Consideration of patient situation Case Study 2022

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
tenderness on palpation. She was diagnosed with cholelithiasis and cholecystitis via
ultrasound. She is admitted to the operating theater for laparoscopic cholecystectomy under
general anesthesia. During the Perioperative nursing care, the patient had some mild
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

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-operatively patient was complaining of the pain that is radiating to the
shoulders, it is because pain over the shoulders is one of the complications of the
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 of cholelithiasis 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