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.

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?

Answer 1

Question no:1

1. How many years of having hypertension and what are the medications taken for hypertension
2. Did he undergo any procedure for renal calculi?
3. Ask the patient to explain about pain assessment – OPQRST (O- onset,P- provocation, Q- quality, S-severity, R- radiation, T- Frequency of pain)
4. Did he have any allergy to medications
5. Get the SAMPLE history ( S- signs/ symptoms, A- allergies, M- previous history of medications, P- past medical history, L- last meal, E- Event preceding the incident)
6. Previous laboratory test reports
7. Collect the characterization by episodes of biliary colic pain

Question no:2

1. Since patient is anxiety, provide follow needs
   1. Psychological support
   2. Explain the importance of procedure
   3. Do’s and don’ts of the procedure
   4. Introduce the patient who have undergone same procedure
   5. Explain the importance of NPO
2. Prepare pre-operative checklist
3. Maintain hygiene of the patient
4. Maintain input output chart ( as he was having Foley’s catheter)
5. Administer medications as per MAR
6. Monitor vital signs frequently
7. Collect all the reports before going to the surgery.
8. Get the anesthetic opinion
9. Maintain position of the chart
10. Arrange blood for blood transfusion if required