Nursing Care Post-Laparoscopic Cholecystectomy Assessment Answer

Introduction

Laparoscopic cholecystectomy refers to a kind of minimally invasive surgery that is performed in order to remove a diseased gall bladder (Hassler et al., 2022). The following scenario portrays the case of 42-year-old Kimberley who has undergone a laparoscopic cholecystectomy. This essay aims to address various aspects which include priorities, assessments, and rationale related to Kimberley’s nursing post her laparoscopic surgery. Moreover, the essay will also provide recommendations that would focus on Kimberley’s speedy recovery.

Nursing Priority

(i) Pain management

Firstly, medications such as opioids which include fentanyl, morphine or oxycodone can be given to Kimberley which are highly effective in reducing pain; since she reports a pain score of 8 out of 10 (Mord & Farrokh, 2018). Secondly, medications like acetaminophen which fall under non-opioid medication or other nonsteroidal anti-inflammatory drugs (NSAIDs) can also be given. This includes drugs like ibuprofen which can be used alone or can be combined with opioids (Barazznchi et al., 2018). The third alternative can be to subject Kimberly to local anaesthesia around the site of the surgical incision which can provide relief from the pain. (Macias & Finneran, 2022). The last approach can be providing Kimberley with heat or ice therapy around the site of the incision which can prove to be effective in the reduction of pain and swelling (Bicket et al., 2020).

(ii) Wound management

Firstly, ensuring that Kimberley’s wound remains clean and dry should be a priority to prevent any kind of infection. Kimberley was administered Cephazolin for the prevention of any kind of infection. Enoxaparin was given to prevent any blood clots (Kim et al., 2018). Gauge dressing and small tapes can be used for effective dressing of the wound. The wound dressings should be changed regularly and carefully in order to ensure proper healing of the wound (Elsayed et al., 2021). The incision site should be regularly monitored to check for any signs of infection. These can comprise swelling, redness, drainage or warmth. Lastly, it is important to ensure that the wound site does not receive any kind of strain or pressure which can lead to the formation of pressure ulcers around the wound site (Geffen et al., 2022).

( iii) Elimination

This would involve keeping a check on Kimberley’s bowel movements. Disrupted or inadequate bowel movements are a problem that Kimberley might experience post her cholecystectomy. This can also lead to a condition called post-operative ileus which can result in serious consequences. This would also deal with the high fluid collection in the drain tube which might indicate bile leakage (Massironi et al., 2020).

(iv) Patient education

This would deal with educating Kimberley about ways in which she can focus on her post-operative care. Educating her about the management of her wound and appropriate ways of wound dressing is important. For pain management, it is important that she is provided with education which informs her about the dosage and side effects of the medications prescribed to her; for instance, Fentanyl-based PCA and Enoxaparin (Yorkgitis et al., 2019). It is important that Kimberley takes a sufficient amount of rest. Lastly, educating her about techniques such as meditation or breathing which can help in reducing pain would also be beneficial for Kimberley (Decker et al., 2019). 

Nursing Assessment

The nursing assessment would be designed in a way that is patient-centric and holistic in its approach and caters to Kimberley’s concerns and needs. Firstly, pain assessment in Kimberley’s case can be done by using the Numerical Rating Scale (NRS). This is a numeric scale that has 11 points that indicate the severity of pain in an individual. The scale ranges from 0-10 with 0 being the absence of any pain and 10 representing pain of the highest degree imaginable (Pathak et al., 2018). In the case study, Kimberley reports her pain score to be 8 out of 10 which according to NRS is considered to be severe. The pain assessment would also focus on the elements of intensity, duration, location and description of the pain. The second assessment would focus on the surgical wound which would involve a surgical wound assessment tool (SWAT).

This tool helps in the assessment of wounds based on various parameters such as the location of the wound which can provide information about the type and cause of the wound, the degree of damage, the size of the wound, the extent of drainage in the wound and the type of infection present, if any. It helps to monitor the progress related to the process of healing the wound. It also enables early risk detection related to wound healing (Do et al., 2023). The third assessment would be for elimination as in Kimberley’s case the fluid amount is high in the drainage tube. It is important to assess her bladder and bowel function. This would also involve asking Kimberley about any difficulties she might be experiencing at the time of urinating (Makaryus et al., 2018). The last assessment would be patient education. This would encompass assessing her learning abilities and her knowledge and level of comprehension towards her present condition and treatment plan. Kimberley’s concerns regarding her recovery and medications would also be addressed in addition to the use of written materials or visual aids to enhance her understanding (Utens et al., 2018).

Rationale

First and foremost, the use of a validated tool for Kinberley’s pain assessment is important for the prevention of any kind of complications like sedation, respiratory depression or delayed healing of the wound (Khan et al., 2018). In addition to this, the assessment of Kimberley’s response to pain medication and making her aware of non-pharmacological approaches can help in pain management (Patil et al., 2018). Moreover, since Kimberley has a history of asthma and has Ventolin and Flixotide as prescribed medications, it is important that her respiratory status is assessed for any detrimental effects of pain medication and possible signs of exacerbation (Chapman et al., 2021). Secondly, the assessment of the surgical wound plays a crucial role in the identification of signs of infection and the prevention of complications related to the wound such as delayed healing (Falcone et al., 2021). Regular dressing and the use of Exudrain would be useful in making sure that the drainage is sufficient and would help in the healing of the wound (Lohana et al., 2019).

Furthermore, since Kimberley has undergone a laparoscopic cholecystectomy, it is important to keep a check on her temperature along with signs of hypotension or fever (Di Buono, 2019). Thirdly, conditions like urinary retention and postoperative ileus following cholecystectomy can result in delayed recovery. Therefore, it is essential to assess urine characteristics and urine output for the identification of any sort of anomalies (Kalff et al., 2018). It is also important to assess Kimberley’s fluid intake which would help in the improvement of bladder and bowel function (Makaryus et al., 2018). In addition to this, since she is on enoxaparin for the prevention of blood clots post her surgery, assessment for risk of bleeding is important to identify any signs of gastrointestinal bleeding (Vasilakis, 2020). Last but not the least, the assessment of the learning requirements of Kimberley and her husband can help to design a plan which suits their needs and improve their understanding regarding the treatment and medications. In addition to this, since Kimberley is in a drowsy state post-operation, assessment is important to ensure that she is aware and alert of her surroundings before communicating or providing education (Sole et al., 2020) 

Recommendations

To effectively manage the nursing priorities identified in Kimberley’s case, collaborating with an interdisciplinary team can play an important role. The team would comprise the surgeon, pharmacists, anesthetist, dietician, physiotherapists, healthcare personnel and social workers who work collaboratively to ensure that Kimberley receives specialized care (Berian et al., 2018). Firstly, to address pain management, the interdisciplinary team of doctors and nurses can keep an eye on the effectiveness of the PCA and adjust the medication accordingly. The physiotherapist can also work with the nursing team and help them in developing a plan which could assist with pain management and early mobilization of Kimberley (Hyland et al., 2021). Secondly, for wound management, a wound care specialist can team up with the nursing team so that the healing of the wound is proper without the presence of any infection (Eriksson et al., 2020).

Any concerns or signs of infection related to the wound can be brought to the attention of the surgeon. In addition to this, the pharmacist can also help by making sure that the antibiotics given to Kimberley are appropriate for her condition (Eriksson et al., 2022). Thirdly, to deal with issues of elimination, a dietician and physiotherapist can be consulted for the development of a plan which enables bowel management along with early mobilization. Moreover, the surgeon can also be consulted to avoid any complications and ensure the proper functioning of Exudrain (Davenport & Stetzer, 2020). Lastly, the nursing team can connect with Bob to educate him about the various priorities to be managed and other complications that might need medical attention. Social workers and psychologists can collaborate with the nursing team to take care of any psychological issues such as fear or anxiety that Kimberley might have (Utens et al., 2018).

References

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