1 Patient background and signs and symptoms of bowel cancer along with the diagnosis
Mr. Dwight has been diagnosing with bowel cancer over the last few months. As per the opinion of the Ambulance officer, Mr. Dwight was vomiting frequently. Moreover, he had symptoms of kenotic breathing and type2 diabetes. He has also left eating and drinking over the past few days and was found weak before he was taken to the local healthcare organization. The bowl cancer treatment of Mr. Dwight was going through Hartman’s procedure with colostomy formation. The symptoms of heart problem were also identified with the blood glucose level of 22mmol/L.
The signs and symptoms of bowel cancer include the change in normal bowel motion; for example frequent diarrhea and constipation problem (Rutter, Nickerson, Rees, Patnick, & Blanks, 2014). Moreover, a feeling of unemptied after a full motion, stomach fullness, unusual weightless and breathlessness are also the diagnosis symptoms for bowel cancer. Apart from that, rectal bleeding and bleeding stools are significant symptoms of bowel cancer (Rutter, Nickerson, Rees, Patnick, & Blanks, 2014).
The symptom of rectal bleeding can be diagnosed through the rectal exam, anemia, and stool sample testing. CT scan and MRI scan can also be prescribed for the diagnosis process of bowel cancer (Rutter, Nickerson, Rees, Patnick, & Blanks, 2014). The application of Hartman’s procedure is a useful technique to promote the diagnosis process of rectosigmoid Colon. As per the case study, Mr. Dwight’s bowel cancer has been diagnosed with Hartman’s process.
2 Anatomy, physiology, and necessity of Hartman’s process
Anatomy: Anatomy defines the structure of Hartman’s procedure. The proctosigmoidectomy includes the Hartman’s procedure. A midline incision is made with the number 10 blade and turns the blade into umbilicus. This umbilicus results in cosmetically incision. The cosmetically incision qualifies the rectosigmoid colon through anorectal stamp to mitigate the colostomy. Hence, this helps in nullifying the symptoms of bowel cancer (Llosa et al., 2015). However, skin irritation is the most notable side effect of Hartman’s surgery (Sinha et al., 2014).
physiology; The physiological areas that are concerned about Hartman’s process are uterus to avoid complication, excessive bleeding from pelvic plexus, splenic issues and traction on the liver (Garcia-Allende et al., 2014). The traction of the liver results in unusual venous bleeding. The Hartman’s treatment process has been followed while diagnosing Mr. Dwight to avoid the complication of the splenic injury.
Necessity; The Hartman’s operational process is generally used to eliminate the colorectal mucosa that promotes the growth of bowel cancer (Llosa et al., 2015). Additionally, this process is helpful in preserving the postoperative bowel to nullify the complications in the anal route.
3 Risk factors that may contribute to Dwight’s diagnosis of bowel cancer.
Mr. Dwight has been diagnosing with the Hartman’s operational surgery for his bowel cancer (Llosa et al., 2015). The Hartman’s surgical process is easy and most effective to reduce the colon and rectum complications (Garcia-Allende et al., 2014). However, the risk factors that contribute to the diagnosis of bowel cancer anastomotic leak and risk of a hernia.
Anastomotic leak; The anastomotic leak is the resultant of the stoma reversal surgery. It is one of the most dreaded complications of the Hartman’s surgery (Garcia-Allende et al., 2014). It generally reduces the mortality rate. The after surgery may increase the morbidity and mortality rate of Mr. Dwight up to 34%. It develops high stomach pain, unusual fever, frequent vomiting, and nausea. Mr. Dwight has experienced frequent vomiting before his admission to the local hospital. It decreases the blood pressure and reduces the urinary free flow. Additionally, it creates complication as it requires two surgical operations and takes around 6 to 8 weeks for complete healing (Schuette et al., 2017).
Risk of a hernia; The Hartman’s surgical process can reduce generally increases the abdominal pressure (Garcia-Allende et al., 2014). The increased abdominal pressure can develop the risk of a hernia for Mr. Dwight. The complications of a hernia can result in urinary complications, heavy lifting, and fluid transportation in the abdomen (Nam et al., 2014). It is capable to decrease the tissue strength and reduces the tissue elasticity.
4 Four signs of bowel obstruction
The existence of colostomy can create a large intestine at the abdominal wall of Mr. Dwight to divert the colon and create the stoma. Additionally, it infects the lower abdomen and injury in the lower rectum (Van Rooyen & Mokoena, 2015). It is one of the most significant symptoms for the bowel obstructions (Garcia-Allende et al., 2014). The four signs of bowel obstructions are the deterioration of the digestive system in the grinding halt, decrease in appetite, diarrhea, vomiting, stomach pain and swallowed belly (Van Rooyen & Mokoena, 2015). The bowel obstruction may result in a hernia, damaged blood vessels, and growth of a tumor. The deterioration of the digestive system may completely damage the grinding halt and the unusual stomach pain may result in bowel cancer (Van Rooyen & Mokoena, 2015).
5 Normal BGL level for adults and the intervention process for the development of BGL.
The normal BGL level for the adults is slightly lower than 4.0 to 5.4mmol/L. However, it is noticed that the BGL level of Mr. Dwight is 22mmol/L which is much above than the normal level. The high BGL level increases the diabetic symptoms, increases the obesity, high BMR, excessive body weight, and high heartbeat (Daviaud et al., 2014). As mentioned in the case study, Mr. Dwight has been suffering from the diabetic symptom. Moreover, he has become immobilized and has the inability to conduct anything without external help. It is notable that high BGL upholds the body glucose level that promotes the colostomy block up (Daviaud et al., 2014).
Intervention; The high BGL level must be reduced in order to control the blood sugar level and demote the symptoms of type2 diabetes. Thus, effective maintenance of diet moderation can be most helpful techniques to reduce the BGL level (Daviaud et al., 2014).
Diet moderation; diet moderation is a most effective technique to reduce all the risk factors associated with high BGL level (Daviaud et al., 2014). Low calorie and low-fat food must be taken during the meal time and spicy snacks must be r5educed from the food habit. This can be an effective technique for Mr. Dwight to control the body glucose level. Controlled body glucose can always be beneficial for the mitigation of high BGL level (Daviaud et al., 2014).
6a. Clinical use of blood and blood products for the patients of bowel cancer.
Blood transfusion is the most effective clinical use for patients suffering from bowel cancer. Blood replacement is another clinical use that uses to transmit to the patient’s body to replace the polluted blood cells with fresh blood. (Musso et al., 2014).
6b. 7 standard of NSQHS. Four required actions to ensure safety and administrate blood products
As per the National Safety and Quality Health Service (NSQHS), the guide is primarily developed to inform about the criterion for the quality standard (“National Safety and Quality Health Service (NSQHS) Standards – QIP – Quality Innovation Performance Limited”, 2019). It is a document-based approach to improve the quality based healthcare services. The seventh standard of the NSQHS promotes the healthcare decision-making process, develops care models and measures effective systems for the quality care (Jha & Zaslavsky, 2014). Four required actions to ensure safety and administer blood products are as follows;
- Ensures the recommendations for blood transfusions
- Promotes the risk benefits by developing awareness
- Develops opportunities to asks blood transfusion-related questions
- Provides consent for the development of the blood transfusion
7a. Why does Mr. Dwight require a nasogastric tube?
The nasogastric tube is used to feed the patients suffering from neck or facial injuries, facial surgeries and the patients who are in ventilation. It is notable that Mr. Dwight lacks the food and drinking habit for the past three days and is getting weaker every single day. Moreover, he has lost mobility and cannot do anything without external help. Thus, a nasogastric tube can be useful for Mr. Dwight to satisfy his appetite and help to balance his daily diet. Additionally, a nasogastric tube is an authentic technique for liquid medication (Kronman et al., 2015). Thus, the nasogastric tube can be more effective to provide liquid medication to Mr. Dwight.
7b. requirement and implementation of routine check
A routine check-up is essentially required for the patient having a nasogastric tube. Mr. Dwight requires a regular blood sugar check and blood pressure check beofre the use of the nasogastric tube. Moreover, proper flow of medicine and meals through nasogastric tube should also be checked with high priority The blood sugar check can be helpful to keep track of the glucose level (Daviaud et al., 2014). Mr. Dwight has the symptoms of low blood pressure. Thus, regular measurement of blood pressure level can be helpful for the healthcare personnel to apply effective medication through a nasogastric tube.
8 Identification and discussion on clinical priority for Mr. Dwight
Clinical priority is essential for patients suffering from cancer and any surgical experiences (Berra, Rippe, & Manson, 2015). The required clinical priority for Mr. Dwight is the mitigation of the body glucose level from 22mmol/L to reduce the symptoms of type2 diabetes that may incur further complication in the bowel cancer.
Clinical priority can be implemented in three ways; urgent, semi-urgent and routine check-up. The urgent and semi-urgent clinical priority is generally applied for acute cancer pain and functional immobility (Zalai, Panics, Bobak, Csáki & Hamar, 2014). The routine clinical priority is generally implemented for persistent long-term pain (Berra, Rippe, & Manson, 2015). Mr. Dwight has essentially required the effective implementation of urgent clinical priority to reduce his body glucose level.
9 SMART framework for one short-term goal of the clinical priority
The short-term goal that can be implemented to develop the identified clinical priority is to mitigate there body glucose level and reduce the ED level from 22mmol/L.
| Specific | Measurable | Attainable | Realistic | Time-bound |
| The body glucose and ED level can be mitigated with the implementation of urgent clinical priority | It can be measured through blood sugar test in both empty stomach and a full stomach | It can be attained through low sugar and low-fat diet and proper medication | It is realistic that application of urgent clinical priority with proper diet and quality can reduce the ED level | This can be achieved within 4 weeks of Mr. Dwight’s admission to the emergency ward |
10 Two interventions to achieve a short-term goal
The aforesaid short-term goal has mentioned reducing the body glucose level by mitigating the ED level from 22mmol/L to 4mmol/L to 5mmol/L (Daviaud et al., 2014). Mr. Dwight requires proper quality care to promote the intervention process to achieve the goal. The required interventions to limit the body glucose level are as follows
Low sugar and low-fat diet: The low sugar and low-fat diet are essential for the holistic development for the patients suffering from high body glucose level (Daviaud et al., 2014). The high body glucose level increases the ED level that promotes all the symptoms for type2 diabetes. However, the low fat and low sugar diet keep control the sugar level in blood and reduce the obesity level. It can be helpful for Mr. Dwight to limit the ED level (Daviaud et al., 2014).
Assistance for physical exercise; Mr. Dwight requires a daily exercise to reduce the blood sugar level. However, he also needs external assistance to continue his physical exercises due to his immobility (Zalai, Panics, Bobak, Csáki & Hamar, 2014). A regular physical exercise can always be beneficial to limit body weight and body glucose level (Daviaud et al., 2014).
11Two methods to evaluate and justify outcomes
The pain management of bowel cancer and mitigation of ED level can be evaluated through two different methods; regular monitoring and performance evaluation of the caregivers (Pot, Blom & Willemse, 2015).
Regular monitoring: A regular monitoring is a quality outcome of evidence-based nursing care. The regular monitoring of the improvement level of the cancerous pain and blood glucose level (Daviaud et al., 2014) of Mr. Dwight.
Performance evaluation: The performance evaluation of the nursing care staffs is effective to evaluate the quality care outcome of the patient. It is capable to develop the treatment process of Mr. Dwight.
12Two risk factors associated with chemotherapy with evidence
The standard 3 of NSQHs defines the prevention and control from the healthcare infections. Mr. Dwight had gone through chemotherapy. The risk factors are a hospital-acquired infection and lack of Patient-care communication (Elwyn et al., 2014).
Hospital-acquired infection; The hospital-acquired infection includes the nosocomial infection that spreads toxic items into the patient’s body that can create healthcare complications (Elwyn et al., 2014). For example- an unclean hospital ICU floor can infect and promotes the morbidity and mortality rate.
Lack of patient care communication: The lack of patient care communication reduces the interventions
process of the patient (Elwyn et al.,
2014). For example- the unawareness of the patient regarding the hygiene and
cleaning measures of healthcare organization may affect the interventional
process of the patient.
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