Post Operative Care After Gall Stone Removal

Post Operative C ar After Gall sway RemovalBianca RobinsonPatients who be undergoing operative procedures are required the delivery of ongoing care to optimize their recovery and frustrate complications. This delivery of care bequeath enable early identification of circumstances surrounding surgery that whitethorn put patients at risk of harm. Mr Whakanna is a 36 year darkened Polynesian male who has just surrendered to the ward after having a laparoscopic cholecystectomy. A laparoscopic cholecystectomy is the surgical removal of the gall bladder using laparoscopic technology in a process besides know as keyhole surgery (Graham, 2008, p. 47). The buzz off of this report is to identify and prioritize the problems associated with in the first four hours of Mr Whakaanas return. It is important for nurses to have an understanding of gallstone disease and the surgical procedure, to checker that patients are cared for with empathy but also safely and effectively. This report prese nts the four highest problems that whitethorn occur with Mr Whakaana on return to the ward from surgery.ABCDs, Vital Signs and PainAlthough contrasting surgical procedures require specific and specialist treat care, the principles of post-operative care live the same. It is essential 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 Environment are examined. This is known as a primary assessment, and is expendd to identify either signs of airline obstruction, respiratory failure, circulatory failure or neurological dysfunction (Graham, 2008). In this scenario, the nurse must pay particular fear to Mr Whakaanas airline business due to the fact that he has been administered 8mg of morphine, and morphine heap cause respiratory natural depression (Tiziani, 2010). Bradypnoea is a respiratory rate less than 12 breathes per narrow-minded 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 Coma Scale, the nurse must pay particular attention to this to ensure that Mr Whakaana does non go into shock (Elliot, Aitken Chaboyer, 2007). It is also helpful to admit 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 quantitys include fall pressure, respirations, pulsate, temperature and group O saturation levels. Changes in Mr Whakaanas blood pressure tail assembly be used to monitor changes in his cardiac output pulse assessment can determ ine Mr Whakaanas meat rate and rhythm, and can estimate the volume of blood being pumped by his heart (Elliot, Aitken Chaboyer, 2007). Core body temperature differences can occur in illnesses and an abnormal rendering can be an indication of infection Mr Whakaanas temperature is 36.5C at present, which is in spite of appearance 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 guarantor 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 annoying control is required for an optimal physical and mental recovery. Post-operative nausea and vomiting (PONV) is common after laparoscopic cholecystec tomy because of peritoneal gas insufflation and habit 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 heedful using an assessment tool that identifies the quantity and quality experienced 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 whitethorn result in patients not reporting pain accurately (REFERENCE). For example, Mr Whakaana may not report his pain because of the effects of sedation or lethargy and reduced motivation as a consequence of the surgery.Fluid Balance / OutputPatients foll owing surgery are vulnerable to changeful 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 limpid balance is an essential factor in evaluating his condition. This should include grim 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. opposite factors that should be taken into account include diarrhoea, sweating 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 management endeavor for Mr Whakaana is to optimize metabolic control through close monitoring, 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 on that point are local policies in place to guide nursing staff, the function for understanding the reasons for actions lies with each individual practitioner.REFERENCESDagogo-Jack,S., Alberti,K.G. (2002). Management of Diabetes Mellitus in Surgical Patients.Diabetes Spectrum. insid e10.2337/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 unfavourable 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 entropy 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 tell 2 Practice Nursing Times. 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