Case Study 1: Maree (Cholecystitis – Laparoscopic Cholecystectomy)

Maree is a 45 year old woman who works as a nurse in a large public hospital. Maree is obese (BMI of 37) and has been diagnosed with type 2 diabetes. Maree is estranged from her husband and is the sole provider for her two children, who are in primary school. Maree’s parents live nearby and they sometimes assist in caring for their grandchildren.
Maree was admitted to the emergency department at 6am with severe nausea and vomiting, severe pain, tenderness and guarding in the right upper quadrant of her abdomen and a temperature of 38.8oC. Maree was diagnosed with acute cholecystitis. She was reviewed by the medical and surgical teams and it was decided, given Maree’s condition, to perform an emergency laparoscopic cholecystectomy. Maree was informed that an open abdominal procedure may be required and it was suggested she remain overnight after the procedure.
Maree’s surgery was uneventful during the intra-operative stage. On her arrival to the Post Anaesthesia Recovery Unit (PARU) she was unconscious and oxygenated with via laryngeal mask at 10 litres per minute. 15 minutes post emergence, Maree complained of nausea and the PARU nurse administered ondansetron and dexamethasone. Maree remained drowsy and was reluctant to take deep breaths. Her vital signs were: HR 75 (sinus rhythm), BP 110/70, RR 12, Temp 36.5 oC, capillary refill <2 seconds.
Maree returned to the ward after 40 minutes in PARU. Maree was noted to be drowsy but easy to rouse. She was placed in the Semi-Fowlers position, with the head of the bed at approximately 30 degrees. Maree had a 0.9% sodium chloride infusion running at 125 ml/hr and was ordered IV Paracetamol 1g 8/24, IV Tramadol 50mg 6 hourly PRN and IV Ondansetron 8mg 8/24 PRN.
4 hours after surgery Maree complained of nausea and abdominal pain. Following appropriate assessment, the nurse administered IV Ondansetron 4mg and Maree was reviewed by the surgical team. Maree continued to refuse to take deep breaths and appeared reluctant to move around the bed.
The next day Maree was assessed as ready for discharge. Maree had tolerated a light diet and fluids and reports that her nausea has resolved. She says that her car is parked outside and she needs to leave immediately to pick up her children from her parent’s house.
NRSG258 Acute Care Nursing 1, Semester 2 2015
QUESTIONS
Please refer to the rubric on page 14 on the Unit Outline for full marking criteria
1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice explore current treatment options for your patient’s condition, include any pharmacological and non-pharmacological considerations.
2. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case study.
3. Develop a discharge plan to support your patient on discharge. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale.