Paul Brown, a 72-year-old male, presents to his local doctor with a four-week history of indigestion, fatigue, nausea, and intermittent abdominal pain. He states that the abdominal pain has worsened and become more frequent over the past week. Paul is diaphoretic and appears restless. He rates his pain 7-8/10. Paul tells you that he doesn’t know how to cook, typically buying takeaway or heating-up frozen meals in the evening. He consumes about 2-3 beers most nights.

Paul is seen by the medical team and diagnosed with Cholecystitis and scheduled for an Open Cholecystectomy tomorrow morning 0730hrs.

Medical History – Current smoker, Hypertension, hypercholesterolemia, and osteoarthritis (in his left knee)

Family history – Father (hypertension and ischaemic heart disease); Mother (Cholecystitis)

Medications: Ramipril 10mg/day, Simvastatin 80mg/nocte (takes these ‘when he remembers’), Voltaren gel (applies to left knee PRN)

Social; Paul lives alone after the recent death of his Wife. He has two adult Daughters who both live Interstate. Paul and his Wife were very social and had a large group of friends. However, since the death of his Wife, Paul has not attended social engagements.

Assignment Instructions

This Assessment task is based on the above case scenario of ‘Paul Brown.’ The purpose of this assessment task is to walk the reader through Paul’s perioperative journey (including the preoperative, intraoperative, and postoperative phases).

There are THREE separate sections of this assessment task, that outline Paul’s perioperative journey. Ensure you complete all three sections of this assessment task. Total word count for this task is 1000 word +/- 10%. Please note that the below word count allocations for each section are only a guide).

Please note that an introduction or conclusion is NOT REQUIRED for this assessment task. Subheadings are encouraged (eg. Section 1. Preoperative Care; Section 2. Intraoperative Care; Section 3. Postoperative Care), as these assist in the logical flow of information.

Section 1. (approx. 400 words)

Identify and discuss the subjective and objective nursing assessment of Paul during the preoperative period. You must use evidence-based literature to support your discussion. (eg. Textbooks; Clinical Keys; Journal articles).

Note: The overall goal of preoperative assessment of a patient is to identify risk factors and plan care to ensure patient safety throughout the surgical experience. It may assist you to discuss specific nursing assessment under the subheadings of subjective and objective data, however this is only a suggestion. You must use evidence-based literature to support your discussion. (eg. Textbooks; Clinical Keys; Journal articles; Government websites)

Section 2. (approx. 250 words)

Describe nursing management of Paul during the intraoperative period. This should include the type of anaesthetic Paul is most likely to receive (he will be undergoing an OPEN CHOLESTECTOMY); the role of the anaesthetic nurse during the intraoperative period; as well as the considerations involved in the administration of anaesthesia to older adults.

You must use evidence-based literature to support the above discussions. (eg. Textbooks; Clinical Keys; Journal articles; Government websites)

Section 3. (approx. 350 words)

Please note that there are two parts to this question (Part A & B)

1. A) Select TWO of the below potential priority nursing problems that may occur in the immediate post-operative period (first 4 hours following return to the ward). Utilising the Clinical Reasoning Cycle, and evidence from the literature provide a rationale for each of your chosen nursing priority problems eg. Why might Paul be at risk of developing this potential nursing problem? What does the literature tell you? What do you know about his medical history, family history, the surgery itself, etc, that may increase Paul’s risk of developing the chosen nursing problem? Ensure you support your rationale with relevant evidence-based literature.

Potential priority nursing problems:

• • Acute Pain
• • Nausea and vomiting
• • Airway obstruction
• • Hypoxaemia
• • Hypovolaemia

B) Identify ONE evidence-based nursing interventions (actions) and ONE nursing assessment that may be used to prevent or manage EACH of your chosen priority nursing problems.

Assessment Submission Instructions.

Nursing Intervention- Eg: Sit the patient up in Fowlers position so that there is no obstruction of breathing.

Nursing Assessment: Eg: Perform Vital signs or measure input and urine output.