surgical nursing care for choleysectomy patient
• mid 40 years of age, sedentary lifestyle
• no other significant medical history
• Undergone cholecystectomy following presentation in ED due to complaint of abdominal pain
• LDH cholesterol
Upon arrival of PACU
• Unconsciousness, spontaneously breathing with guedel airway insitu and a Hudson mask at 6L
• Positioned with head elevated to 30degree
• Vital signs: BP161/86, RR:12, HR 85, SO2 97%, T: 36.5
• Wound drained by redivac with minimal amount
Later on still in PACU
• Start to rouse from anaesthetic, begin vomiting bile
• Agitated, indicating that she can not breath, becoming distress and anxious.
• 10 mg Reglan IV
• 8L O2 via Hudson mask, SO2: 95
• 2mg morphine for pain, with minimal effect, followed by another 2mg morphine with good effect but patient become drowsy
On the ward:
• IV Hartmant 4/24 hrly rate
• 4mg Ondansetron 6 hrly/24
• 10mg Reglan 4 hrly/24
• 1 g Paracetamol 6 hrly/24
• 100 mg Tramodol 6 hrly/24
• 90 mg Toramacycin 3 times/ day
1. identify and discuss airway management (and rationales) as related to the case study (350words)
+ assessment of level of consciousness, ( wake patient up, call her by name for example)
+what conscious patient can do for their breathing, and airway ( coughing up excessive secretion as a result of anaesthesia, deep breathing)
+ assessment of respiration ( observe, listen and feel)
+ Discuss how to maintain airway patient.
+take into account the detail that that the patient become agitated, distressed, and anxious as it is the signs of hypoxia, and what you can do in this situation
+take into account the detail the what the impact on conscious patient with guedel airway insitu. And discuss when appropriate to remove it
+ the effect of pain on breathing how it can compromise airway, how pain management is important
+the side effect of pain medication how it compromise airway and breathing, and what you can do in this situation to maintain patient safety
2. In order of priority, using evidence based literature, identify and discuss the nursing interventions (and rationales) required to care for the chosen patient in the first 24 hours upon returning to the ward.
Nursing intervention/care presented needs to be accurate, relevant and specific to the chosen case study (750words)
The first 24 hours care:
Can you identify the discuss the issue in priority, I think respiration?
The following here is only my suggestion
Vital signs monitoring, how frequent, why it is importance
Patient is at risk of DVT, BMI>=30, and undergone surgery, discuss prophylactic measure.
Pain management, how it is important
Wound care, drainage identified abnormalities for this casse
Fluid and electrolyte monitor, control nausea and vomiting
Monitor medication side effect: pain medication…
3. initiate discharge planning. Identify the allied health professional/s you would refer your case study patient to and discuss the rationale behind your referral, what treatment may this health professional/s provide (250words)
Education on diet, limitation of physical activities, wound care, seek for medical attention for signs of abnormality
GP follow up
Discuss on the role of the above health care professionals.