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 Roman Font Style
B. Utilize at least three (3) or more references
C. References should be 2010 and latest
D. Output should be submitted as posted in the Google Class Assignment in PDF Format
E. Use the templates in pages 5 – 8 as guides in accomplishing your output
F. You will be graded according to the Rubric in pages 9-10

CASE SCENARIO:
PRE-OPERATIVE PHASE
 A 42-year-old female patient sought consultation in the emergency department with chief complaint of severe
abdominal pain in her right upper quadrant and spreads to her right shoulder and back, accompanied by nausea
and vomiting. She verbalized that she has had similar pain intermittently over the past week, however, today her
pain has become constant and unbearable. Upon initial assessment, vital signs showed a body temperature of 38.2
C and positive for tenderness over her abdomen upon palpation. Blood tests and abdominal ultrasound have done
and revealed presence of peritonitis with diagnosis of acute calculous cholecystitis . The surgical resident ordered
for a surgical procedure: Open Cholecystectomy. Patient’s symptoms of having high fever (Temp: 39C) and
pain were initially managed in the Emergency Room prior to transport to the Operating Room.
Antibiotic skin-testing was endorsed to the Operating Room Nurse for orders of giving IV Cefuroxime
750mg before induction of anesthesia (RA-SAB).

IMMEDIATE POST-OPERATIVE (PACU):

 After an hour of surgery (Cholecystectomy), the patient is transferred to the Post-Anesthesia Care Unit
for immediate monitoring. Patient is arousable upon calling and an hour later the patient is fully awake,
is capable of moving both upper extremities only. Patient is able to breathe spontaneously and cough
two times with vital signs of BP: 120/80mmhg, RR= 20bpm, PR= 89bpm, Temp: 35.9, and 02SAT: 96%
with oxygen inhalation at 2L/min via nasal cannula.
Table 1.0 Laboratory Results
Examinations Patient’s Result Normal Value Indication
Blood Exam
1. RBC 5.0 x 1,000,000/mm3 4.2-5.4 x Normal
1,000,000/mm3
2. Hemoglobin 14.0 g/dL 12.0-15.5 g/dL Normal
3. WBC 30.2 x 1000/mm3 5.7-13.6 x Above normal, may be an indication
1000/mm3 that the immune system is
attempting to eliminate an infection.
4. Platelets 250 x109/L 174 -391 x 1,000 Normal
mm3
Urinalysis
Clear-very slight Normal
5. Appearance Clear
cloudy
 Pale light yellow – Above normal, may be an indicator
Yellow that dehydration, excess, unusual, or
6. Color Dark yellow
potentially dangerous waste
products are circulating in the body
6. pH 5.0 4.5-8 Normal
7. Protein Negative Negative Normal
1.002-1.030 Slight Above normal, can indicate
8. Sp. Gravity 1.040
mild dehydration.
9. Glucose Negative Negative Normal
Casts None 0-5 Normal
WBC 1–2 <=2-5 Normal
RBC 0–1 <=2 Normal
Fecalysis
Shades of brown Clay colored may indicate post
Color Light Clay hepatic jaundice, obstruction to the
flow of bile to intestine.
Plastic, not unusual Watery stool may indicate food
to see fibers, poisoning, infection, lactose
Consistency Watery
vegetable skins intolerant, and or drinking too much
coffee, oily foods, and spicy foods
Occult blood Negative Negative Normal
Ova & parasites None seen None Normal
Negative for May indicate signs of infection
Bacteria ++++
pathogenic bacteria
Stool Analysis: Negative Negative Normal
Laboratory findings are indicated above in Table 1.0, wherein the attending physician concludes to proceed
with antibiotic regimen via intravenously.

Medications on Board:
1. Metoclopramide 10mg IV q8 prn for vomiting
2. Paracetamol 300mg IV prn for temp >37.8
3. Cefuroxime 750mg IV ANST ( ) prior to induction of anesthesia
4. Tramadol 50mg IV prn for moderate to severe pain

CASE STUDY QUESTIONS:

1. Classify the client’s surgery based on the following categories (next page)

Categories Description Rationale

1. According to Urgency Urgent – the patient needs to
undergo surgery within a few
weeks or month. Examples
are Acute gallbladder
infection, and kidney or
ureteral stones.
Urgent surgeries are usually
life-threatening that needs
immediate intervention to
prolong the life of the patient.
If left untreated, the patient
may experience serious
 complications, or even death.

2. According to Risk General Health Status – this The patient experiences

includes problems in
metabolic process of the
patient such as infection, and
autoimmune disorders.
Peritonitis, infection and
inflammation of peritoneum
of abdomen and Cholecystitis,
swelling of gallbladder. Both
disease disrupts the normal
metabolic process of
digestion of the patient.

3. According to Purpose Palliative - Performed to Discomfort of the patient such

relieve thesymptoms of a
disease processcorrecting the
disease causingthe symptoms
as the pain in her right upper
quadrant that spreads to right
shoulder and back.
Cholecystectomy is
performed to remove the
inflamed gallbladder that
causes discomfort to the
patient.

2. Post-operative nursing consideration/s for patients who have undergone Spinal Anesthesia (RA-SAB).
Nursing Consideration
 Hypothermia is treated with warm blankets and, if necessary, forced warm air blankets. Warm
intravenous fluids can be helpful too.
 Hypotension is managed with crystalloid infusions, blood products, or vasopressors.
 Respiratory function is supported with supplemental oxygen, proper airway positioning, and if needed,
artificial airways and mechanical ventilation.
 Urinary retention is managed by bladder scanning and intermittent catheterization.
 Symptomatic bradycardia is treated with atropine
 Nausea and vomiting are managed with prophylaxis. If the patient is still vomiting and nauseous, rescue
it by using 5-HT.
 Conduct Post anesthesia assessment using the table below.
Postoperative Observation Category
Patient’s Condition Alert and oriented vs. unresponsive
Need for physiological support Ventilator dependent or awake and extubated
Complexity of the surgical procedure Open laparotomy or laparoscopy
Type of anesthetic administered General Inhalation vs. local infiltration
Need for pain therapy Intermittent analgesics vs. continuous epidural
effusion
Prescribed period for monitoring parameters to Stable vs. unstable vital signs
evaluate physiological status

 Use the guidelines for Post Anesthetic Care using the as indicated below

Category Assessment Guide

Respiratory Assessment of
 Airway patency
 Respiratory rate
  Oxygen saturation
 Attention to oxygenation and ventialation
 If patient is awake and extubated or
ventilator-dependent
Cardiovascular  Monitoring heart rate and ECG
Mental Status  Assessing mental status
Pain Need for pain therapy/management
Hydration Certain operations may involve significant blood
lossand require additional intravenous fluids
management
Urine Urine output and voiding is assessed
Drainage and bleeding Should be periodically assessed to prevent
postopcomplications
Advocacy Family members are notified when a
patient isadmitted to the PACU to let them
know the surgicalprocedure is complete,
which helps to relieve theanxiety
experienced during the hours of waiting

 Use pain measurement scale to measure pain. For children, Mcgraw hill is used and NRS for adults. RA-
SAB Aldrete scoring.

Mcgraw hill scale

NRS Scale
 Aldrete Discharge criteria and scoring
 Patient endorsement Data or Hand off report information should be done.
Postop Nurse Responsibilities Rationale
Patient name, age, and sex Proper identification and accuracy ofthe surgical
procedure and postanesthetic care are critical for
patient’ssafety and appropriate care
Physiologic condition and assessment Baseline vital signs, along withpatient’s history are
crucial duringendorsements since they serve as
 Assessment
thecriteria for care and basis of patient’spostop
 Allergies status
 Vital signs
 Preoperative medical and surgical history
Surgeon and the procedure performed
Anesthetic used and patient’s response
Any unusual circumstances during theprocedure
may include infectious findings. These data will serve as a guide in theaccuracy of
Blood loss and fluid replacement patient care in terms of

All medications given in PACU  Types of surgery

 Medication
 POST OP nausea and vomiting  Fluid and electrolyte imbalances
 IV fluids  Cross contamination
 pain  Coordinated care with other allied health
Dressings and drains care workers.

 folley and catether

Tests and treatments performed inPACU and any
postop orders
Valuables and their quality
Location and contact information forsignificant
other or caregiver
Removable prostheses are safeguardedby the
PACU nurse then properlyendorsed to the postop
nurse for anychanges in the usage
The presence of family or significantothers is
important in providingeffective psychological and
emotionalsupport.

3. Based on the Aldrete Score in the PACU, is the patient eligible for discharge and to be transported back
to the Surgical Ward?
Criteria Scoring
Activity: 2 extremities can be moved 1
Respiration: Able to breathe and cough freely 2
Circulation: Blood pressure +/- preanaesthetic level 2
Consciousness: Fully Awake 2
O2 saturation: able to maintain O2 sat >92% on air 2
room

According to the Aldrete scoring above, she scored for a total of 9 points, meaning she can be endorsed
for discharge from the post anesthesia care unit.

4. Immediate post-operative care involves monitoring vital signs frequently, the nurse notices that there is
a sudden drop in Blood Pressure from 110/70mmHg to 80/40mmHg. There is a standing order for
starting a dopamine drip. Please compute for the following:

 10:00-Start up-titrating Dopamine 200mg/250ml at 10mcg/kg/min by 2ml/2hrs to titrate SBP greater or

equal to 100mmHg. Patient weight is 70kgs. Compute for the actual dose of the following time:
a. 12:00: 10.8 mcg/kg/min
b. 14:00:11.6 mcg/kg/min
c. 16:00: 12.4 mcg/kg/min

Sources:
Domingo, M. (2021). Care of the Clients with Problems in Oxygenation, Fluids and Electrolytes,
Infectious, Inflammatory, and Immunologic Response, Cellular Aberrations, Acute and Chronic.
Perioperative Nursing Care. Western Mindanao State University.

O’Neill, J., & Helwig, E. (2016). Postoperative Management of the Physiological Effects of Spinal
Anesthesia. Journal of PeriAnesthesia Nursing, 31(4), 330–339. doi:10.1016/j.jopan.2015.01.018

Samsodin K. (2013). Stool Analysis. Slideshare. Accessed at:

https://www.slideshare.net/ZawahirahSamsodin/fecalysis

Postoperative recovery and discharge (2003). McGrath, Brid et al.Anesthesiology Clinics of North
America, Volume 21, Issue 2, 367 – 386. doi:10.1016/S0889-8537(02)00080-9
Solution in No. 4: