Perioperative Care Case Study
Added on 2021-04-16
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Healthcare and Research
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Running head: PERIOPERATIVE CARE CASE STUDYPeri-operative Care Case studyName of StudentName of UniversityAuthor Note
1PERIOPERATIVE CARE CASE STUDYThe purpose of this paper is to review the care taken of a 38-year-old female patient whounderwent a laparoscopic cholecystectomy. The discussion will focus on the brief description ofthe patient’s medical history, journey of the preoperative, intra-operative and post operativesurgical procedures as well as the methods used by the healthcare providers to address patientsafety, communication between the service care providers and efficacy of the teamwork amongthe system (Halverson et al. 2011 pp.305-310). Peri-operative care is a critical procedure thatrequires skilled professionals who can perform effective clinical assessment, surgicalrequirements and strict monitoring after the operation until the patient fully recovers (Krajewskiet al. 2014pp.24-36). The whole process starts with preliminary assessment to determine theproblem with the patient and devise a plan of action before commencing the surgical procedure(Nygren et al. 2012pp.801-816). During this time, a team is formed which consists of a surgeon,an anaesthetic nurse, an anaesthetist, a circulating andscrub nurses. It is the duty of theregistered nurses to look after the patient and monitor for any signs of distress. The paper willreflect on the mistakes of the procedure and support with evidence based research to understandthe implications of clinical mal practice. The patient is a 38-year-old woman named Olivia Randell, who had been suffering forthe previous six months with pain and discomfort on her right hand side of hypochondrium. Shecame in with bitter taste in her mouth, nauseous, releasing gas from her upper gut, burningsensation in heart and alternative diarrhoea and constipation like conditions. The physiciandiagnosed her with acalculous cholecystitison analysis of ultrasound report of gallbladder scan(Huffman and Schenker 2010pp.15-22.). The report showed that the patient’s gall bladder lininghas thickened to form 6mm sludge like structure obstructing functionality. The patient had beenreferred to a surgeon who suggested laprascopic cholecystectomy (Tsimoyiannis et al.
2PERIOPERATIVE CARE CASE STUDY2010pp.1842-1848). The patient underwent a laparoscopic sleeve gastrectomy prior to thissurgery to lose weight by restricting the stomach food intake (Eid et al. 2012pp.262-265). Thisprocedure lowered her basal metabolic rate (BMI) from 40 to present day 30. Frequent hydrationwas the given advice to the patient after her weight loss procedure. The previous procedure ofthe patient subjected her to post operative vomiting and nausea (PONV) which was not properlyaddressed in the previous healthcare setting (Apfel et al. 2012 pp. 742-753). She was worriedabout the repetition of the same incident after the current procedure as well and was anxiousabout it, as she did not have prior acquaintance with the surgical crew, which she mentioned tothe anesthetist (Jlala et al. 2010 pp.369-374). The first pre-operative mistake observed in the following situation, is that the anestheticnurse who noticed that the consent form was completed by the ward nurse but the signature ofthe patient was missing. The anesthetist questioned the ward nurse to whom she replied that shewas not the assigned nurse for the patient, only helped her move into the operation theatre(Jeyaseelan et al. 2010 pp.407-408). The anesthetic nurse was quick to make sure that the patientwas completely aware of the procedure about to performed on her, to which the patientresponded positively after which the patient was escorted to the anesthesia ward.The traditional intraoperative surgical crew consists of an experienced surgeon, ananesthetist, circulating nurse and scrub nurses. The surgeon was experienced with laprascopiccholecystotectomy for 25 years. The anesthetist was a registered nurse whom the surgeon wastraining under the supervision of consultant who was then working in another operation theatre.The surgeon and the anesthetist did not have any prior professional acquaintance or familiarity.The usual scrub nurse assigned to the surgeon was on leave due to illness that day andreplacement was an experienced nurse from agency, but had not previously worked for the
3PERIOPERATIVE CARE CASE STUDYcurrent hospital. The circulating nurses was professionally acquainted with the surgeon and hisworking procedure abut was then supervising a registered nurses who was in her preliminaryweeks of practice in the operation theatre. The operation list arrived late due to unavailability ofinstrument supply while another operation was taking place. Anesthesia was performed using a combination of 1.5 mg/kg Propofol Intra VitrealInjection (IVI) of bolus, using 1.5 mcg/kgfentanyl, 0.03 mg/kg midazolam, and 0.01 mg/kgvecuronium. The oxygen maintenance was providedwith a ProSeal laryngeal mask airway(LMA) (Seet et al. 2010 pp.602-607). Anaesthesia was kept with sevoflurane and50% N20/O2ventilation, and a blend of Propofol (75 mcg/kg/min) and remifentanil (0.05mcg/kg/mininfusion). Intra-operative checking was done using standard procedures which comprised ofusing non-invasiveblood pressure, ECG, pulse oximeter, end tidal carbon dioxide (ETCO2), andthermal measurement.The anesthetist was at that time concerned that during initial maskaeration the patient’s abdomen hadinsufflation from previous weight loss surgery (Chaudhuri etal. 2012 pp.646-653). IVI Cefazolin 2 g administered immediately adjacent to the previousincision.The patient was in supine position, and later positioned to reverse Trendelenburg(Hathorn et al 2013 pp.308-313). Laparoscopic port insertion and induction of the pneumo-peritoneum were commencedwith CO2 performed after prepping anddraping. The circulatingnurse directed the new graduate RN to connect the light, video, andgas leads and to verbalize thepressure on the insufflator, which was 10 mmHg.The surgery took one hour instead of the designated 45 minutes due to following issuesof removal of surgical adhesive from the area of the patient from her previous surgery (Rothrock
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