Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
College of Health Sciences

CASE ANALYSIS
Case no. 8

Patient 8 is a 49 years of age, female who arrives in the SICU following

Cholecystectomy, surgical intervention using the laparoscopic approach on September
17, 2021.
Patient 8's airway and ability to maintain respiratory stability is evaluated immediately.
Her respiration is 16 breaths per minute, and her heart rate is 78 beats per minute.
Oxygen is being administered at 2 liters via nasal cannula. A pulse oximeter is
placed on his left forefinger, and his oxygen saturation is measured at 95%. The
patient is arousable but easily drifts off to sleep.
The report is received from the operating room staff. Her operative course was
unremarkable. Patient history obtained during the preoperative phase of care showed
that she was a 1 pack per day smoker and she denies taking any prescribed or over-
the-counter medications. Patient 8's weight is documented at 110 kg.
Further assessment of the patient demonstrates normal skin perfusion with good
capillary refill in all extremities. She has a drain in his abdomen with a small amount
of yellowish discharge. The wound site and sutures are clean and dry without
bleeding or discharge. With a Foley catheter is in place.
Patient 8 wakes when the second set of vital signs is obtained. He reports that his pain
is 8 on a 10-point scale. She states that she has pain in his shoulder and pressure
in his abdomen. Morphine (5 mg) is ordered for the pain, and 4 mg is
administered IV. Her husband is in the waiting room, and he comes into the unit to visit
and sits by her bed reading while the patient dozes off.
Repeat vital signs are obtained every hour. At 2 hours after admission, the patient's
oxygen saturation is noted to be 90%. SICU staff suctions secretions from the
patient's throat, and she is instructed on how to use the incentive spirometer. Her
oxygen flow is increased to 4 liters/minute by nasal cannula. No change in the patient's
oxygen saturation is noted over the next 15 minutes despite compliance with the
respiratory exercises.
At one hour after admission, the patient's oxygen saturations remain at 89% to 90% ,
her respiratory rate is 16 breaths per minute, and she is more difficult to arouse. The
nurse notifies the physician of the changes in Patient 8's status. Oxygen delivery is
changed again to a face mask at 4 liters/minute without improvement in the
oxygen saturation level. All other parameters remain stable, demonstrating a
readiness for discharge.
Despite the improvement in the patient's status, the oxygenation issue remains
worrisome. The patient is admitted for an overnight hospital stay, and respiratory
exercises are continued, eventually demonstrating an improvement in oxygen
saturations to a high of 94%.

 49 years of age, female

 Dx: Cholecystitis, Cholelithiasis

 Lap Cholecystectomy on Sept 17, 2021.

 D5LR 1L x 8°
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
College of Health Sciences

 With IC, JP drain

 With O2 support via nasal cannula regulated @ 2 LPM

 VS, I & O, GCS monitoring Q1