NURS2010 – Acute Care Nursing Case Study

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 Amelia Flowers and her pre-operative, intra-operative, and post-operative care. Each question has background information about the clinical scenario to help your response. As the format of this case study is the short answer there is no introduction or conclusion required. It is expected that each of the short answer responses is approximately 650 words in length and referenced appropriately.

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.

You will be assessed using the following criteria:

Skill in clinical reasoning and decision-making Ability to source and apply best-practice evidence to the clinical case study Demonstrated understanding of the nurse's role in patient care and education across the perioperative pathway. Demonstrated understanding of quality nursing care Academic writing. Format and referencing

For more details related to the marking criteria, refer to the marking rubric.

Introduction to the case study

This case study relates to the care of Amelia Flowers and her perioperative journey. Amelia is a 44-year-old woman admitted to the surgical ward at a local regional hospital in preparation for laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) tomorrow afternoon. Amelia 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, Amelia has been unable to eat or drink due to increasing episodes of severe right upper quadrant pain that has been non-responsive to simple analgesics. Pain has been well controlled on admission with regular endone and paracetamol administered orally. An IV cannula has been inserted and fluidscommenced at an 8/24 rate overnight. The plan is for Amelia to fast from 2400 hours tonight.There is no other relevant medical past history. However, the anesthetist has reviewed her tonight and expressed concern that her BMI is 34 and she smokes approximately 20 cigarettes a day. Amelia has reported feeling anxious about surgery tomorrow as she is worried about pain and how soon she can return to work.

1. Preoperative care

You are the registered nurse caring for Amelia on the morning shift. Amelia 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: Role of the Registered Nurse in pre-operative teaching

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

2. Intraoperative care

Amelia has been transferred to the holding bay in the theatre and the nurse undertaking the final-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. Amelia is also unable to communicate in her own words what her surgical procedure involves and any risks involved in her surgery.

Question: Informed consent

Discuss what constitutes informed consent and if in Amelia'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?

3. Postoperative care

Amelia has returned to the ward following laparoscopic cholecystectomy and IOC under general anesthesia. You attend to her routine post-operative observations and find that Amelia is hemodynamically stable and her pain is well controlled with patient-controlled analgesia of morphine 1mg per bolus. However, Amelia 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: Evidence-based management of postoperative nausea and vomiting

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