in bowel complaints and gut microbiota. In the case of Mike, it is reported that the dietary intake is only on the pureed diet which is not enough to fulfil the need of the system (Drago et al. 2019).
The negative influence will be seen on the microbiota that is affecting the faece's movement and creating pressure on abdominal walls. It is a root cause of pain that is making an emergency admission. Brain injuries and neurological diseases will impact the gut microbiome and gut barrier that causes bowel syndrome. Gut microbes are protected by the brain that is maintaining the population. It will lead to the niche to promote that is responsible for the functioning of the abdomen and stomach.
Any kind of injuries that hamper the junctions will infiltrate peripheral immune cells due to which the leaky gut is observed. To overcome abdominal dysfunction, taking care of the injuries is a must that will manage the alteration of stool form and frequency and any kind of discomfort (El-Hakim et al. 2022). In addition, age is a factor that is arising from constipation and other gastrointestinal disorders in the elderly population. The reason behind the disorder is the loss of physiological integrity that is impairing function and vulnerability toward death.
The declining effects will be measured over motility, enzyme function and digestion and absorption. It constantly impacts the digestion of food and causes the patient to face a variety of signs and symptoms. In addition, the advancement in signs and symptoms outcomes in the fewer effects of medication and disease origination (Dumic et al. 2019). Therefore, it is crucial to gather the signs and symptoms that are leading to abdominal pain in Mike. After gathering the information about the patient important is to make the SMART goals that will help in addressing the care need of Mike.
Nursing care plan intervention and its rationale
To identify the exact cause of abdominal pain, it is a primary step to perform the evaluation that will lead to ruling out the secondary and organic causes. It will require a detailed medical history with a focus on alarming signs and symptoms like rectal bleeding, weight loss and change in bowel movement. An abdominal X-ray was used for the diagnosis of abdominal pain. The method gives information about the masses, holes in the intestine, and blockages.
It will be useful for the identification of disorders in the GI tract or urinary tract (Lalouni et al. 2019). Based on the X-ray, the results that are found are showing patient faeces are severely impacted. Mike is on a pureed diet and does not like to take fluids. It leads to a dry mouth and lack of moisture that is leading to breathlessness. Also, the information is supported by the ABCDE assessment that is taking the signs and symptoms to gather.
Based on the information, the following is the nursing care plan that needs to be provided to Mike to manage the abdominal pain and other associated conditions.
Dietary and lifestyle advice that manages constipation their diet. Providing the dietary fibres is a must by which stool frequency and consistency can be managed. Signs and symptoms like abdominal bloating and flatulence improved by providing the diet (Baran and Ates 2019). Water intake alone is not enough as it will lead to the stool frequency to get increased which is making the essential nutrients to get lost. Second is moderate physical activity in elders that improves the signs and symptoms of abdominal pain and constipation.
Lack of physical activity contributes to building lactic acid in the muscles. It will decline the level of electrolytes and cause pain in the abdominal area (Rosa et al. 2021). Third is the withdrawal of drugs which is about revising the list of medications and trying to remove the medication. In the case of Mike, managing Lactulose is important as it pulls out water and softens the stool. Bloating is a common side effect of medication that makes the stomach feel full and tight. It causes discomfort and pain in the abdomen area. Regulating the dose is needed to control the side effects of medication and promote comfort for patients. Fourth is toileting education which is making the patient able to use the correct toileting routine.
It comprises regular defecation and will give the appropriate assistance in the access of the toilet (Shenvi and Platts-Mills 2019). In addition, it will be avoiding prolonged pushing that will maintain the normal functioning of the system and remove any unnecessary pressure over the system. In the case of Mike, a foul smell of urine is noticed that implying the need for toileting education. Laxative providing can be helpful that is the medication by which the primary reason for abdominal pain can be dealt with. It will include the digestion process to get facilitate that is leading to the faster absorption of nutrients.
Fourth is prokinetic agents that is activating the serotonergic receptor and trigger the release of acetylcholine that is enhancing colonic motility. It will relieve symptoms of constipation and improve the quality of life (Sabo et al. 2021). In addition, a drug will be provided that act locally and increase the intestinal secretion of fluids. The positive impact will be seen in spontaneous bowel movements, decreasing straining, and improving stool consistency. Lastly, biofeedback is a training practice that is aiming to educate patients to relax. It is an effective and safe treatment that is reporting a success rate of 70-80 per cent.
The importance will be seen in the elder patient who requires improvement in cognitive and physical state (Tran et al. 2019). It will make the patient like Mike to be cooperative with the therapist that is leading the delivery of a personalized plan.
Outcomes of the nursing care plan
The outcome of the nursing care plan and intervention will be seen as having a balanced diet of fruits and vegetables will keep the digestive system functioning to be maintained. Abdominal pain and constipation can be taken care of by providing a diet plan that is a balance of liquid and solid components. It makes the digestive system and immune system healthy which improves the difficulty in digestion and increases the nutritional intake.
The second is reducing abdominal pain and promoting comfort. Promotion of physical activity will make the lactic acid to get metabolise that is relieving abdominal pain (Long et al. 2019). In addition, drinking enough water before and after exercise is important to keep the system active. Third is managing the dose of a drug that is needed as the patient is on polypharmacy which is a reason for complications and adverse conditions of the patient.
The positive impact of toileting education will be seen in the context of managing the routine of toileting activities and defection when required. It is important for stool defecation and managing the requirements of the patient (Okuyan and Bilgili 2019). Providing the medication will significantly improve the intolerance that is reported in the patient Mike. It will improve the rate of absorption of nutrients that regain weight and help the patient to take the food items (Buhamed et al. 2019).
It overcomes the barrier of fluid restriction and allows dietary intake. The intake of medication like laxatives and others will make the bowel movement to get ease that is releasing the pressure on the abdominal walls and reduce the pain. In the case of Mike, abdominal pain seems to be a reason that is leading to distress and discomfort. The class of medication will facilitate the improvement of the condition of Mike. Also, providing the positioning gives a scope that is making muscles to be relaxed and contracts the floor muscle and abdominal muscle that increase absorption (Dumic et al. 2019).
The positive outcomes of biofeedback will be making the patient able to get a personalized session that is making them able to get the care that is desired.
The above case study is indicating the presence of comorbid situations. It will require the assessment and care plan that is allowing the recovery of patients. ABCDE assessment is applied that is a systematic approach for critically ill and injured patients. Followed by the care plan by which the variable-identified needs of the patient are addressed. In conclusion, it promotes the recovery of patients (Mike). Taking the insight of the above care plan, the nursing intervention like a dietary plan, medication and physical activity will improve abdominal pain and provide the comfort to patient. In conclusion, by providing an adequate care plan signs and symptoms of the patient can be improved.
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