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Question:

Discuss the assessments and actions that could have been undertaken to reduce the risk of opioid intoxication in the case of Doris Bowman; apply the clinical reasoning cycle to the case to enable you to use a structured approach.

Answer:

Overview of the case of Doris Bowman:

Doris, a 39 year old women became admitted in the hospital with pain in the abdomen. She undertook total hysterectomy through bilateral salpingoopherectomy with the help of general anaesthesia. During surgery, 400mls loss of blood took place along with inclusion of 2lt of Hartman’s fluid. Despite of such loss, the treatment presented varied types of benefits and risks (Scott-Conner, 2009).

The benefits and associated risks

Doris attained relief from extreme pain, general weakness as well as extremely high blood pressure rates. Other than this, with the help of surgical incision, the patient attained comfort from heavy menstrual problems and the question of death (Goldman et al. 2012). In case of sudden death of the patient, the management or the surgeon in-charge had to offer the death certificate and hence the reputation and brand image of the healthcare might get hindered in the market among others. Moreover, in such a competitive situation, death of a patient might create varied types of discrepancies such as conflict the doctors and medical staffs and this would hamper the popularity of the brand as compared to many other rival players. Other than death, Doris Bowman would undergo severe weakness, fatigue as well as anaemia. Extreme vomiting tendency might also be viewed occasionally within the patient in certain cases. Contrary to the latter statement, it may be mentioned that proper treatment and assistance by the doctors and nurses would mitigate the symptoms of Doris Bowman and minimise her troubles significantly (Zimmerman, 2012). Doing so, may increase the supremacy and fame of the healthcare along with the pleasure of Doris Bowman as well. Thus, proper analysis of the entire history of the patient is the prime requirement for the doctors to reduce the tendency of demise of Doris Bowman. Improper analysis might create problems for the patient as well as the management of the healthcare organisation.

Pain management regime

To reduce the pain of abdominal incision, the doctors prescribed analgesic injections to Doris along with anti-inflammatory injections. Other than this, to reduce the symptoms of nausea, vomiting, fatigue and general weakness, various antibiotics are offered such as cefuroxine injections, indomethain, paracetamol tablets and morphine injections (Scott-Conner, 2009). All these medicines are injected into the veins of the patients to present immediate actions. The injection of cefuroxine is presented to reduce the intensity of cepticemia within the entire body of Doris Bowman (Scott-Conner, 2009). However, in case the nurse fails to present such types of intravenous medicines to Doris then it would create a high time. Then the improvement of the patient (Doris) would get delayed and the heeling process might get late. Moreover, all the medicines and the nursing care need to be given regularly by the healthcare. Regular check-up of the doctor is mandatory. Blood pressure check-up and condition of the urine and the condition of the haemoglobin need to be carefully checked and also the electrolyte balance also need to be maintained. 

In addition to these injections, the doctors also prescribed or injected the dose of antitetanus, just before the operation. Glucose saline also needs to be offered intravenous (IV) along with clexane so as to mitigate the troubles of operations. Due to severe blood loss of Doris Bowman, intravenous (IV) blood of the specific blood group also needs to be presented. Only then, the patient would attain relief from the problem of cepticemia, tetanus, or excess blood loss that may create a serious condition of Doris. Due to which, the blood pressure might get enhanced, and the body may stop interacting with the medicines offered. Hence, the situation of death might arise. Therefore, the reduce the extreme condition, the above mentioned medicines need to be given to Doris Bowman by the doctors. In contrast, failure in giving such types of medicines might lower the life span of the patient and it would prove injurious (Zimmerman, 2012). Thus the most relevant best practice decision of the management in case of Doris Bowman’s case is the surgical operation. The prime cause behind it is that, surgical operation would get rid from the troublesome symptoms, undertaken by Doris.

Other than this, the management of the healthcare also need to present accurate medicinal facilities such as an advanced oxygen cylinder, inventive saline set, minimum two bottles of blood, innovative blood pressure machines and ECG machine. Furthermore, anaesthesia machines and many other surgical instruments need to be present at the time of the operation of Doris. The operation theatre (OT) also needs to be entirely sterilised and cleaned, piror the commencement of the operation (Zimmerman, 2012). The OT also needs to be fully automated with varied types of lights so as to perform the operation in an efficient way that would relief Doris from varied types of problems. With the help of sterilised cotton, the internal residual blood and fluid need to be cleared by the nurses present within the time of the OT.

The management of the healthcare firm also needs to be extremely conscious about the diet of the patient so as to reduce the problem of acids, gas or other digestive problems. Since, such type of symptoms might prove problematic and harmful for Doris in the long run.

However, in order to make the operation process effective in all regards, certain legal and ethical issues need to be followed. Just before the operation process of Doris, the total blood biochemistry report comprising of:

Apart from this, before operation process, consent of the patient party and the relatives is also extremely essential and so it need to be taken by the management. Proper nursing and coordination also needs to be maintained so as to reduce any sort of discrepancies. Such type of coordination may reduce sort of mental or physical disbalance or inconsistency. On the contrary, Scott-Conner (2009) denoted that improper maintenance of such type of methods might create unethical or legal liabilities and it may reduce the scope of the treatment. Hence, the intention of death of Doris due to such surgical operation might get enhanced. Other than this, proper assistance of nurses to the surgeon at the time of operation is also vital to make the surgery effective in all aspects. Failure to do so, might prove unfavourable for the doctor as well as patient and thus the success rate may get declined. Not only assistance, proper sterilization of the instruments is also mandatory, prior surgery. Otherwise, it may create unethical issues within the healthcare and its registration may get blocked by the medical council (Goldman et al. 2012). the entire charge of the surgery need to be clearly presented by the doctors or the administration department executives to the relatives of Doris. By attaining it, the relatives of Doris or Doris herself might get an opportunity to decide, whether the surgery is feasible. Inappropriate information might create a gap within the minds of the relatives of Doris and it would result in switchover costs. Along with this, the reputation of the healthcare concern might also get diminished significantly. Therefore, to reduce such types of unethical and legal issues, the management need to be more cautious and vigilant towards the services so that, the patient (Doris) gets best treatment at competitive price. Only then, Doris would get rid from the pain of surgical incisions and hysterectomy within a very small time frame. 

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