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Laparoscopic Cholecystectomy Case Study

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Introduction
Besides postoperative pain, postoperative nausea and vomiting (PONV) is the most frequent and most unpleasant adverse outcome of surgery and general anaesthesia.[1] The incidence of PONV is estimated at 25% to 30% in all patients and as high as 80% in patients with multiple high-risk factors.[2,3] PONV is distressing and potentially detrimental to a patient's recovery as it can result in wound dehiscence, bleeding, aspiration of gastric contents, electrolyte imbalances, and delayed hospital discharge.[4] Laparoscopic cholecystectomy has rapidly emerged as an alternative to open cholecystectomy and is a routinely performed procedure for symptomatic cholelithiasis.[5] The incidence of PONV following laparoscopic cholecystectomy …show more content…

Nausea defined as a subjectively unpleasant sensation associated with awareness of the urge to vomit, where as an episode of vomiting was defined as either vomiting (expulsion of stomach contents) or retching (an involuntary attempt to vomit but not productive of stomach contents). The intensity of nausea episode was assessed using a visual analogue scale (VAS) (0, no nausea; 10, worse nausea)[20] and retching and vomiting assessed by simply questioning for yes or no. No retching or vomiting scored 0 and yes scored 1. Rescue medication for PONV (metoclopramide 10 mg as an initial rescue drug) was administered upon patient request or complaint of established nausea (VAS score >5) or vomiting. No use of rescue medication scored as 0 and if used scored as 1. PONV score means the total no. of the patients who suffered either from nausea or emesis (vomiting/retching) or if needed rescue medication. A complete response was defined as the absence of PONV and no use of rescue antiemetics. Adverse events were evaluated and recorded by the investigator during the entire observation period. The primary outcome measure of this study was the incidence of nausea and vomiting during the first 24 h after surgery. Secondary outcome measures were the severity of nausea, need for rescue medication, and incidence of adverse

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Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.

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