Question

Objective: Management of a post-operative patient after laparoscopic cholecystectomy.

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.

He is now status post laparoscopic cholecystectomy.

Situation: Mr. Jones had surgery very early this am. He is still somewhat sedated. He is complaining of upper right chest/shoulder pain that is pretty intense. He is alert and oriented x4. His wife has arrived and is visiting at this time.

Current Plan: Patient is experiencing post-operative pain. He has 4 incisions. Three located in the right upper quadrant and one is distal to the umbilicus. Current plan is to control pain and report any new findings to provider.

Provider Orders:

            Foley catheter in place

            0.9% Sodium Chloride infusing at 200 mL/hr.

            Monitor SpO2 – Oxygen to maintain Sp02 greater than 94%

            Start clear liquids once bowel sounds heard or passing gas.

            Medications as per MAR.

            Post Op Vital Signs

                        2 x 15 min

                        4 x 30 min

                        2 x 60 min, then Q 4hours

            Sequential Compression Devices while in bed.

           

           

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 200 mL/hr
Dilaudid 1-2 mg Q2hr IVP as needed for pain

You do not have to look these up again as it was completed last week.

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?

3.    What tasks need to be completed for this patient?

4.    How would you prioritize your assessment with this patient?

Answer 1

1. a) Tell how you feel the pain?

b) where is the pain?

c) is it radiating to anywhere?

d) how often it occur?

e) is it occur in a sudden manner or here before?

f) is this pain occur associated with any action?

g) do you have fever before?

h) how is your appetite?

2. The anticipated needs of the patient are

• Reduce pain
• Promote appetite
• Cure fever
• Control overweight
• Make a control over hypertension
• Reduce other health related problems
• Good sleep at night

3. Reduce pain by removing the gall stones surgically

Educate the patient regarding the consequences of overweight in future

Educate the recurrence of this and act accordingly

Medical management for other signs and symptoms

Reduce pain post operatively also

Antibiotic therapy to prevent further infections

4. Reducing pain is the first priority:-

by providing analgesic s it can be controlled

Provide proper position ( right lateral position)

Assess the pain level using pain rating scale

Diversional therapy ie, communicate with the Patient other than the painful matters

Promote sleep

Reducing pain will promote sleep

Ensure a peaceful and comfortable environment for sleep ie, switch on fan switch off lights

Imbalanced nutrition greater than body requirement (obesity)

Assess the nutritional status of patient

Reduce fat producing diet

Start a balanced diet

Do exercises

Health education regarding dietary pattern

Reduce anxiety

Educate about the medical condition and the treatment method it will reduce the anxiety

Be with the patient. Don't allow to be the patient alone