Laparoscopic Cholecystectomy Risks and Complications

This assignment delves into the potential risks and complications associated with laparoscopic cholecystectomy, a surgical procedure for removing the gallbladder. It examines factors influencing these complications, such as patient comorbidities (e.g., diabetes), surgical technique, and postoperative care. The assignment emphasizes the importance of minimizing these risks through meticulous preoperative assessment, skillful surgical execution, and diligent postoperative management.

Running head: CLINICAL REASONING
CLINICAL REASONING
Name of the Student
Name of the University
Author Notes

1CLINICAL REASONING
Clinical reasoning is defined as the process by the use of which healthcare professional
like nurses obtain information from patients in order to provide optimal diagnosis and care for
the patient. The process of clinical reasoning requires the nurses to generate inferences from the
data collected and carry out clinical judgments in order to ensure favorable patient outcomes. It
is associated with thinking together with clinical decision making and subsequent application of
clinical practice (Goudreau, Boyer & Létourneau, 2014). Clinical reasoning is highly essential in
nursing practices as it involves the nurse’s ability to think in a logical and systematic manner,
along with reflection of their own judgments in order to provide effective nursing intervention
(Menezes, Corrêa & Cruz, 2015).
Patient safety is also essential, particularly in the healthcare system. Healthcare
professional are required to improve patient safety with respect to professional norms,
expectations and ethical foundations (Carayon et al., 2014). Errors occurring in healthcare
practices can give rise to serious complications. Therefore, it is necessary to improve processes
or operational systems that minimize the likelihood of errors. The concept of patient safety not
only deals with responding to patient problems but also deals with preventing such problems
(Makary & Daniel, 2016).
This essay provides a reflective writing that deals with a patient who has undergone open
cholecystectomy and the associated nursing care to prevent any complications post surgery.
The patient for whom I am caring for is a 61year old female, named Dora Smith. She was
initially admitted to the hospital following symptoms of pain in the upper parts of her stomach
along with nausea, vomiting and digestive problems like indigestion, bloating, heartburn, gas,
among others. She was diagnosed with gall bladder stones and was prescribed to undergo

2CLINICAL REASONING
laparoscopic cholecystectomy. The reason why she had to undergo open cholecystectomy is that
she suffers from diabetes mellitus. Cholecystitis is associated with biliary statis and occurs in
patients suffering from diabetes mellitus (McKay, Abulfaraj & Lipschitz, 2012). According to
research various risk factors can bring about transformations from laparoscopic cholecystectomy
to open cholecystectomy. These include conditions of acute cholecystitis, obesity, gangrene,
gallbladder empyema, among others (Thyagarajan et al., 2017). Moreover, apart from diabetes,
she also suffers from high levels of cholesterol and hypertension. Patients suffering from
diabetes and high cholesterol levels usually suffer from effects of gall stone formations.
Cholesterol is one of the major components of gall stones (Njeze, 2013; Agunloye et al., 2013).
I am a registered nurse of the hospital and was assigned the duty of caring for her to
prevent any post operative complications. Diabetic patients are prone to various surgical
complications due to their various co-morbidities and as a result morbidity and mortality rates
are higher in these patients post surgery. One of the important complications associated with
diabetic patients following surgery is wound infections. They are highly prone to developing
serious surgical wound infections due to the defects in their immune responses (Martin et al.,
2016). In order to prepare a nursing care plan for her, I had to use my clinical reasoning skills in
order to provide the effective care plan that will ensure a favorable outcome for her. This will
also ensure safety of the patient. As she was both diabetic and suffered from hypertension, it was
necessary to ensure continuation of medication for her to manage her medical conditions in order
to prevent any post-operative complications. These post-operative complications could be
infection, heart failure, pneumonia and kidney failure, which can even lead to death.
Medication error is a barrier to patient safety. Adverse situations can arise when
healthcare professionals provide wrong medications to patients. Medication errors are

3CLINICAL REASONING
preventable forms of error, but such errors have been responsible for the death of patients
(Magellan et al., 2015). The patient safety model that I am going to apply in this scenario is the
Swiss Cheese Model. This model of patient safety is normally applied to the healthcare system
and helps the healthcare professionals to prevent mistakes with regards to medications. These
can be prescribing errors, dispensing errors, among others (Braithwaite, Wears & Hollnagel,
2015). Diabetes patients are at a high risk of suffering from medication errors in hospital
settings. As she has undergone an open surgery and also suffers from diabetes, it is necessary for
me to remove all the barriers that may ultimately give rise to insulin over dosage. Over dosage of
insulin in patients can give rise to hypoglycemia. The symptoms include pale skin, confusion,
fits, coma, irritation, among others (Www.express.co.uk, 2017). Some of the insulin dosage
errors could be misreading of the information on the label of the insulin ampoule, use of wrong
syringe and injection of wrong insulin type. In order to prevent insulin over dosage of the patient,
I will develop standardized protocols during prescribing the insulin, include generic names in the
protocols to prevent confusion, generate a standardized algorithm for the insulin dosing, avoiding
the use of abbreviations and using the complete word like units, when communicating the insulin
dosages to be given, use a particular standardized concentration of insulin and carry out proper
storage of insulin. Moreover, it is also necessary to keep a record of the number of times insulin
is administered to prevent over dosage. Overdosing can be prevented by maintaining electronic
medical records. Moreover, it is also necessary to track the episodes of hypoglycemia in order to
prevent adverse patient outcomes. Moreover, I will also monitor whether the patient has got the
desired dosage of insulin. Improper maintenance of diabetes following surgery can give rise to
serious wound infections in the patient.

4CLINICAL REASONING
Clinical reasoning
Patient situation
Mrs. Dora Smith is 61 years old. She had undergone open cholecystectomy in order to
remove her gall stones. She has a medical history of diabetes, hypertension and high cholesterol.
Due to complications as a result of her cholecystitis, she had to undergo open cholecystectomy,
which is not favorable in the case of diabetic patients. Her condition is now normal and she has
been given intravenous insulin in order to increase her wound healing to prevent surgical wound
infections. She has been given a diet that would help to keep her blood glucose levels in check.
Her wound dressing as of now is looking dry and intact. She is in constant monitoring in order to
keep a check on her blood glucose levels.
Collection of information
The patient suffers from hypertension as well as diabetes. Her blood pressure was
monitored, which was found to be within range. Hypertension or high blood pressure can also
delay wound healing by preventing oxygen supply to the cells (Pierpont et al., 2014). Her blood
pressure has been kept within range by providing her with anti-hypertensives. Her temperature,
respiration rate, heart rate are all within normal limits.
Processing of information
Mrs. Smith showed signs of hypotension, which can be due to her blood loss during
surgery or can be due to electrolyte imbalance. Moreover, her skin looked pale, her lips were
pale and she showed signs of irritation, confusion, loss of consciousness. This can be due to
hypoglycemia, which may have arisen due to over dosage of insulin. Hypotension as well as
hypoglycemia can lead her to shock and even coma (Kalra et al., 2013). Her insulin medication

5CLINICAL REASONING
needs to be stopped or the concentration lowered and she has to be given fluids in order to
prevent her from going into shock following hypotension. Moreover, her pulse rate has also gone
down and the urine volume has also decreased.
Identification of problem
She is hypotensive as a result electrolyte imbalance as well as hypoglycemic and over
dosage of insulin has worsened the situation.
Establishing goals
I want to bring her blood pressure to normal limits and also decrease the dose of insulin
administered to her. But I will call in the doctor to double check with him before carrying out the
interventions.
Taking action
I will provide her with IV solutions like colloids to increase her plasma protein
concentration and with normal saline that would increase her circulatory movement. After she
has become normotensive, she will be given a hypotonic solution of sodium chloride to provide
her with electrolytes as well as water to improve her renal excretion of the metabolic wastes. I
will monitor her IV rate and increase it. In order to manage her hypoglycemia, following insulin
over dosage, she will be given liquids containing glucose. If she is alert, then she will be given
fruit juices with added sugar in order to prevent occurrence of hypoglycemia. Her vital signs will
be constantly monitored apart from measurement of her blood glucose levels, which will be
checked on an hourly basis.

6CLINICAL REASONING
Evaluation
Monitoring of her blood pressure revealed that it is normal, her urine discharge is also
normal. Moreover, her blood sugar levels have also increased following the administration of the
interventions.
Reflection
Keeping in mind the situation that had arisen, next time I will keep a check on the
concentration of insulin that will be administered to her. Moreover, I will also keep a check on
her blood pressure and provide timely administration of fluids if needed. From these incidents I
have learned that although insulin is essential to be administered to diabetic patients following
surgery in order to aid in their wound healing but over dosage can give rise to serious
complications that can send the patient to coma. Moreover, maintenance of electrolyte balance is
also essential to prevent complications resulting from hypotension.
Thus, from the above described events it can be concluded that patient safety is the
highest priority for all healthcare professionals and frequent monitoring of patients who have
undergone surgery is highly essential in order to prevent adverse situations that can even
culminate in the death of the patient.

7CLINICAL REASONING
Reference List
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clinical practice, 16(1), 71-75.
Braithwaite, J., Wears, R. L., & Hollnagel, E. (2015). Resilient health care: turning patient safety
on its head. International Journal for Quality in Health Care, 27(5), 418-420.
Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden,
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8CLINICAL REASONING
Martin, E. T., Kaye, K. S., Knott, C., Nguyen, H., Santarossa, M., Evans, R., ... & Jaber, L.
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killed actor Iain Rogerson?. Express.co.uk. Retrieved 31 December 2017, from
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rogerson-suspected-coronation