Consideration of patient situation Case Study 2022
Verified
Added on 2022/09/29
|10
|2556
|38
AI Summary
Contribute Materials
Your contribution can guide someone’s learning journey. Share your
documents today.
Assessment task 3: Case study – Perioperative Consideration of patient situation Mrs. Jane Austin is a 59-year-old woman presented to the emergency department with complaints of several episodes of severe right upper quadrant abdominal pain associated with uncontrolled nausea and vomiting. On admission, she was febrile, right upper quadrant tendernessonpalpation.Shewasdiagnosedwithcholelithiasisandcholecystitisvia ultrasound. She is admitted to the operating theater for laparoscopiccholecystectomy under generalanesthesia.During thePerioperativenursingcare,thepatienthad somemild hemodynamic instability during the insufflations and maintenance of pneum-operitoneum. Collection of information Mrs. Austin has a past medical history of hyperlipidemia, hypertension, and a body mass index of 28 and is a smoker. Her present complaint is several episodes of severe right upper quadrant abdominal pain associated with nausea and vomiting. On assessment, she has tachycardia, febrile and complained of upper quadrant tenderness on palpation. She also has the complaints of recent intolerance to fatty foods, resulting in nausea when ingested. A dual diagnosis of cholelithiasis and cholecystitis was made by ultrasound. The treatment plan for Austin is a laparoscopic cholecystectomy under general anesthesia. Observation, auscultation, palpitation and blood investigations are done to rule out the condition of the patient. On observing the level of consciousness she was alert and awake. On auscultation over the chest shows the absence of air entry to the base. Gastrointestinal auscultation shows the absence of bowel sounds. On palpation over the abdomen, mild
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
abdominal distension is present and the patient complaining of abdominal pain on palpation. On Pain assessment using the pain, the scale shows that her pain score is 6/10 which is referring to shoulder tip. Her vital signs are elevated (HR 115 b/mt, RR 28/mt, Temp 37.5 Celsius). Her blood pressure is elevated (125/70 mm Hg). The saturation level is low (Spo2 89%). Blood culture shows no growth after 3 days. White blood cell count is normal. C- reactive protein is elevated. Process the collected information Post-operative Three major issues in the postoperative period was the impaired gas exchange, increased heart rate and the pain that is radiating to the shoulders. Critical analysis of the issues helps the nurse to establish goals and to plan the nursing interventions to promote the health of the patient.Post-operativelypatientwascomplainingofthepainthatisradiatingtothe shoulders,itisbecausepainovertheshouldersisoneofthecomplicationsofthe laparoscopic surgery which normally stays for 24 hours. (Çoban et al. 2017).The patient was suffering from tachycardia post-operatively which is one of the complications of laparoscopic surgery. Generally, the patient undergone laparoscopic surgery has the potential complication of tachycardia. The post-operative assessment shows that the patient had air entry to the base of the lungs. One of the common complications of laparoscopic cholecystectomy was the abdominal distension which caused the absence of air entry to the base of the lungs. Identification of problem Mrs. Austin is presented with the signs and symptoms ofcholelithiasis and cholecystitis. She is also presented with associated disease conditions like hypertension, hyperlipidemia, and a
body mass index of 28. The nursing problems identified in the case scenario are impaired patent airway related to high body mass index and anesthesia, impaired breathing related to anesthesia and hypertension related to age and increased body mass index. Impaired patent airway The perioperative assessment shows that vital signs are elevated. Increased breathing (RR 28/mt) and decreased saturation levels (Spo2 89%) show that the airway is not patent. Saturation represents the oxygen concentration in the blood. Decreased saturation shows that the oxygen exchange is abnormal (Pascoal et al. 2016).Auscultation on the chest shows that there is a lack of air entry to the base of the lungs which is one of the signs for impaired airway patency. The airway is the high priority nursing problem that has to be treated immediately to prevent further complications(Çoban et al. 2017).The nurse has to find the causative factor of the impaired airway patency to establish the goals and plan the nursing interventions. The main causes of impaired patent airway are age, increased body weight, hyperlipidemia, and hypertension. The nurse needs to consider the contributory factors and alleviate the factors to ensure the patent's airway (Edmark et al. 2015). Impaired breathing Impaired breathing is the second priority nursing problem that needs to be taken care of in the case of Mrs. Austin. The Perioperative period is the stage that the nurse has to do close monitoring and implement nursing interventions that improve the patient’s condition. The patient’s vital signs are abnormal. Her respiratory rate is elevated (RR 28/mt). The saturation level of the patient is decreased (Spo2 89%). Decreased Saturation level shows that oxygen concentration in the blood is low. Low saturation levels lead to impaired tissue perfusion
which is considered to be a medical emergency (Gallagher, & Parks, 2014).The nurse has to consider the causes for the impaired breathing and alleviate the related factors to maintain normal breathing. Auscultation of the chest shows that there is a lack of air entry to the base of the lungs which is one of the evidence for impaired breathing. The causes for impaired breathing are the age, hyperlipidemia, present disease condition, and increased body mass index. Acute pain Mrs. Austin has complaints of pain over the surgical site that is radiating to the shoulders. Thepostoperativepainscoreis6/10.Radiatingpainisoneofthecomplicationsof laparoscopic surgery. Acute pain is the main nursing problem that needs to be rectified to ensure comfort for the patient(Argoff, 2014).Because pain may affect patient recovery, co- operation, and sleep pattern. Pain may cause stress to the patient which leads to elevated vital signs. Any patient who underwent a surgical procedure suffers pain postoperatively, but in the case of laparoscopic surgery, both the surgical incision and the mode of surgery (laparoscopy)causepainanddiscomforttothepatient.Pharmacologicalandnon- pharmacological pain management improves the patient's condition and alleviates the pain. Establishment of goals Establishment of goals is an essential part of the nursing care which aids the nurse to plan appropriate nursing intervention. Mrs. Austin is presented with past and present medical disease conditions. She has both medical and surgical conditions (Davis, 2015).The nurse needs to establish the goals that meet both the medical and surgical needs of the patient. The nurse has to prioritize the goals according to the condition of the patient. The patient’s airway
Paraphrase This Document
Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
is patent without supportive mechanisms within 24- 48 hours of nursing care. The patient’s breathing is maintained normally within 48 hours of nursing care. Normal saturation is maintained after close monitoring and nursing care for 48 hours. Normal vital signs are maintained after the nursing care for 48 hours.The patient’s pain score is 2/10 within 48 hours of nursing care. The patient verbalizes that the pain is reduced and she is comfortable. The patient shows the signs and symptoms of recovery with 3-4 days of nursing care. Nursing interventions Maintenance of Patent airway Nursing interventions need to be planned to maintain a patent airway. Assess the breathing and depth of the patient. Position the patient in semi-fowlers to enhance the optimal expansion of the lungs (Castellan et al. 2016).Do suction every two hourly if there are excess mucous secretion and obstruction. Monitor the vital signs and saturation continuously. Auscultate the breath sounds to monitor the normal gas exchange (Park,2014). Maintain normal breathing Maintenance of normal breathing is essential to maintain the patient’s condition and speedy recovery. The patient’s respiration and saturation have to be monitored continuously. The nurse has to administer oxygen therapy as per the doctor’s order. Position the patient in semi fowlers is she tolerates (Choi, Ha, & Kang, 2017).Educate the patient on deep breathing exercises to enhance normal breathing. Ensure patent airway, to maintain normal breathing. Normalbreathingandgasexchangepromotestissueperfusionandsupportsrecovery (Katabathina, Zafar, & Suri, 2015)
Alleviate the pain The nurse needs to monitor the level of the pain continuously with the help of the pain scale. The nurse has to locate the pain aggravating factors and remove the same from the environment. The nurse needs to ensure a comfortable position for the patient with the support of an extra pillow, cushions. The nurse needs to provide a favorable environment to rest, by ensuring noiseless surroundings, less lighting, and ventilation (Argoff, 2014).The nurse needs to administer analgesics as per doctor’s order. Encourage the patient to adhere to the non-pharmacological pain management mechanisms like relaxation technique, music therapy, deep breathing exercise, diversion therapy which helps the patient to manage the pain independently and it also promotes the action of the pain killers. Evaluation Evaluation of nursing care helps the nurse to discover effective nursing interventions. In the case scenario, Mrs. Austin presented with surgical and medical conditions. Three nursing problems are identified and the nursing interventions are implemented for the recovery of the patient. Nursing interventions are planned based on the causative factors of the nursing problems. The implemented nursing interventions are moderately effective because the major cause for all three nursing problems are hyperlipidemia and increased body mass index. The nursing care provided was moderately supportive and the recovery of the patient was delayed. Reflection Reflection of the nursing care for Mrs. Austin helps the nurse to analyze and improve the knowledge. Nursing care of the patient who had undergonelaparoscopic cholecystectomy
under general anaesthesia helped me to learn the nursing care of the patient with medical and surgicalconditions.Ilearnedthatcaringforthepatientwithmultipledisorderslike hyperlipidemia and hypertension has to implement with the support of evidence-based literature review.I learn to ensure the nursing care that isethical, legal, evidence-based, and holistic person-centered in my future career. References Argoff, C. E.(2014). Recentmanagementadvancesin acutepostoperativepain.Pain Practice,14(5),477-487Retrievedfrom https://onlinelibrary.wiley.com/doi/abs/10.1111/papr.12108 Allen, S. N. (2013). Gallbladder disease: pathophysiology, diagnosis, and treatment.US Pharm,38(3),33-41Retrievedfrom http://stage.uspharmacist.com/article/gallbladder-disease-pathophysiology-diagnosis- and-treatment Alam,I.(2016).Individualizedcareinpatientsundergoinglaparoscopic cholecystectomy.International Journal of Medical and Health Research,2(5), 69-72 Retrieved fromfile:///C:/Users/admin/Desktop/2-10-21-398.pdf Bavishi, C., Bangalore, S., & Messerli, F. H. (2017). Outcomes of intensive blood pressure loweringinolderhypertensivepatients.JournaloftheAmericanCollegeof
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
Cardiology,69(5),486-493Retrievedfrom http://www.onlinejacc.org/content/69/5/486.abstract Castellan, C., Sluga, S., Spina, E., & Sanson, G. (2016). Nursing diagnoses, outcomes, and interventions as measures of patient complexity and nursing care requirement in Intensive Care Unit.Journal of advanced nursing,72(6), 1273-1286 Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12913 Çoban, G., Yildirim, E., Göktürk, S., Çahşkan, Z., Türk, E., & Akçil, M. (2014). Body mass index, cholecystitis, cholelithiasis, pancreatitis and imaging of common bile duct stones.The American journal of the medical sciences,347(5), 364-369. Retrieved fromhttps://www.sciencedirect.com/science/article/abs/pii/S0002962915303347 Choi, U. J., Ha, T. U., & Kang, J. S. (2017). The effects of semi-fowler's position on post- operative recovery and pain for patients with laparoscopic abdominal surgery.Journal of the Korea Academia-Industrial Cooperation Society,18(5), 412-419 Retrieved fromhttp://www.koreascience.or.kr/article/JAKO201718836885631.pub Davis, H. (2015). Nursing care: care of the perioperative patient.Veterinary Clinics: Small AnimalPractice,45(5),1029-1048Retrievedfrom https://www.vetsmall.theclinics.com/article/S0195-5616(15)00075-3/abstract Edmark, L., Auner, U., Lindbäck, J., Enlund, M., & Hedenstierna, G. (2014). Postoperative atelectasis–a randomized trial investigating a ventilatory strategy and low oxygen fractionduringrecovery.ActaAnaesthesiologicaScandinavica,58(6),681-688 Retrieved fromhttps://onlinelibrary.wiley.com/doi/abs/10.1111/aas.12322
Gallagher, T. K., & Parks, R. W. (2014). Gallstones.Surgery (Oxford),32(12), 635-642 Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S026393191400204X Hassler,K.R.,&Jones,M.W.(2017).Gallbladder,cholecystectomy,laparoscopic. InStatPearls[Internet].StatPearlsPublishingRetrievedfrom https://www.ncbi.nlm.nih.gov/books/NBK448145/ Katabathina, V. S., Zafar, A. M., & Suri, R. (2015). Clinical presentation, imaging, and managementofacutecholecystitis.Techniquesinvascularandinterventional radiology,18(4),256-265Retrievedfrom https://www.sciencedirect.com/science/article/abs/pii/S1089251615000657 Pascoal, L. M., de Carvalho, J. P. A., de Sousa, V. E. C., Santos, F. D. R. P., Neto, P. M. L., Nunes, S. F. L., & de Oliveira Lopes, M. V. (2016). Ineffective airway clearance in adultpatientsafterthoracicandupperabdominalsurgery.AppliedNursing Research,31,24-28Retrievedfrom https://www.sciencedirect.com/science/article/pii/S0897189715002323 Park, H. (2014). Identifying core NANDA‐I nursing diagnoses, NIC interventions, NOC outcomes, and NNN linkages for heart failure.International journal of nursing knowledge,25(1),30-38Retrievedfrom https://onlinelibrary.wiley.com/doi/abs/10.1111/2047-3095.12010 Shah, S. S., Alqufayi, A. A., Ismael, R. M., Alharbi, A. S., Almofadhli, A. A., & Kausar, M. A. ROLE OF LABORATORY INVESTIGATIONS AND ULTRASONOGRAPHY