Post Operative Care After Gall Stone Removal

Post Operative Care After Gall Stone RemovalBianca RobinsonPatients who are undergoing operative procedures are required the voice communication of ongoing reverence to optimize their recovery and clog complications. This delivery of care will enable early identification of circumstances surrounding surgery that may put patients at risk of harm. Mr Whakanna is a 36 year old Polynesian male who has just returned to the ward after having a laparoscopic cholecystectomy. A laparoscopic cholecystectomy is the working(a) removal of the gall bladder using laparoscopic technology in a process alike known as keyhole surgery (Graham, 2008, p. 47). The aim of this report is to target and prioritize the problems associated with in the frontmost four hours of Mr Whakaanas return. It is important for nurses to have an understanding of gallstone disease and the running(a) procedure, to ensure that patients are cared for with empathy but also safely and effectively. This report presents th e four highest problems that may occur with Mr Whakaana on return to the ward from surgery.ABCDs, Vital Signs and PainAlthough different surgical procedures require specific and specializer nurse care, the principles of post-operative care remain the same. It is necessary for a structured assessment of Mr Whakaana to be carried out such as that described by Elliot, Aitken Chaboyer (2007) where Airway, Breathing, Circulation, Disability and purlieu are examined. This is known as a primary assessment, and is used to identify any signs of airway obstruction, respiratory failure, circulatory failure or neurological disfunction (Graham, 2008). In this scenario, the nurse must pay particular attention to Mr Whakaanas airway due to the fact that he has been administered 8mg of morphine, and morphine can cause respiratory depression (Tiziani, 2010). Bradypnoea is a respiratory rate less than 12 breathes per minute in an adult at rest, and is the first sign of respiratory depression Mr Whakaana should be monitored closely to prevent this (Tiziani, 2010). Mr Whakaanas conscious state should also be monitored especially as he is currently scored as 1 on the Glasgow insensibility Scale, the nurse must pay particular attention to this to ensure that Mr Whakaana does not go into shock (Elliot, Aitken Chaboyer, 2007). It is also helpful to include the patency of drainage systems and vascular devices into your primary assessment of Mr Whakaana, and note if any allergies are known (Elliot, Aitken Chaboyer, 2007).Vital signs should be assessed as often as possible (every half hour/hour) during the first four hours of Mr Whakaanas return to the ward to determine any signs of deterioration. Vital sign measurements include caudex pressure, respirations, pulse, temperature and oxygen saturation levels. Changes in Mr Whakaanas blood pressure can be used to monitor changes in his cardiac output pulse assessment can determine Mr Whakaanas heart rate and rhythm, and can estim ate the volume of blood being pumped by his heart (Elliot, Aitken Chaboyer, 2007). Core body temperature differences can occur in illnesses and an abnormal information can be an indication of infection Mr Whakaanas temperature is 36.5C at present, which is within normal range (REFERENCE). Pulse oximeters give a non-invasive estimate of the arterial haemoglobin oxygen saturation, and measurement should always be above 95% (REFERENCE). The nurse should be aware that Mr Whakaana is currently on 3L per minute of oxygen via nasal prongs, as this could give a false sense of security when recording/documenting Mr Whakaanas oxygen saturation (Elliot, Aitken Chaboyer, 2007).Pain and discomfort are also important factors in Mr Whakaanas postoperative period as good pain control is required for an optimal physical and psychological recovery. Post-operative nausea and vomiting (PONV) is universal after laparoscopic cholecystectomy because of peritoneal gas insufflation and manipulation of the bowel (Graham, 2008). There are additional risk factors to consider including the use of peri-operative opioids (REFERENCE). Opioids, such as morphine, are a common cause of PONV and so their use, even during laparoscopic cholecystectomy, should be kept to the required minimum. Pain should be measured using an assessment tool that identifies the quantity and quality go through of Mr Whakaanas pain. Patients self-reporting of their pain is regarded as the gold standard of pain assessment measurement as it provides the most valid measurement of pain (REFERENCE). Self-reporting can be influenced by numerous factors including mood, sleep disturbances and medications and may result in patients not reporting pain accurately (REFERENCE). For example, Mr Whakaana may not report his pain because of the personal effects of sedation or lethargy and reduced motivation as a consequence of the surgery.Fluid Balance / OutputPatients following surgery are vulnerable to silver and electrolyte imbalance due to many factors, including blood loss, fasting for long periods and exposure during surgery (Walker,2003). Therefore an accurate measurement of Mr Whakaanas fluid balance is an essential factor in evaluating his condition. This should include strict readings of the output of drains as well as urine and vomit, and the measurement of fluid intake (oral, nasogastric and intravenous). Wound drainage sites and the surgical wound itself should be inspected at regular intervals for excessive blood loss, as this may indicate haemorrhage. Other factors that should be taken into account include diarrhoea, egest and the use of diuretic therapy.Blood SugarsDiabetes is associated with an increased requirement for surgical procedures and increased postoperative morbidity and mortality (Dagogo-Jack Alberti, 2002). Hyperglycaemia impairs leukocyte function and wound healing (Tiziani, 2010). The circumspection goal for Mr Whakaana is to optimize metabolic control through close monit oring, adequate fluid and caloric repletion, and sensible use of insulin (Dagogo-Jack Alberti, 2002). This assessment is to prevent hyperglycaemia and prevent further complications during Mr Whakaana hospital stay.Infection /SepsisConclusionAlthough postoperative care is a daily occurrence within many areas of practice, it is evident that the theory underpinning nursing actions is often forgotten in daily practice and hence actions may not be prioritised as they should be. It is hoped that this paper has enabled the reader to revisit the principles underpinning postoperative care. Such care must be viewed as a priority, and although there are local policies in place to guide nursing staff, the responsibility for understanding the reasons for actions lies with each person practitioner.REFERENCESDagogo-Jack,S., Alberti,K.G. (2002). Management of Diabetes Mellitus in Surgical Patients.Diabetes Spectrum. doi10.2337/diaspect.15.1.44, Retreived from http//spectrum.diabetesjournals.org/ content/15/1/44.fullElliott,D., Aitken,L.M., Chaboyer,W., Australian College of Critical Care Nurses (2007).ACCCNs critical care nursing. Sydney Mosby Elsevier.Graham, L. (2008). Care of patients undergoing laparoscopic cholecystectomy.Nursing Standard,23(7), 41-8 quiz 50. Retrieved from http//0-search.proquest.com.alpha2.latrobe.edu.au/docview/219887551?accountid=12001Tiziani, A. (2010). Havards nursing guide to drugs. Sydney, New South Wales Mosby/Elsevier Australia.Walker,J.A. (2003).Care of the postoperative patient Practice Nursing Times.RetrievedMarch28, 2014, from http//www.nursingtimes.net/care-of-the-postoperative-patient/200004.articleWalker,J.A. (2003).Care of the postoperative patient Part 2 Practice Nursing Times. RetrievedMarch28, 2014, from http//www.nursingtimes.net/care-of-the-postoperative-patient/200004.article