Question

Objective: Preparation of patient for surgery from Emergency Room. Management of a client with significant anxiety before a surgical procedure. Monitoring of vital signs and lab results.

Patient Information

NAME: Chad Jones

AGE: 40

DOB: March 18, 1978

WEIGHT: 195 lbs. (88.6 kg)

HEIGHT: 67 inches (170 cm)

Past Medical History: Chad Jones is 40 years old. He lived in Poland until he was 12 years old and relocated with his mother and sister to the US at that time. He is currently married. Chad works as a grocery produce manager. He is approximately 40 lbs. overweight. Besides his activity being a produce manager, he does not participate in organized exercise.

He is being treated for hypertension, but otherwise healthy.

Situation: Mr. Jones presented to the emergency room (ER) with right flank pain two hours ago. After ultrasound, it was discovered that he had extensive calculi in his gall bladder. Additionally, the gall bladder was distended with slight wall thickening, subtle regional fat-stranding, and an obstructing stone in the neck of the gallbladder.

CBC with differential, liver function tests, Amylase and Lipase drawn and sent to lab.

Current Plan: The surgeon has been called to examine patient and this has been completed. The lab results have not yet returned, but the surgeon told the patient he may need surgery. He becomes very anxious as he has never had surgery before. This anxiety increases the symptoms of this gall bladder attack (vomiting, pain).

No complications are anticipated, although he has a history of sleep apnea, so he will be closely observed for apnea and reduced respiratory effort post-op.

Provider Orders:

            Pre-surgical scrub, place mannequin in clean gown, place IV catheter, and place Foley   catheter

            Monitor SpO2 – Oxygen to maintain Sp02 greater than 94%

            NPO prior to surgery (12 hours)

            Medications as per MAR below.   

           

Medication	Drug Classification, expected action, indication for use	Possible Adverse Effects	Medication or Food Interactions	Nursing Considerations	Client Education and Evaluation of Effectiveness
Aspirin
Hydrochlorothiazide
Lisinopril
Ondansetron
NS at 250 mL/hr for 2 liters
Dilaudid
Ativan

Pre-Simulation Questions: (3-5 full sentences detailing needs of this patient)

1.    What would be pertinent questions to ask this client during the assessment?

2.    What are the anticipated needs of this patient?

CBC with Differential	What will this tell us?	What is the specific reason for this patient?
Liver Function Tests	What are they?	What could they tell us about this patient?
Amylase	Normal Range?	What would elevation tell us?
Lipase	Normal Range?	What would elevation tell us?

What is a pre-surgical scrub? Why is it used? And look up one Evidence Based Practice article that would support this practice. Reference the article using APA format.

Answer 1

Pertinent questions that should be aasled are - If patient is not having any othother chronic illness like Asthma, Tubeculosis, Epilepsy, Diabete these will modify the treatment he is having and can also affect the surgery.

- Is there any previous history of any surgery or trauma because these will have effect on surgery because any organ could have been damaged leading to preblematic procedure.

Anticipated needs of patient are- During the surgery, the anaesthesiologists should be having sharp monitoring of blood pressure of the patient and over oxygen saturation and otger vitals.As the patient is known hypertensive it increases the risk of him having respiratory distress. And cardiac effects after surgery like hypotension and syncope.

CBC - COMPLETE BLOOD COUNT

It includes- 1) Total RBC count

2)Total WBC count

3) differentiated leucocyte count. 4) Hb levels .5) Platelet count

This tells us about the above parameters and is required in patient because he is going to have an emergency surgery for gall bladder calculus . Which woyld have caised an infection and hence raised neutrophils level . So WBC count will be increased.

Platelets level is necessary because it will help healing of wounds after surgery.

Liver Function Tests - these are 1) ALT 2) AST 3) Prothrombin time .4) aPTT. 5) serum bilirubin

These are raised in any kind of liver damage causing hepatitis or fivrosos or cirrhosis of liver. Raised PROTHROMBIN TIME indicates that pt is having clotting disorder and after surgery he should be given clotting agents.

AMYLASE-   It is an enzyme secreted by pancreas and is useful here because the patient is having gall stones which will obstruct the biliary duct and hence pancraetic duct leading to pancreatitis. If found increased duct should be checked for stones and removed during surgery. Normal range= 40-140 IU/L

Lipase - also an enzyme secreted by pancreas and is raised during pancreatitis due to gall stones.Normal range= 0-40IU/L

PRESURGICAL SCRUB

It is sanitary clothing wore by surgeon, nurses, anaesthesiologists before surgery. These are made to prevent infections during surgical procedures. It is often preceded by hand washing in running tap water according to WHO guidelines which says that hand washing should be thoroughly done for upto 5 minutes. Also for preventing transmission of infections. And surgery should be performed under aseptic conditions.