Analysis of pre-operative and post-operative care of a patient with cholelithiasis/cholecystitis who underwent an open cholecystectomy - Medical Science Assignment Help

Assignment Task

Task Details

This assignment requires you to consider the case scenario of Ebony White. You are required to write a 2000-word analysis of the case scenario. Your answer will examine a case of a patient cholelithiasis/cholecystitis and who has undergone an open cholecystectomy.

Applying your knowledge and understanding of gastrointestinal function, hypertension, hypercholesterolaemia, associated pathophysiology and aetiology including surgery you will write an academic essay applying the following principles throughout your discussion:

Question 1 (500- 600 words)

Examining the pre-operative assessment data and clinical signs and symptoms, outline the collaborative assessment data that would support the patient’s probable diagnosis of cholelithiasis/cholecystitis in the context of the patient episode.

Your response will provide an articulate, insightful discussion relating to the pathophysiology, aetiology and prevalence of cholelithiasis/cholecystitis. You will support your answer by explaining how the clinical assessment data and clinical signs and symptoms indicate cholecystitis. As an example, you may explain why the patient with cholecystitis presents with shoulder tip pain and respond by demonstrating an understanding of the linkages with pathophysiology and objective and subjective clinical signs of cholecystitis. Evidence provided from the case study explicitly supports and relates to your analysis of the clinical data and diagnosis and links with the underlying pathophysiology and symptomatology (clinical signs and symptoms) the patient would experience.

Question 2

Examine the case to identify actual clinical issues, nursing interventions and rationales (1100-1200 words)

This section will focus on the post-surgical care for the patient. Consider Ebony’s co-morbidities including obstructive sleep apnoea (OSA), hypertension, and hypercholesterolaemia in the context of recovering from surgery. Importantly, consider the postoperative clinical data such as increased pain, to determine the priority issues and how you will monitor and manage the issue. Justify each problem based on Ebony's clinical assessment data.

1. Identify THREE (3) PRIORITY clinical issues (for example, based on the patient’s current condition, the nurse recognises that the patient’s priority needs will be to prevent ____________.
2. Choose NURSING INTERVENTIONS for each of the three clinical issues e.g., monitor urine output hourly.
3. Provide RATIONALES for each nursing intervention. Rationales justify your interventions, are referenced. e.g. explain the pathophysiology of why you are monitoring Ebony's urine output hourly

Suggestion: Intervention: Encourage deep breathing exercises including use of the spirometry, hourly; Rationale: Smith (2019) surmises that deep breathing promotes normal lung expansion increases oxygen levels and is useful in preventing pneumonia and atelectasis.

Your response will require you to refer to pathophysiology to explain why you are encouraging hourly deep breathing and a synthesis and an analysis of the evidence-based literature to support your answer.

Case

Ebony White a 60-year-old obese female is being seen in her general practitioner's (GP's) office with a possible history of gallstones and now with a possible diagnosis of cholecystitis. Ebony works full time as a ward medical receptionist in a busy Brisbane hospital. Her daily medications include Lisinopril for a 5-year history of hypertension, Simvastatin and a multivitamin. When asked about exercise and diet, the patient reports that due to both her and her husband working long hours, they frequently eat take away food. She occasionally goes bush walking with her husband and two dogs. The patient reports that in the past month she has experienced progressively worse indigestion and upper right quadrant pain occurring several hours after eating meals high in fat and is especially severe when going to bed. Using a pain intensity scale, the patient reports the intermittent pain to be 6/10 to 8/10 with the pain radiating to the right shoulder tip. Her urine has also recently been dark coloured. The pain subsides after a few hours, but the patient reports that her right upper quadrant always feels tender. Ebony is mildly jaundiced, and recent blood results revealed an elevated white blood count.

Scenario Continued: Ebony had an open cholecystectomy 24 hours ago for cholecystitis. As the RN, you are caring for Ebony on the day shift and at 0700, have received a handover from the night RN. Ebony reports feeling nauseous for the past 24 hours and has not been able to eat or drink without vomiting. She also has an IV of 5?xtrose and 0.45% normal saline infusing at 60mL/hour in her right basilic vein. Using the pain intensity scale, she reports that the pain medication she received 1 hour ago decreased her pain level from an 8/10 to 6/10. She is unable to deep breath and cough due to the pain and she appears mildly drowsy. She has a T-tube draining a moderate amount of bile. The dressing on her right upper quadrant is clean and dry.

Introduction (approx. 100 words)

• An introduction will provide clear scope about the direction of your assignment. This includes providing some background to your essay (not restating the case) and defining the issues that you will be addressing in your discussion.
• Provide an overview of the structure of the assignment. Provide a brief overview of how you will approach each section. Outline examples in your essay that will be used to respond to the assignment question. Avoid restating the case study.

Question 1: Assessment findings and diagnosis (500-600 words)

• Determine which collaborative assessment findings that includes subjective and objective data which supports a diagnosis of cholecystitis
• Describe (succinctly and briefly) the underlying pathophysiology, aetiology and symptomatology (clinical signs and symptoms) the person may experience. This will require you to research cholecystitis and cholelithiasis and sequelae of the disease to explain the symptomatology (clinical signs and symptoms) the person is experiencing

Question 2: Identifying clinical issues, nursing interventions and rationales (1200-1300 words)

Clinical issues

• Consider pathophysiology and aetiology of Ebony’s co-morbidities, current medications, surgery, and response to general anaesthesia
• Consider the clinical assessment data you have been given in the case and other assessment and clinical data you will need to collect to care for Ebony
• Choose three (3) prioritised clinical issues related to caring for Ebony in the post-operative period. Clinical issues will be supported with contemporary published literature
• Consider the subjective and objective clinical data that is necessary to develop a nursing plan of care for Ebony relevant to the context of the case scenario (be specific to the case scenario)
• It is expected that the information in this section will be referenced (Academic sources 4-6 would be reasonable for this section)

Prioritised interventions supported with researched rationales

• Evidenced based nursing interventions and rationales should relate to pathophysiological processes and aim to improve clinical outcomes. This includes interventions that will aim to detect and prevent patient deterioration and improve patient clinical outcomes.
• The rationales support your interventions and justify the reasons for your chosen clinical issues and explain why they are a priority. Rationales need to be referenced. (Academic sources 4-6 would be reasonable for this section

Conclusion (approx. 100 words)

Provide a critical review and summarise the main findings of the assignment.

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