Assignment on Perioperative Care

Running head: POSTOPERATIVE CARE 1
Postoperative Care
Student Name
Institutional Affiliation

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Postoperative Care
Introduction
Perioperative care is the management provided to a patient before, during, and after a
surgical procedure until homeostasis is achieved. In the care of the patient in these stages, the
clinicians have a role in providing individualized care depending on the procedure the patient is
undergoing (Thorell et al., 2016). Postoperative Care Unit (PACU) is the unit where patients
from a surgical procedure are monitored until they become stable. The specialist nurse in the unit
has an integral role in the provision of patient-centered care, focusing on evidence-based care
and a holistic patient approach in establishing the priority care plan for the patient. Patient
transition through the three sections is critical as it involves disturbances in the body’s normal
function (Huang et al., 2016). The nurse practitioner has a role in providing care to the patient
focusing on the legal-ethical issues that govern perioperative care to promote patient recovery.
Clinical reasoning is the process assimilated by nurses in patient management, and it
involves the collection of relevant cues, analyzing information collected, synthesis of the patient
situation, developing a plan of care, and implementation of the care (Hunter, & Arthur, 2016). It
ensures the chain of care is not broken even in cases of shift changes since patient management
is documented and drafted systematically. The cycle emphasizes the importance of patient
outcome evaluation, reflection and learning from the process. Application of this framework in
the clinical areas ensures care providers provide patient-centered care that is evidence-based and
holistic in nature (Johnsen, Slettebø, & Fossum, 2016). This cycle acts as a basis for nursing
intervention and boosts the clinical rationalizing of responses. The purpose of this article is to
synthesize a case study utilizing the clinical reasoning cycle to manage the patient scenario.

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Patient situation
The patient is Mrs. Jane Austin, a 59-year-old woman who has been admitted to the
PACU after undergoing laparoscopic cholecystectomy. The patient is alert and awake with
complaints of pain rating it at 6/10. The vital signs taken on admission to the unit; Respiratory
rate -28, heart rate – 115 b/min, BP -125/70mmHg, SpO2 89% on room air, and Temp 37.5°C.
The patient has four incision dressings that are not oozing. On auscultation, bowel sounds are not
heard, and there is no air entry into the lung bases.
Health information
Mrs. Austin arrived at the emergency department with complaints of extreme right upper
quadrant abdominal pain that started suddenly and was increasing in intensity. The pain was
associated with uncontrolled nausea and vomiting. The ingestion of fatty foods aggravated
nausea and vomiting. Mrs. Austin has a past medical history of hypertension, hyperlipidemia,
and a body mass index of 28. She reports no history of previous hospital admission or any
surgical procedure. She says to be compliant to her medications; Lipitor and perindopril, and
states that her blood pressure is well controlled. She smokes cigarette and does not take alcohol.
On examination, she was tachycardic, febrile and complained of right upper quadrant tenderness
on palpation.
In the analysis of Investigations; an abdominal ultrasound and chest x-ray were
requested. The chest x-ray was clear, while the ultrasound confirmed a diagnosis of cholelithiasis
and cholecystitis. Laboratory results showed elevation in the levels of C-reactive protein. The
patient was therefore admitted for laparoscopic cholecystectomy. After the procedure, the

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anesthetist informed that during the insufflation and maintenance of pneumo-peritoneum, the
patient experienced mild hemodynamic instability. The procedure took longer than expected
because the surgeon had difficulty visualizing the common bile duct due to the patient’s weight.
Hyperlipidemia is the accumulation of low-density cholesterol and triglycerides to a level
that is more than normal body levels. It is caused due to excessive consumption of saturated fats.
In the pathophysiology of cholelithiasis, hyperlipidemia plays a significant role. Cholelithiasis is
the blockage of bile ducts by gall stones (Tazuma et al., 2017). When the concentration of
cholesterol is high in bile, it may promote its crystallization hence forming stones that block the
exit of bile. The accumulation of bile in the gall bladder leads to its inflammation; a condition
called cholecystitis. The elevation of C-reactive protein is a sign of gall bladder inflammation.
The patient is tachycardic due to the stress response to the pain perceived. Nausea and vomiting
occur as a response to stretch to the gall bladder. The inflammation triggers the stretch receptors
hence stimulating nausea and vomiting center in the medulla (Kwatra et al., 2019). Excessive
vomiting depletes the body of electrolytes and acid and can lead to electrolyte depletion with
metabolic alkalosis.
Postoperatively, the patient is still tachycardic and is complaining of pain to the shoulder
tip. The respiration is elevated to correct the hemodynamic instability encountered during intra-
op insufflation. Creation of pneumoperitoneum is important in laparoscopic procedures since it
separates the peritoneum from the abdominal contents enabling clear visibility (Koo et al., 2016).
SpO2 levels are low 89% compared to normal (96%-99%). Intravenous Hartman's solution is
administered to correct the fluid lost through vomiting and during the surgical procedure to attain