Western Mindanao State University

College of Nursing
Zamboanga City

Alternative Learning System

Related Learning Experience
Operating Room

Instructions:
Answer the provided questions comprehensively following the subsequent format.:
A. Use the Times New Roman Font Style with 12-point font size, 1.5 spacing, 8.5 x 13 paper size
B. Utilize at least three (3) or more references
C. References should be at least from the year 2015 onwards
D. Refer to the rubrics for alternative learning system for the rating system of your output

CASE SCENARIO:

A 54-year-old-female presented with a 3-month history of abdominal pain and nausea. She reported recent bought
of pain associated with large Italian meal, but noted that she did experience pain unrelated to oral intake. In the
emergency department, she underwent US and CT scan, both of which were negative for acute diseases. She was
admitted to the hospital for pain management and further workup, including a CCK-HIDA scan which was also
negative. The decision was made to proceed with cholecystectomy. She underwent uncomplicated laparoscopic
cholecystectomy, with immediate resolution of symptoms post-operatively. At 6 months post-operatively, she
remains symptom free.

History:
• 3 month Abdominal pain and nausea

Subjective:
• Pain associated with large Italian meal but noted that she did experience pain unrelated to oral
intake.

Objective:
• Negative for acute diseases
• Negative pain management

Procedures:
• Underwent laparoscopic cholecystectomy for acalculous cholecystitis

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Analysis

Test Result Analysis

Ultrasound Negative for acute diseases Though this is used to diagnose
CT-Scan Negative for acute diseases cholecystitis, a negative result may
still indicate that the patient had
developed acalculous cholecystis.
Negative results mean that there
are no calculous material present
in the gall-bladder. But still, this
may show gallbladder wall
thickness, striations of the
gallbladder wall, pericholecystic
fluid & biliary sludge, intramural
gas, mucosal sloughing, and
murphy’s sign.
CCK-HIDA Negative The HIDA scan is both 95%
sensitive and specific for acute
calculous disease. As with US, the
accuracy declines with acalculous
disease with and sensitivity and
specificity of 70 and 90%,
respectively.

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 A. Output Template

1. Study of the Illness Condition

ASSESSMENT ANATOMY PHYSIOLOGY PATHOPHYSIOLOGY ANALYSIS

The gallbladder serves Though abdominal pain and nausea is

Cues as a reservoir for a a common symptom for diseases, in
yellow-green fluid cholecystitis, there are also other
Subjective Cues: produced in your liver symptoms that needs to be included,
• Pain associated with (bile). Bile flows from such as murphy’s sign, fever, jaundice,
large Italian meal your liver into your and sometimes, weakness & fatigue.
but noted that she gallbladder, where it's
did experience pain held until needed during According to studies, only 50% of all
unrelated to oral the digestion of food. patients with acute disease have a link
intake. When you eat, your between their abdominal discomfort
gallbladder releases bile and their meals. Which is most likely,
Objective Cues: into the bile duct, where even without taking meals, abdominal
• Negative for acute it's carried to the upper pain is present.
diseases (US & CT part of the small
scan) intestine (duodenum) to Ultrasound and CT SCAN are
Reference/s:
• Negative pain Accessed at:
help break down fat in commonly used for visualizing biliary
management (CCK- food. diseases. However, its accuracy drops
https://www.mayoclinic.org/dise
HIDA) whenever the patient has acalculous
ases-
Reference/s: Bile stasis and enhanced lithogenicity of disease. This is to detect any material
conditions/cholecystitis/sympto
bile are regarded to be the main causes of present in the body. While CCK-
ms-causes/syc-20364867
History: Lindenmeyer C. (2021). this illness. Because of increased bile HIDA is used if US and CT-scan are
• 3-month Acute Cholecystitis. viscosity due to fever and dehydration, as negative. CCK-HIDA shows the tracer
Abdominal pain Merck Manuals. well as a prolonged lack of oral feeding moved slower than normal through the
and nausea Cleveland Clinic. resulting in a decrease or absence of body. This may be a sign of a
Accessed at : cholecystokinin-induced gallbladder blockage or a problem with liver.
merckmanuals.com/pro contraction, critically ill individuals are References:
fessional/hepatic-and- more susceptible and causes
biliary- inflammation of the gall bladder. Thus Bridges, F., Gibbs, J., Melamed, J.,
disorders/gallbladder- Cussatti, E., & White, S. (2018).
Page 3 of 13

2. Surgical Procedure and Instruments used
Surgical Procedure
Laparoscopic Cholecystectomy -
surgery to remove your gallbladder.
The gallbladder is a small organ
under your liver. It is on the upper
right side of your belly or abdomen.
The gallbladder stores a digestive
juice called bile which is made in the
liver.
and-bile-duct- leading to abdominal pain, and nausea as
disorders/acute- elicited by the patient.
cholecystitis?qt=cholec
ystitis&alt=sh%202011 No interventions would cause perforation
of gangrene and extrabilliary abscess
formation in the gall bladder.
References:
Shojamanesh H. (2019). Acalcalous
Cholecystitis. Gastroenterology.
Medscape. Accessed at:
https://emedicine.medscape.com/article/1
87645-overview#showall
Instruments Category
Name Image
Light Source w/ Inspecting
Video Monitor
Clinically diagnosed cholecystitis: a
case series. Journal of surgical case
reports, 2018(2), rjy031.
https://doi.org/10.1093/jscr/rjy031
Hepatobiliary (HIDA) scan
with/without CCK. (2017).
johnstonhealth.org/wp-
content/uploads/2013/12/Hepatobiliar
y-HIDA-Scan-with-without-CCK.pdf
Functions
Lights up the site of operation and
gives visualization through the
laparoscope.
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 Inspecting h allows a surgeon to access the
Laparoscope inside of the abdomen (tummy) and
pelvis without having to make large
incisions in the skin

Hasson Trocars Trocars/Cannula placed through the abdomen during

laparoscopic surgery

Electrocautery Cautery to destroy abnormal tissue, such as a

Device tumor or other lesion. It may also be
used to control bleeding during
surgery or after an injury.

Endoscopic Suctioning designed to provide various flow

Suction Irrigation rates during laparoscopic procedures
System that require irrigation

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 Laparoscopic clip Grasping/Holding reusable instruments for both open
applier and endoscopic procedures that
deliver and close metallic ligating
clips

Endoscopic Grasping/Holding used for endoscopic therapy for

ligature loop gastrointestinal perforation,
ESD/EMR assistance, bleeding
control and ligation of polyps.

Endoscopic Grasping/Holdig a disposable device used as a

retrieval pouch receptacle for the collection and
extraction of tissue specimens

Reference:
Burns A. (2016). Surgical Instruments. SlidePlayer. Accessed at : https://slideplayer.com/slide/9750401/

Page 6 of 13
 3. Nursing Care Plan

PLANNING
NURSING
ASSESSMENT OBJECTIVE IMPLEMENTATION EVALUATION
DIAGNOSIS INTERVENTION RATIONALE
OFCARE
Acute pain related to Short term goals: Independent The patient verbalizes
Subjective: disease process After 1 hour, the patient Note possible
• Pain associated Acute pain is that which The pain is due to acalculous that she likes to talk to
with large (cholecystitis) as will verbalize methods that pathophysiological and follows an injury, trauma, cholecystitis deviate the actual
Italian meal but evidenced by self-report provide relief and psychological causes of pain or procedure such as surgery or feeling of pain in the
noted that she of pain. demonstrate the use of occurs suddenly with the onset abdomen area as a
did experience relaxation techniques. relaxation technique..
pain unrelated
of a painful condition
to oral intake.
Moreover, the patient
Long term goals: Note client’s age, affecting the ability to report Client is female, 54 year old. added that the pain has
• Experiences
nausea and developmental level, and pain parameters or response to reduced from 8 to 5
vomiting. After 2 hours, The patient current condition pain and pain management preoperatively, and can
• Pain in the will report of pain using a interventions be inferred as reduced.
upper right of
pain scale, and behavioral Determine client’s acceptable Client may not be 100% pain Client stated that the pain is
tummy.
and/or physiologic level of pain and pain control free but may feel that a “3” is a bearable during early
indicators reflect that pain goal. manageable level of months but developed after
Objective: is either reduced or at an discomfort, while another may the third month. She
• Negative for acceptable level
acute diseases require medication for pain at reported it as 7.
• Negative pain the same level because the
management experience is subjective
Work with client to prevent Use flow sheet to document Murphy’s sign is indicated
History:
• 3 months of
rather than “chase” pain pain, therapeutic interventions, with the client. Pain level
abdominal pain response, and length of time preoperative is increased to
and nausea before pain recurs. Instruct 8. The client stated that she
client to report pain as soon as will verbalize any changes
it begins, because timely in pain.
intervention is more likely to be
successful in alleviating pain.
Encourage verbalization of to evaluate coping abilities and The client is anxious about
feelings about the pain to identify areas of additional the operation and might
concern cause more pain. Client is
open about her feelings.

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Review procedures and
expectations and inform the
client when treatments will
hurt. Discuss pain management
methods
to reduce concerns of the Client was noted about the
unknown and muscle tension operation with the goals and
associated with anxiety or outcomes.
fear.

Encourage adequate rest to prevent the fatigue that can Encouraged the client to
periods impair the ability to manage or relax to reduce tension and
cope with pain. pain, before and after the
procedure.
Provide or promote use of relaxation exercises, Client likes to talk as a
nonpharmacological pain diversional or distraction nonpharmacological pain
management activities management to deviate the
actual feeling of pain.
Review nonpharmacological Relaxation skills and Client likes to talk as a
measures for lessening pain. techniques such as self- nonpharmacological pain
hypnosis, biofeedback, and management to deviate the
therapeutic touch have no actual feeling of pain.
detrimental side effects.
Collaborative
Establish a collaborative Pharmacological management Established a collaborative
approach for pain management is based on the client’s approach for pain
based on the client’s symptomatology management with the
understanding of and and mechanism of pain as well physician in accordance for
acceptance of available as tolerance for pain available treatment options.
treatment options

Notify physician/healthcare Helps in pain management. Notified the physician that

provider if regimen is the pain control goal is met.
inadequate to meet pain control
goal.

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References:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2018). Nursing diagnosis manual: Planning, individualizing, and documenting client care. Philadelphia, PA: F.A. Davis.
In Herdman, T. H., In Kamitsuru, S., & North American Nursing Diagnosis Association,. (2018). NANDA International, Inc. nursing diagnoses: Definitions & classification 2018-2020.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: F.A. Davis Co.

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4. Drug study
GENERIC NAME: Ampicillin
BRAND NAME: Novo-Ampicillin
DRUG ILLUSTRATION:
CLASSIFICATION:
PHARMACOTHERAPEUTIC: Penicillin.
CLINICAL: Antibiotic
MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE REACTION
Inhibits cell wall synthesis in susceptible
microorganisms by binding to PCN binding protein. Side effects:
• Pain in IM site
Therapeutic Effect: Bactericidal in susceptible microorganisms. • GI disturbances
• Oral/vvaginal candidiasis
• Rashes
• Urticaria
• Phlebitis
INDICATION: • Thrombophlebitis
• Headache
• Treatment of susceptible infection to Streptococci, S.
pneumoniae, staphylococci, meningococci, Listeria, • Dizziness
Klebsiella, E. coli, H. influenzae, Salmonella, Shigella, • seizures
including GI, GU, respiratory infections
• Adverse Reaction:
Meningits
• Endocarditis prophylaxis • antibiotic colitis
• super-infections
• altered GI bacterial balance
• hypersensivity reactions
• •
CONTRAINDICATION:
• Hypersensitivity to penicillin or ampicillin
• Infection caused by non-penicillate organism
NURSING RESPONSIBILITY
Baseline Assessment:
• Question for history of allergies,
especially penicillin,
cephalosporins; renal impairment.
Intervention/Evaluation
• Promptly report rash (although
common with ampicillin, may
indicate hypersensitivity) or
diarrhea (fever, abdominal pain,
mucus and blood in stool may
indicate antibiotic-associated
colitis).
• Evaluate IV site for phlebitis.
Check IM injection site for pain,
induration.
• Monitor I&O, urinalysis, renal
function tests.
Be alert for superinfection: fever,
vomiting, diarrhea, anal/genital
pruritus, oral mucosal changes
(ulceration, pain, erythema).
Patient/Family Teaching
• Continue full treatment
• Space dose evenly
• More effective if taken after eating
• Discomfort in IM is considered
• Report if any rash occurs.
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 DOSAGE/FREQUENCY/ROUTE:

PO: ADULTS, ELDERLY: 250–500 mg

q6h.
CHILDREN: 50–100 mg/kg/day in divided
doses q6h. Maximum: 2–4 g/day.
IV, IM: ADULTS, ELDERLY: 1–2 g q4–6h
or 50–250 mg/kg/day in divided doses.
Maximum: 12 g/day.
CHILDREN: 25–
200 mg/kg/day in divided doses q6h.
Maximum: 12 g/day.
NEONATES: 50
mg/kg/dose q6–12h.

Reference:

Kizior RJ, Hodgson KJ. Saunders Nursing Drug Handbook 2021 / Robert J. Kizior, Keith J. Hodgson. Elsevier; 2021.

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 B. Rubric for ALS

4 3 2 1
Follows and
Follows Demonstrat
Exceeds Follows
CATEGORY some but es little
expectations instructi
not all comprehens
noted in ons
instructions ion
instructions
I. STUDY OF ILLNESS CONDITION (total score = 48 points)
1. Assessment
• Differentiates between subjective and
objective cues
• Analyzes laboratory examinations
2. Anatomy
• Indicates and labels the affected organ
• Cites reference/s & Paraphrases
3. Physiology
• Discusses the normal functions of the
organ involved
• Cites reference/s & Paraphrases
4. Pathophysiology
• Explains the pathophysiology based on
the diagnosis
• Develops the pathologic pathway of the
patient’s current illness
• Cites reference/s & Paraphrases
5. Analysis
• Correlates signs & symptoms to the
illness condition
• Relates laboratory / diagnostic exams to
the illness condition
• Indicates the normal values and
significance of the laboratory results
TOTAL
POINTS

46 – 48 = 1.0
44 – 45 = 1.25
42 – 43 = 1.5
39 – 41 = 1.75
37 – 38 = 2.0
34 – 36 = 2.25
32 – 33 = 2.5
30 – 31 = 2.75
29 = 3.0

Prepared by: Noted by:

DR. MARIA SOCORRO C. DOMINGO FREDIE M. OMAR, MAN, RN

Clinical Coordinator Curriculum Chair

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Approved:

DR. MARY JOSELYN C. BIONG

Dean

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