Nursing Care and Post-operative Assessment: A Laparoscopic Case Study

This case study report delves into the post-operative care of Mabel Davis, a patient who underwent a Laparoscopic Cholecystectomy. The report highlights the importance of nursing observations and assessments in identifying potential complications such as pain, bloating, and the risk of sepsis. It discusses the significance of monitoring vital signs, conducting diagnostic tests like ABG analysis and imaging, and implementing patient-centric communication strategies. The report also emphasizes the need for timely interventions, including antibiotics and vasopressors, to prevent severe septic shock. Furthermore, it underscores the role of healthcare policies and guidelines in ensuring high-quality post-operative care and preventing infections.

Case Study Report

Table of Content.
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Regard the Evidence gone from the case study ..........................................................................1
Further post-operative procedure info for the patient. ................................................................2
Analysing report to the physician................................................................................................3
CONCLUSION ...............................................................................................................................4
REFERENCES................................................................................................................................5

INTRODUCTION
Laparoscopic Cholecystectomy is the incursive medical surgery perform by health care
staff to remove the gall bladder. Usually the small incision are done in the body to remove out
the gall bladder by the physician. These type of operation are conducted to modulate pain,
infection or stone develop in the patient body. This report expound about the Mabel Davis who
has been gone through the operation where they has return after having the 5-days hospital stay
to Serene Meadows. In this report various nurse observation are obdurate to provide the accurate
assessment to the patient while providing the verbal or non-verbal communication (Lyu & et. al.,
(2019)).
MAIN BODY
Regard the Evidence gone from the case study
After analysing the case report it has been seen that is the pain or cramps that patient is
feeling 5-days the operative session. It is seemed that during the operative there is chance of gas
blow up inside the abdomen which might be the reason of experiencing bloating, cramps or pain.
Since, the recovery rate in patient differ from one to one patient depending upon their health
condition and the lifestyle they follow. Patient in suddenly facing the accelerated pain after
experiencing the relief is need to assisted immediately by the nurse. The reason behind the pain
might be patient is going through with either peritoneal stretch or the diaphragmatic aberration.
The cause of these actions are the accelerated intra-abdominal force due to the operation. To
analyse the accurate cause nurse should advice the patient carry out the x-ray or the ultrasound
report of the Mabel abdomen so as to analyse the authentic cause behind it. Other than it can be
diagnose through the blood test or the urine test (Sarmadi & et. al., (2021)).
Flow rate of CO2 in the abdomen is need to monitor by the nurse as to regulate the
further associated complication. These monitoring is done by the nurse by conducting the Atrial
blood gas analysis (ABG). It is the process used to analyse the magnitude of the carbon dioxide
or oxygen in the abdomen. Additionally, this report is used to analyse the acid base balance in
the body. Normally it is said that the ordinary partial pressure of the oxygen (Pa02))is 75 to 100
mm Hg and the partial pressure of carbon dioxide (PaCO2) is in range of 35 to 45 mm Hg. When
after diagnosed the pressure in patient body is found to be more than that there is need to be
provided with the treatment to the patient as it is associated with the progression of different
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heart illness in the body. Its progression will outset from the either the slight or severe
bradycardia and which can further develop into the risk of cardiac arrest as patient is already
diagnosed with the hypertension. However, patient is having the trouble in passing the stool, it is
recommended for them to take amylase and lipase test as amylase enzyme analysis will help the
nurse to evaluate the magnitude of the break down polysaccharide. Whether in proceeding its
rate is low then it might develop the pancreatic or kidney abnormality. It may also develop the
development of the cystic fibrosis. The low level of lipase enzyme when not analyse in instance,
it might lead to dementia or depression in patient (Miura da Costa & Saxena, (2021)).
Further post-operative procedure info for the patient.
Nurses are concerned for the development of sepsis contagion as the post-operative
hindrance in the Mabel case. Sepsis id life-threatening state in the body which develop due to the
development of the infection in the tissues. Through the medical evidence it has been found that
the sepsis development is majorly trigger by the infection like the peritonitis or the rigid-ness
caused in the abdominal muscles. It is recommended to diagnose the progression of sepsis
infection in the immediate manner. It has been seen when the sepsis infection is caused in the
body in regulates the vasodilation in the body, the inflammatory mediators and the endothelial
dysfunction of the tissues. Further these vasodilation is basically cause the widening of the blood
vessels which carry through the high amount of blood flow in the body with the epochal
reduction of pressure in the vessels. These reduction lead to development of the hypotension in
the tissues or the organ (GalivancheL & et. al., (2020)).
These immunity mediators causes the vasoconstriction and in some patients due to
endothelial dysfunction development of edema is seen. It is the condition caused due to the
development of the swelling due to speeded up fluid caparison in the tissue or the itching. In
common these all symptoms lead to the rapid flow of the blood in the microvascular vessels of
the organs. It further leads to the development of the ischaemia which his the condition cause
due to failure of the vessels in part of the body encompasses into the cell death. Whenever these
diagnosis or treatment is left untreated than it might lead to the development of severe septic
shock. It is occur when significant tragical reduction in the blood pressure is seen. The
complication which the patient might go through are the unfitness action of the lungs to proceed
the oxygen and the heart to pump out the blood (Gabriel & et. al., (2019)).
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National sepsis program is run by the government body to analyse the treatment and it
outcomes for the patient diagnosed with the septic. This program provides the special care to the
patient who have gone through the surgery recently to ensure that they don't develop the
infection. The regulation provided by the Australia healthcare system for the prevention of the
sepsis is providing the high quality environment to the post-operative or the patient who are with
the high risk of development of infection. It includes the regular cleaning of the wound or injury
in the hygiene manner and guide the patient to clean their body on daily base. As it can be
transmitted through blood stream its diagnostic test are need to be performed immediately after
the rival of indication. Within the one hour of suspection fo the sepsis in patient it is
recommended to provided them antibiotics and vasopressor drugs for treatment (Tucker & et. al.,
(2019)).
Analysing report to the physician
After enchanting the Mabel vitals next day, nurse has examined that patient was not sense
pleasant to communicate and even their movement was slow. As the patient was in the pain,
nurse has assisted all the information to the physician through the data form so as to provide
them evidence based information. Also mooted the nurse concern of spread of sepsis to the
patient. Report of ABG analysis, X-ray or the test reports were provided to physician by the
nurse to identify the cause behind the sudden pain that patient is facing back again (Schlapbach,
Weiss & Wolf, (2019)).
Effective clinical communication with the patient is essential when analysing the patient
about what they are feeling. It primarily means having the knowledge about how to interpret the
condition of the patient while analysing their vitals or how convey them the beneficial
information of care for their health without making them sense the action in the stressful manner.
While communicating with the patient it is essential to talk with them in the easy language
without using solid medical tern as it may push away the patient trust as they don’t understand it.
When communicating show them through the non-verbal arrangements that their health is only
your concern as to assembled the relationship with them. Evidence-based impelling method that
should be used by the providers to furnish patients time so that patient become comfortable to
convey the alteration in the care or the health they are feeling directly without having the
hesitation. Talk to them in the respectful manner irrespective of their culture, belief or
professional they belong to.
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NSW is policy guideline provided by the government to the health care practitioner to
deliver the active communication to the patients. It provides the ethical or professional behaviour
conduct which are need to be followed by all healthcare practitioner. Here the approach used are
the patient centric while providing them the path to deliver their opinions or demands with
proper dignity and encourage them to make the fearless choices to improve their health. This
policy framework don’t encourage the bully or the harassment of the staff or the patient on any
basis (Mohammmed Iddrisu & et. al., (2018)).
CONCLUSION
From the above report the various deterioration is described when delivery the patient the
care to them. This case report concluded about the Mabel case report in the reference of the
nurse. Report covers about the various alteration faced by the patient during the post–operative
assembly and the supportive assessment is also carry through here. Additionally, describe the
risk of development of sepsis to the patient and its associated complication when not diagnosed
on limited time instance. Also the patient centric approach by the nurse is also mooted.
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REFERENCES
Books and Journals:
Gabriel & et. al., (2019). Risk factors for post-operative sepsis and septic shock in patients
undergoing emergency surgery. Surgical Infections, 20(5), 367-372.
GalivancheL & et. al., (2020). Postoperative pressure ulcers after geriatric hip fracture surgery
are predicted by defined preoperative comorbidities and postoperative
complications. JAAOS-Journal of the American Academy of Orthopaedic
Surgeons, 28(8), 342-351.
Lyu & et. al., (2019). Laparoscopic common bile duct exploration plus cholecystectomy versus
endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for
cholecystocholedocholithiasis: a meta-analysis. Surgical endoscopy, 33(10), 3275-3286.
Miura da Costa & Saxena, (2021). Complications in pediatric laparoscopic cholecystectomy:
systematic review. Updates in Surgery, 73(1), 69-74.
Mohammmed Iddrisu & et. al.. (2018). Nurses' role in recognising and responding to clinical
deterioration in surgical patients. Journal of Clinical Nursing, 27(9-10), 1920-1930.
Sarmadi & et. al., (2021). A comparison between two groups of diabetic and non-diabetic
patients regarding complications during laparoscopic cholecystectomy. Tehran
University Medical Journal TUMS Publications, 79(9), 674-680.
Schlapbach, Weiss & Wolf, (2019). Reducing collateral damage from mandates for time to
antibiotics in pediatric sepsis—primum non nocere. JAMA pediatrics, 173(5), 409-410.
Tucker & et. al., (2019). Patient, nurse, and organizational factors that influence evidence‐based
fall prevention for hospitalized oncology patients: An exploratory study. Worldviews on
Evidence‐Based Nursing, 16(2), 111-120.
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