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CASE SCENARIO 3 Preop

Mrs. MK is a 57-year-old female who was brought to the emergency room with severe abdominal pain, nausea, and vomiting. She was diagnosed with cholecystitis. Tests revealed gallstones and elevated blood sugar and hemoglobin A1c levels. She is scheduled for an open cholecystectomy the next day to remove her gallbladder. As a pre-operative client, the nurse must ensure informed consent is obtained, complete a pre-op checklist, and provide health teachings to Mrs. MK about what to expect and how to prepare for her upcoming surgery. The anesthesiologist's pre-op orders are aimed at assessing Mrs. MK's risks and preparing her medically for anesthesia and the surgical

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176 views3 pages

CASE SCENARIO 3 Preop

Mrs. MK is a 57-year-old female who was brought to the emergency room with severe abdominal pain, nausea, and vomiting. She was diagnosed with cholecystitis. Tests revealed gallstones and elevated blood sugar and hemoglobin A1c levels. She is scheduled for an open cholecystectomy the next day to remove her gallbladder. As a pre-operative client, the nurse must ensure informed consent is obtained, complete a pre-op checklist, and provide health teachings to Mrs. MK about what to expect and how to prepare for her upcoming surgery. The anesthesiologist's pre-op orders are aimed at assessing Mrs. MK's risks and preparing her medically for anesthesia and the surgical

Uploaded by

Edgar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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UNIVERSITY OF SANTO TOMAS

COLLEGE OF NURSING
NUR81018

TEACHING-LEARNING ACTIVITY (TLA)

LEVEL: SECTION:
COURSE/SUBJECT: NUR81018
PROFESSOR:
TOPIC: CARE OF A PRE-OPERATIVE CLIENT
DATE: August 2020

ACTIVITY: Case Scenario 3


CARE OF A PRE-OPERATIVE CLIENT

FOCUS OF STUDY:

- CARE OF PREOP CLIENT

Learning outcomes:

After studying the case scenario, the learner should be able to:

1. Identify condition/s requiring surgical intervention.

2. Classify surgical intervention as to degree of risk and urgency

3. Interpret the different diagnostic exams and identify the surgical risks.

4. Discuss the requirements for a valid consent..

5. Determine specific preop health teachings for the client who will undrgo cholecystectomy.

DESCRIPTION OF THE ACTIVITY AND RELATED INSTRUCTIONS:

MEDIAL SURGICAL NURSING Case Scenario 3


CARE OF A PRE-OPERATIVE CLIENT

Mrs. MK, 57 years old, female was brought to ER because of severe abdominal pain
accompanied by nausea and vomiting. The nurse noticed that she was holding on the RUQ of her
abdomen, her face was very pale and cold clammy skin and was diaphoretic. Initial VS taken was
150/90, PR 89, RR-27. Other PE was done and was given the clinical impression of cholecystitis.
Meperidine HCl 50 mg IM was administered by the ER Nurse. Surgical ROD attended to Ms. MK
and ordered the ff:

- For admission to room of choice


- DAT
- CBC, FBS, HbAic, PT
- Chest Xray , ECG
- Rt. Urinalysis
- Ultrasound of Liver, Gall bladder, pancreas

The next day Ultrasound of LGBP was done and showed multiple cholelithiasis. Other results of
procedures showed the ff. findings:

CBC – Hgb 11G/dl

Hct – 35%
RBC – 4.31 mil/mm3

WBC – 15,000/mm3

PT – 30 sec.

FBS – 158 mg/dl, HbAic- 7.8%

Urinalysis - pus cells 6-8/hpf

Red cells – 1-2/hpf

Chest Xray revealed clear lung fields , atheromatous aorta

ECG showed sinus rhythm, left ventricular hypertrophy

Attending physician came in and examined Mrs.MK . Explanations regarding her


conditions and proposed surgery were given. She was scheduled for Open Cholecystectomy
under general anesthesia at 7 am the next day. The anesthesiologist visited her and ordered the
following:

- Pt seen and examined , noted to be non-smoker, non alcoholic


- Hypertensive, + DM, taking antihypertensive drugs (Amlodipine ) and oral
hypoglycemic agents (Metformin)
- Allergic to seafood, no asthma
- Anesthesia technique (General Orotracheal Anesthesia) explained, understood and
accepted
- Refer to Dr. De Leon for cardiac evaluation and preop risk assessment
- Secure consent for surgery and anesthesia
- Weigh and record
- NPO FMN
- Dormicum 15 mg. tab p.o. HS
- D5NR 1L to KVO using Venflon G18 to be inserted at 530 am tomorrow
- Preop meds: on call to OR
o Nalbuphine 10 mg. IM
o Dormicum 5 mg IM
o Atropine sulfate 0.3 mg IM
- Bactidol in AM and on call to OR

CRITICAL THINKING EXERCISES:

1. Mrs MK will undergo cholecystectomy. Define terms that are not clear to you .
2. What is the main condition of Mrs MK that requires surgical intervention? What is
the purpose of the surgery? Classify the surgery as to risk, urgency.
3. Are there factors that can influence MKs surgical risk? Anesthesia risk?
4. What could be some fears and anxieties of MK related to her forthcoming surgery?
How will the nurse respond to this?
5. What pertinent data do you need to gather related to her forthcoming surgery?
6. What are the significance of the diagnostic examinations?significance of the results.
7. An informed consent by the patient is a must for any surgical procedure. How will
you ensure its validity as a legal document?
8. What are the contents of the preop checklist that the nurse need to complete
before MK goes to surgery.
9. What preop health teaching do you need to give Mrs MK prior to her surgery?
When is the best time to give them?
10. Discuss the rationale of each of the anesthesiologist’s preop orders.

INSTRUCTIONS:
1. Each RLE group will submit their written output before the case discussion in
synchronous session. This will be graded and counted as part of their presentation
grade
2. Each student must be ready to participate for interactive discussion related to the
focus of study. This will be graded and counted as part of their participation grade.
3. There will be feedback regarding learning issues related to the presentation.

MN/Aug 2020

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