Caring for an Ascending Aortic Dissection Repair Patient

Caring for an Ascending Aortic Dissection Repair Patient

Introduction

According to MedlinePlus, Aortic dissection is a medical complication that arises when there is a tear on the aorta making blood to flow between the layers of the walls of the aorta. Aortic dissection leads to ischemia which is the limitation of the blood flow to the body organs and also can rupture the aorta. Basing on our patients medical history, it could have been caused by high blood pressure, arteritis,and aging or as a result of the surgery he went through. Aortic dissection is repaired surgically or through vascular method. My paper therefore is going to focus on the care I did to a patient suffering from an ascending aortic dissection repair.
Nursing interventions involve the practises performed by the nurse to help the patient recover. These interventions may be initiated by the nurse taking care of the patient, another physician or by a group of health providers.I was therefore very keen in ensuring that the patient under my care was safe and progressing well towards recovery. I performed the below responsibilities while attending to my patient.

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Involving the patient in therapy program
I would ensure that the patient was attending to his therapies. This can be efficient if the nurse liaise with the therapist conducting the therapy to monitor the attendance and progress of the patient. A family member of the patient can also be involved in order to motivate the patient to attend the therapies. I would therefore constantly remind the patient on the importance of the therapy to his health and journey to recovery. These therapies can either be occupational or physical. Physical therapy would enable the patient to move more easily without the need of support by an assistance device. Occupational therapy on the other hand would enable the patient to perform his daily and personal activities more easily than before. I would therefore oversee the setting of realisable and appropriate therapy goals for patient and ensure the patient achieve them without forcing him.

Encouraging the patient to exercise
I advised the patient on a moderate physical activity to engage in. This is because a more physical activity exerts a lot of pressure on the repaired aortic wall and may lead to recurrent injuries on the aortic walls. The aorta will be forced to pump blood faster to all the body parts during a strenuous physical activity. I also helped the patient to walk around more regularly as a way of exercising since the patient could not walk on his own. This helped the patient to a smaller extend to lower his blood sugar level. Exercising enables the patient to lower his body mass index and therefore reducing his blood pressure.

Encouraging the patient to drink more fluids
I encouraged the patient to increase fluid intake since the patient is unable to urinate after the surgery. Urinal retention was caused by analgesic drugs which were used to enhance anaesthesia in order to operate the patient. The drugs interfere with the normal functioning of the nerves and muscles which facilitate the urination process. Drinking more fluids helps in stimulating the bladder to release urine and relieve the patient. Walking around the room for some time also helps in stimulating the bladder.

Monitoring the patients daily weight
The patient had a history of hypertension and hence and increase in body weight would worsen his health. I monitored it daily to ensure that any minimal change is handled earlier before the situation gets complicated. The patient’s body mass index was 48.67kg/m2 which indicated that he is already obese. A BMI of 30 and above is considered obese.
I also adviced the patient on the ways he can do to lower his body mass index like adapting healthy living through proper dieting and exercising. Obesity would lead to the blockage of blood vessels hence hindering blood flow. The heart would therefore have to pump blood at a very high pressure to enable the blood to flow. This will cause the grafted part of the ascending aorta to rupture hence hindering healing.

Monitoring the patient’s fluidintake and output
The patient needed to have a balanced fluid intake and output. Frequent monitoring helped me to detect any abnormality and find ways to put it under control. For instance, I ensured that the patient’s fluid balance did not exceed 800 millilitres of urine to 2000 millilitres of water intake per day.(Wolf, 1990)Whenever I noticed a fluid and electrolyte imbalance, I would encourage the patient to increase the intake of deficient minerals and decrease the intake of excess minerals in his blood stream.
Electrolytes help in blood clotting, maintaining a normal pH of blood, transferring nerve signals, building new body tissues, facilitating heartbeats and also enhancing fluid balance in the body and blood plasma. An electrolyte imbalance would therefore hinder these processes. More so, a fluid balance in the body would enhance a faster recovery of the patient. A nurse can ensure that the patient has adequate electrolytes by encouraging the patient to be hydrated always and eat foods rich in electrolytes like bananas, oranges, avocadoes, beans and also spinach.

Ensuring the safety of the patient while still on admission
My responsibility was to ensure that the patient is not exposed to any harm. I was always of sound mind while attending to the patient to prevent medication errors like administering wrong drugs. I also made sure that I fully put patient falls under control.(Hughes, 2009)I was attending a recognized and certified medical school which made me qualified professionally and equipped with the relevant skills to take care of the patient. More so, I would always consult widely before making crucial decisions regarding the treatment of the patient.
I abided by the rules and regulations put in place to enhance the patient’s safety. There was a proper coordination of duties for all health providers including nurses and physicianswhich limited confusion hence preventing harm to the patient. I would use the skills I had gained at school to access the possible risks to be faced by the patient and come up with efficient ways to deal with the risks. I was also able to easily and faster detect medical errors and handle them appropriately.
The Hospital management ensured that we, the nurses, were well staffed as understaffing would have increased the chances of harm occurrence to the patients since we would be overstretched and not able to react efficiently to emergencies.(Rogers, 2004) Lastly, I made sure I was flexible enough to respond faster to emergencies like when a patient presses the bed alarm to signal he needs the help of the nurse. I was always available when the patient was in need. We had therefore subdividedourselves with each of us put under the watch to a specific minimum number of patients.

Monitoring the patient’s bladder
I constantly evaluated the level of urine in the urine of the patient. A patient’s blood pressure increases as the bladder continues to be filled while it is very low when the bladder is empty. This is achieved through conducting bladder scans. If the bladder is full and cannot be emptied naturally, the nurse is supposed to catheterize the patient. Catheterization is a process of inserting a tube to the patient’s bladder through the urethra to allow urine to empty from the bladder. Catheterization should only be conducted after being advised by a physician or if the patient feels he needs comfort. I conducted catheterization in a way that minimized pain to the patient. A full bladder would hinder faster healing of the patient as it may result to the rupture of the grafted ascending aorta as it will prompt the heart to pump blood faster than normal. This will exert pressure to the healing part causing further injury hence elongating the expected healing duration.(Joel, 2009)

Ensuring the patient uses an incentive spirometer appropriately and timely
An incentive spirometer is a device that helps the lungs to breathe slowly and deeply. It is very important for a patient who has undergone an operation. I taught the patient on how to use it properly. Inefficient use or not using an incentive spirometer may lead to difficulties in breathing. The heart would therefore receive inadequate oxygen to pump blood. It will thus have to pump blood at high pressure to enable oxygenated blood to reach all parts of the blood. As discussed above, pumping blood at a high pressure would affect the healing of the grafted ascending aorta as it will further injury the repair. The incentive spirometer should only be used when the patient is awake and according to the instructions of the physician.

Advising the patient on the proper diet
The patient was obese and had a history of hypertension. I ensured that the patient was reducing the intake of foods with high fat content as it will increase his body fat content which in turn would lead to a higher blood pressure. I would oversee this personally when the patient was under my care or admitted but when he was discharged, I explained to the patient’s family about their need to oversee his diet by ensuring he eats healthy foods which would enhance fast recovery. For instance, I advised the patient to reduce protein and fat intake and increase fruits and vegetable intake. Proper dieting would help lower his level of hypertension and hence a lower risk of damage on the grafted ascending aorta. Proper dieting would also enable the patient to lose weight hence lowering his body mass index.

Ensuring the patient takes his medication as prescribed by the physician
When the patient was still admitted in the health facility, I constantly reminded him to always take his drugs when it was the right time. For instance I would personally take the drugs to the patient up to his bedside with a cup of water for him to take. Sometimes the patient would dislike the medication and therefore would try to avoid taking it. I would always inform the patient on the importance of taking drugs appropriately rather than force him to. Taking medication effectively will help the patient to recover faster. When the patient got discharged, I could no longer monitor his intake of drugs, I therefore advised the patient’s family to ensure that the patient sticks to his dosages.

Helping and encouraging the patient during ambulation
Ambulation as defined by medical dictionary is the ability of the patient to move independently either with an assistance device or without especially after undergoing an operation. It is essential for the patient because it is a form of exercise and also would enable the patient to be independent.I supported the patient when he started to try to walk around until the patient was stable and able to walk around by himself. I would ensure that the floor was not slippery or with a lot of stuff littered around which may make the patient to fall and injure himself. Ambulation is important to the patient as it facilitates proper blood flow and distribution of oxygen and also helps the patient to have a normal breathing rate. Proper blood flow enhances healing of wounds and lowers the risk of blood clots on the patient.It also helps in boosting the patient’s appetite and makes them feel independent again. Patients who are not encouraged to walk after operation are more likely to develop complications like bed sores and urinal infections.
Helping the patient to prevent the recurrence of atrial fibrillation
Atrial fibrillation relate to irregular and rapid heartbeats. It causes heart complications. It is caused by high blood pressure and previous heart surgery. People who are at risk of getting infected are the old, those with high blood pressure, obese, alcohol consumers and those with a record of heart surgery. Atrial fibrillation may cause injury to the healing part of the grafted part of the ascending aorta hence elongating the expected healing time. I therefore educated the patient on the importance of preventing it. It is be prevented by eating a healthy diet, avoiding smoking, exercising regularly, reducing his body weight as he was obese and reducing stress. Stress increases the patient’s blood pressure and should therefore be efficiently managed as it has a negative impact on the health of the patient.

Conducting fall risk assessment of the patient
Falling in this perspective means involuntary rest by a patient on the floor. It may be caused by loss of consciousness or general weakness. The old patients are the ones which are at more risk. They should be encouraged to go for walks and also strengthen their lower body parts as they are vital in supporting their body.(Tinnetti, 1988)

General responsibilities of patient care I undertook

I treated my patient with respect. My mode of communication was always professional. More so, my tonal variation while talking to the patient was soft. It enabled my patient to understand the information I was trying to pass across well without any difficulty. I encouraged the patient’s friends and relatives to visit him as more often as they can. This made the patient to feel loved and appreciated. The patient was even being more anxious to get healed and go home to unite with his family and friends.
The patient’s close friends and associates were also be involved in his medication like during decision making. This was more appropriate when the patient was not in a position to make very important decisions for himself. This would in turn faster the medication process rather than waiting for the patient to be in a position of giving his own opinions.
I supported cultural diversity. I was always more than ready and willing to study, understand and appreciate the cultural beliefs and background of mypatient. This enabledme to know more about my patient. A cultural difference is a hindrance to the efficient offering of services in the health facilities like the nurses discriminating the patients basing on their cultural background and beliefs.
I ensured that I develop a mutual relationship with the patient. This mademy patient to be more open and ready to tell me everything that he felt he needed my help. A patient’s perception about the nurse depends majorly on how the nurse treats him. If the nurse acts friendly, he will also be friendly but if the nurse acts harshly, he will seem withdraw.
My patient’s environment was my priority. I made sure that it was clean and properly arranged. This played an important role in preventing occurrence of minor injuries to the patient and also minimizing the risk of the patient getting infected by a disease like cholera. I would therefore monitor the performance of the cleaners and correct them where they had not done the work properly. I always disposed medical waste like bandages and needles carefully. My equipment was also always clean.
I respected my patient’s autonomy. I would always allow the patient to express his views and opinions. The patient has a right for autonomy. For instance if the patient does not want to be operated, the nurse should not go ahead and organize an operation on the patient without his consent. That nurse will have to take responsibility of any damages that may result from the operation like post-surgical complications.
I would constantly ensure that the patient has blood-thinning medicine to help the patient minimize blood clotting since the patient underwent grafting in the repairing of his ascending aorta. This drug should be used as prescribed by the physician.
I asked the patient if he was a smoker. He declined to answer me.I therefore encouraged him to completely stop smoking as it will lower his recovery. Smoking also damages the heart. The patient should be encouraged to continue taking high blood pressure medicine. Efficient controlling of high blood pressure would minimize pressure on the repaired aorta. This lowers the chances of rupturing the healing grafted aorta.

Part two slides
CARING FOR AN ASCENDING AORTIC DISSECTION REPAIR PATIENT
Ascending aortic dissection is a medical complication that arises when there is a tear on the ascending aorta.
Its major cause is high blood pressure

Ways of caring for an ascending Aortic Dissection Repair Patient
v Involving the patient in therapy program.
v Encouraging the patient to exercise.
v Encouraging the patient to drink more fluid.
v Monitoring the patient’s body weight daily.
v Monitoring the patient’s fluid intake and output.
v Ensuring the safety of the patient while on admission.
v Monitoring the patient’s bladder.
v Encourage the use of an incentive spirometer.
v A nurse should ensure the safety of the patient.
v Exercise and healthy dieting are essential for good health.
v A nurse should ensure that the patient has taken medication.
v Regular monitoring of the patients bladder and body weight is very essential.
v High blood pressure worsens ascending aortic dissection repair.
v Aortic dissection is a life threatening health complication.
v Atrial fibrillation should be prevented to enable the recovery of the patient

Improvements on Further Care for the Patient v Consulting the patient before catheterization.
v Involving the patient’s family in his treatment.
v Emphasizing on lowering the patient’s body mass index.
v Discouraging obese patients from consuming high amounts of starch.
v Motivating the patient to attend to his therapies.
v Emphasizing to the patient on the importance of every medication I perform on him.

v Being more close to my patients.
Obstacles faced
v Lack of regulations on visiting time for patients.
v Understaffing.
v Congestion
v Outdated technology.
v Inappropriate coordination of duties.
v Poor hygiene
v Language barrier with the patients
v Long working hours.

Conducting fall risk assessment of the patient
Falling in this perspective means involuntary rest by a patient on the floor. It may be caused by loss of consciousness or general weakness. The old patients are the ones which are at more risk. They should be encouraged to go for walks and also strengthen their lower body parts as they are vital in supporting their body.(Tinnetti, 1988)

General responsibilities of patient care by nurses
The nurse should treat the patient with respect. The mode of communication should also be professional. The nurse’s tonal variation while talking to the patient should be soft for the patient to understand the information being passed across well without any difficulty.
The nurse should encourage the patient’s friends and relatives to visit him as more often as they can. This makes the patient to feel loved and appreciated. The patient would even be more anxious to get healed and go home and unite with his family and friends.
The patient’s close friends and associates should also be involved in his medication like during decision making. This is more appropriate when the patient is not in a position to make very important decisions for him. This would in turn faster the medication process rather than waiting for the patient to be in a position of giving his own opinions. In addition, the nurse should therefore educate the patient on the importance of preventing it. It can be prevented by eating a healthy diet, avoiding smoking, exercising regularly, reducing his body weight as he is obese and reducing stress. Stress increases the patient’s blood pressure and should therefore be efficiently managed as it has a negative impact on the health of the patient
The nurse should hold unto cultural diversity. He should be ready and willing to study, understand and appreciate the cultural beliefs and background of his patients. Thiswill enable the nurse to know more about their patients. Cultural differences would hinder the efficient offering of services in the health facilities like the nurses discriminating the patients basing on their cultural background and beliefs.
The nurse should ensure that he develops a mutual relationship with the patient. This will make the patient to be more open and ready to tell the nurse everything that he feels he needs help. A patient’s perception about the nurse depends majorly on how the nurse treats him. If the nurse acts friendly, he will also be friendly but if the nurse acts harshly, he will seem withdraw.
The nurse should ensure that the patient’s environment is clean and properly arranged. This will help in preventing occurrence of minor injuries to the patient and also minimizing the risk of the patient getting infected by a disease like cholera. The nurse should therefore monitor the performance of the cleaners and correct them where they have not done the work properly. Medical waste like bandages and needles should also be well disposed by the nurse.
The nurse should respect the patient’s autonomy. He should always allow the patient to express his views and opinions. The patient has a right for autonomy.
For instance if the patient does not want to be operated, the nurse should not go ahead and organize an operation on the patient without his consent. That nurse will have to take responsibility of any damages that may result from the operation like post-surgical complications.
The nurse should ensure that the patient has blood-thinning medicine to help the patient minimize blood clotting since the patient underwent grafting in the repairing of his ascending aorta. This drug should be used as prescribed by the physician.
The nurse should ask the patient if he smokes. He should be discouraged to completely stop smoking as it lowers his recovery. Smoking also damages the heart. The patient should be encouraged to continue taking high blood pressure medicine. Efficient controlling of high blood pressure would minimize pressure on the repaired aorta. This lowers the chances of rupturing the healing grafted aorta.

Conclusion

Aortic dissection is a delicate medical procedure which needs to be handled with care by qualified profession. It is fatal when not treated in time as it can kill the sufferer within a day. This is because it leads to internal bleeding which hinders efficient blood flow. High blood pressure has a huge contribution to a slow rate of aortic dissection repair healing as it contributes to the rupturing of the repaired blood vessel through enhancing pumping of blood under high pressure. Therefore, in order to manage in controlling aortic dissection repair, the patient should be advised on how to lower his body mass index. He should lower his body weight naturally through exercising and proper dieting.

References

1. Hughes, R. G. (2009). Nurses' role in patient safety. Journal of nursing care quality, 1-4.
2. Joel, H. and. (2009). The importance of accurate blood pressuremeasurement. The Permanente Journal, 51-54.
3. Rogers, H. S. (2004). The working hours of hospital staff nurses and patient safety. Health affairs, 202-212.
4. Tinnetti, M. S. (1988). Risk factors for falls among elderly persons living in the community. England journal of medicine, 1701-1707.
5. Wolf, C. (1990). Clinical physiology of acid-base and electrolyte disorders. England journal of medicine, 15.


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