A surgical nurse is responsible for monitoring and ensuring quality healthcare for a patient following surgery. Assessment, diagnosis, planning, intervention, and outcome evaluation are inherent in the post operative nurse’s role with the aim of a successful recovery for the patient. The appropriate provision of care is integral for prevention of complications that can arise from the anaesthesia or the surgical procedure. Whilst complications are common at least half of all complications are preventable (Haynes et al., 2009). The foundations of Mrs Hilton’s nursing plan are to ensure that any post surgery complications are circumvented. My role as Mrs Hilton’s surgical nurse will involve coupling my knowledge and the professional post-operative literature, with a critical thinking approach. This will allow me to arrive at best practice decisions and actions supported by a critical review of available literature. Mrs Hilton’s nursing plan following her open cholecystectomy will be individualised for her needs as each patient’s situation presents a unique set of clinical factors.
Mantras that has become ingrained from my nurse training are ‘assessment, assessment, assessment’ and ‘if it is not written it is not done’. In a post-surgical setting, assessment is also pre-emptive and communication and documentation is imperative. Assessment must extend beyond the vital signs to include a focus on pain, skin colour (for cyanosis/shock), respiratory rate (including depth and nature), skin temperature (for hypo/hyperthermia), pulse (rate volume and rhythm), conscious levels (presence of reflexes – swallowing/cough/tears) and signs of haemorrhage or infection (wounds/drains) (Starrit, 1999). Although most hospitals have checklists to help with assessment of the patient post surgery, I am responsible for thinking beyond this checklist to provide Mrs Hilton with quality care. Whilst Mrs Hilton’s surgery was uneventful, her age and medical history of symptomatic cholelithiasis and extremely high body mass index (BMI) of forty-three (Al-Benni, 2011, p. 225) put her into a high risk category. Literature and current studies confirm that obesity, age, and the area of Mrs Hilton’s surgery, i.e. the abdomen, all increase her risk of developing post-surgical complications (Thorrnlow et al., 2009; Brown et al., 2009; Smetana, 2009; Arozullah et al., 2001). This case study looks at five of the most common potential complications for which Mrs Hilton is vulnerable including pain, respiratory complications, namely atelectasis that can lead to pneumonia, deep vein thrombosis (DVT), surgical site infection and a patient’s psychological function. The best practice preventative nursing interventions will be provided for deterrence of these complications together with a rationale for each intervention. Ultimately, Mrs Hilton will be discharged having had no complications and will be educated with best knowledge about self-care, medications and follow up options.
The location of the incision for an open cholecystectomy makes Mrs Hilton susceptible to respiratory problems. Furthermore, obese patients undergoing abdominal procedures are at major risk of pulmonary complications with atelectasis (collapse of the expanded lung) being reported for up to 45% of patients (Al-Beenan, 2011, p.230). Graham et al. (2011) support these statistics with research proving that oxygen desaturation occurs three times faster in obese patients as a result of reduced functional residual capacity and that oral or nasal airway assistance may be required post operatively. Mrs Hilton was given an anaesthetic during the surgery therefore the first priority of her post-operative care was to establish her airway and this must be monitored during her hospitalisation. Together with her vital signs as per protocol, assessment should be made of Mrs Hilton’s respiratory rate and depth, patient’s colour, breath sounds and oxygen saturations (Brown et...
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