Case Study

Abstract

This paper is based on a case study of a patient. The patient had undergone appendectomy. The paper describes the post-operative assessment of patient through ABCDE protocol. It tells about the nursing interventions. It also tells about the pharmacological management of post-operative patent.

Case Study

Introduction

This assignment is based on a case study of patient, Mrs Cheryl Brown, a 44 year old female who presents to the emergency department with a two day history of Right Iliac Fossa (RIF) pain and vomiting. She was referred by her local GP with a provisional diagnosis of Appendicitis. After a surgical review, she was admitted to hospital and transferred to theatre for a laparoscopic appendectomy. Mrs. Brown stated that she has pain and nausea. She was administered Metoclopramide hydrochloride (Maxalon) 10 mg to relieve nausea and vomiting , and Morphine IM for pain. Mrs. Brown vitals were:

Temperature: 36.5 degrees

Heart rate (HR): 80 beats per minute (BPM)

Respiratory rate: 12 respirations per minute (RPM)

SpO2: 96 % on room air

Blood Pressure (BP): 105/60 mmHg The patient needs careful postoperative medical and nursing care. The postoperative nursing care of this patient is described in the following paragraphs. The careful assessment of postoperative patients is an important component of the nursing role. It allows them to get information about the patient's condition. For a proper assessment, a systematic method is required to cover all areas of assessment and to make interventions effective and efficient. First, the nurse needs to check vital signs such as blood pressure, pulse, respiratory rate, and temperature. ABCDE protocol is an important method for proper assessment of postoperative patients (Timmins, & McCabe, 2009). ABCDE protocol includes:

Airway (A)

Breathing (B)

Circulation (C)

Disability (D)

Exposure (E)

Discussion

Airway (A)

Assessment of airway is important as it tells about the signs of airway obstruction. When a nurse approaches a patient, she must look for patient's consciousness and ability for proper breathing. She/he must look for airway patency, patient's ability to maintain airway, colour, signs of distress or exhaustion, added noises, paradoxical chest movements, central cyanosis. (Roseveare, 2009). If there is complete airway obstruction, there would be no breath sounds. An inspiratory 'stridor' can be heard. If there is partial airway obstruction, which tells that the obstruction is at laryngeal level or above. If the obstruction is at lower airways, an expiratory 'wheeze' can be heard (Jarvis, 2008).

Breathing (B)

A nurse must look, observe and feel for the signs of respiratory distress, central cyanosis, sweating, and use of the accessory muscles. She/he must look for respiratory rate (normal rate is 14 to 20 b/min), use of accessory muscles, respiratory rhythm, O2 saturation and symmetry of chest movement. Mrs. Cheryl Brown respiratory rate was 12 breaths per minute and Sp O2 was 96 %. Her respiratory rate was normal below and O2 saturation was normal (normal range is 90-95%) (Crisp & Taylor, 2008). The decreased respiratory rate is due to effect of morphine. The other side-effects of morphine are, depression, delirium, slow breathing, low blood pressure, rigid muscles, etc (Moore, ...