NURSING 7105 Acute Care Nursing I: Care of Grace Flowers

Assessment task

This assessment task is designed to help you plan effective and safe nursing care for a patient across the perioperative pathway.

In this assessment, you are required to respond in short answer format to 3 questions related to the case study of Grace Flowers and her pre-operative, intra-operative and post-operative care.

To complete this case study, you will be required to critically analyse the information provided in the patient scenarios and describe your nursing care based on high-quality evidence, consisting of a broad range of literature sources including clinical practice guidelines, systematic review and evidence summaries, and recent journal publications.

Case study 

This case study relates to the care of Grace Flowers and her perioperative journey. Grace is a 46 year old woman admitted to the surgical ward at a local regional hospital in preparation for a laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) tomorrow afternoon. Grace has been admitted at 1300 hours on the day prior to theatre for management of pain and dehydration prior to surgery. Over the past week Grace has been unable to eat or drink due to increasing episodes of severe right upper quadrant pain that has been nonresponsive to simple analgesics. Pain has been well controlled on admission with regular endone and paracetamol administered orally. An IV cannula has been inserted and fluids commenced at an 8/24 rate overnight. The plan is for Grace to fast from 2400 hours tonight. There is no other relevant medical past history. However, the anaesthetist has reviewed her tonight and expressed concern that her BMI is 34 and she smokes approximately 20 cigarettes a day. Grace has reported feeling anxious about surgery tomorrow as she is worried about pain and how soon she can return to work. 

You are the registered nurse caring for Grace on the morning shift. Grace is first on the afternoon list for her surgery today. You are required to complete her pre-operative checklist and pre-operative teaching in preparation for surgery. 

Question 1: Role of the Registered Nurse in pre-operative teaching 

In this section discuss the importance of pre-operative teaching and the role of the registered nurse in patient education prior to surgery. Describe what your 2-3 priorities would be for pre-operative teaching in this clinical scenario and what evidence-based information you would provide to Grace to prepare her for postoperative recovery. 

Intraoperative care 

Grace has been transferred to the holding bay in theatre and the nurse undertaking the final pre-operative checks has noted that the consent form is for a laparoscopic cholecystectomy only and is concerned that the intraoperative cholangiogram procedure is not documented on the consent form. Grace is also unable to communicate in her own words what her surgical procedure involves and any risks involved in her surgery.

Question 2: Informed consent

Discuss what constitutes informed consent and if in Grace’s case informed consent has been adequately achieved. In your answer outline what actions would you recommend the registered nurse undertake in this scenario and why. What precautions need to be considered in the perioperative environment to ensure consent is indeed informed?

Postoperative care

Grace has returned to the ward following laparoscopic cholecystectomy and IOC under general anaesthesia. You attend to her routine post-operative observations and find that Grace is hemodynamically stable and her pain is well controlled with patient-controlled analgesia of morphine 1mg per bolus. However, Grace is noted to be very drowsy and is vomiting every time she administers a morphine bolus. She is reluctant to continue with her pain management regimen.

Question 3: Evidence based management of post-operative nausea and vomiting

Discuss evidence-based management of post-operative nausea and vomiting. In your answer describe what factors may have predisposed Grace to experience postoperative nausea and vomiting. Considering the contributing factors to post-operative nausea and vomiting in Grace’s case, what would your recommendations for nursing and pharmacological management be?