Case study 2- Joshua Nguyen
Case study 2- Joshua Nguyen
Elective/Emergency Surgery Emergency
Proposed surgical procedure Laparoscopic appendicectomy
Additional assessments required
Include Risk assessments
Provide a rationale for your decision History Previous medical, surgical history
Frequent vital signs Elevated temp. Potential for peritonitis
Focused resp, abdo acute abdomen, scheduled surgery/GA, smoker
Sedation score IV OpiodsPain assessment- PQRST acute abdomen/effect of analgesia
? Last ate and drank
VTE risk assessment surgery ? Pressure injury risk due to low BMI
Visual Infusion Phlebitis score (V.I.P) PIVC assessment
Fluid balance assessment IVT, febrile
Pre-op investigations
(any areas of concern) CT scan reveals appendicitis
Bloods elevated WCC indicative of appendicitis
Pre-operative preparation ? measure & apply TEDs
Anxiety management technique
Education
Diversion
Deep breathing
AntianxiolyticsSupport family, friends, pastoral care
Change into hospital gown and disposable underwear
Remove jewellery (or tape), make up &/or nail polish
Measure & apply TEDs
Recommended Surgical site preparation ? hair removal as per facility procedure
Site marked by surgeon
? skin preparation check facility policy & procedure
Nil by Mouth/Fasting Emergency. Check when last ate and drank. May require rapid sequence induction of anaesthesia important to handover to anaesthetist and anaesthetic nurse
Consent issues/RN responsibilities Had opioid analgesia - ? competent to give informed consent
Education What to expect in OR
Chest physio
Early ambulation
Pain management
Discharge prep
