Assessment task

This assessment task is designed to help you plan effective and safe nursing care for a patient across the perioperative pathway.

In this assessment, you are required to respond in short answer format to 3 questions related to the case study of Grace Flowers and her pre-operative, intra-operative and post-operative care. Each question has background information about the clinical scenario to help your response. As the format of this case study is short answer there is no introduction or conclusion required. It is expected that each of the short answer responses are approximately 650 words in length and referenced appropriately.

To complete this case study, you will be required to critically analyse the information provided in the patient scenarios and describe your nursing care based on high-quality evidence, consisting of a broad range of literature sources including clinical practice guidelines, systematic review and evidence summaries, and recent journal publications.

You will be assessed using the following criteria:

• Skill in clinical reasoning and decision making
• Ability to source and apply best-practice evidence to the clinical case study
• Demonstrated understanding of the nurse’s role in patient care and education across the perioperative
• Demonstrated understanding of quality nursing care
• Academic Format and referencing

For more details related to the marking criteria, refer to the marking rubric.

Introduction to the case study

This case study relates to the care of Grace Flowers and her perioperative journey. Grace is a 46 year old woman admitted to the surgical ward at a local regional hospital in preparation for a laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) tomorrow afternoon. Grace has been admitted at 1300 hours on the day prior to theatre for management of pain and dehydration prior to surgery. Over the past week Grace has been unable to eat or drink due to increasing episodes of severe right upper quadrant pain that has been non- responsive to simple analgesics. Pain has been well controlled on admission with regular endone and paracetamol administered orally. An IV cannula has been inserted and fluids commenced at an 8/24 rate overnight. The plan is for Grace to fast from 2400 hours tonight. There is no other relevant medical past history. However, the anaesthetist has reviewed her tonight and expressed concern that her BMI is 34 and she smokes approximately 20 cigarettes a day. Grace has reported feeling anxious about surgery tomorrow as she is worried about pain and how soon she can return to work.

Preoperative care

You are the registered nurse caring for Grace on the morning shift. Grace is first on the afternoon list for her surgery today. You are required to complete her pre-operative checklist and pre-operative teaching in preparation for surgery.

Question 1: Role of the Registered Nurse in pre-operative teaching

In this section discuss the importance of pre-operative teaching and the role of the registered nurse in patient education prior to surgery. Describe what your 2-3 priorities would be for pre-operative teaching in this clinical scenario and what evidence-based information you would provide to Grace to prepare her for post- operative recovery.

Intraoperative care

Grace has been transferred to the holding bay in theatre and the nurse undertaking the final pre-operative checks has noted that the consent form is for a laparoscopic cholecystectomy only and is concerned that the intraoperative cholangiogram procedure is not documented on

the consent form. Grace is also unable to communicate in her own words what her surgical procedure involves and any risks involved in her surgery.

Question 2: Informed consent

Discuss what constitutes informed consent and if in Grace’s case informed consent has been adequately achieved. In your answer outline what actions would you recommend the registered nurse undertake in this scenario and why. What precautions need to be considered in the perioperative environment to ensure consent is indeed informed?

Postoperative care

Grace has returned to the ward following laparoscopic cholecystectomy and IOC under general anaesthesia. You attend to her routine post-operative observations and find that Grace is hemodynamically stable and her pain is well controlled with patient-controlled analgesia of morphine 1mg per bolus. However, Grace is noted to be very drowsy and is vomiting every time she administers a morphine bolus. She is reluctant to continue with her pain

management regimen.

Question 3: Evidence based management of post-operative nausea and vomiting

Discuss evidence-based management of post-operative nausea and vomiting. In your answer describe what factors may have predisposed Grace to experience post- operative nausea and vomiting. Considering the contributing factors to post-operative nausea and vomiting in Grace’s case, what would your recommendations for nursing and pharmacological management be?

Referencing and formatting

Referencing

You are to select a minimum of 10 peer reviewed journal articles, systematic reviews, clinical guidelines, or government policy documents, as well as any additional academic sources you can find, that address your topic.

The journals that you select for this task must be published within the last 10 years. Please only use journals published from 2011 onwards (unless it is seminal work). Using articles outside of this time frame, no matter how well they address the topic area, may result in significant deduction of marks.

Please do not use websites to support your statements.

Use APA 7th reference style. For access to the online APA 7th style of referencing guide use this link: https://libguides.scu.edu.au/apa

Reference all citations intext.

Ensure the reference list is on a new page and they are listed in alphabetical order. This section is not included in your word count.

Formatting

Your assignment must be submitted via Turnitin from the link on the Blackboard learning site. No assignment will be accepted via email attachment. Your assignments must be submitted as either Word documents (with .doc extension, or .docx). PDF / Note pad assignments will not be accepted. No handwritten assignments will be accepted.

You must check similarity using the draft submission point before submitting the final draft under the final submission point.

Your overall work will be 2000 words. You are given 10% +/- for this work; however, words over this will not be marked, and may result in loss of overall marks. The 2,000 word count allows 10% leeway for in-text citations.

As the format of this case study is short answer format there is no requirement for an introduction and conclusion.

Use the structure and headings outlined in this document. You may choose to include the 3 questions as sub-headings to precede your answers and these sub-headings can be excluded from the final word count also.

Include either a header or footer with your name, student number and include page numbers. Use size 12 font and either 1.5 spacing or double spacing

Special Considerations

All assignment extension requests must be initiated by the Special Consideration process. Late assignments without an approved extension from the Unit Assessor will receive a penalty of -5% per day including weekends & holidays.

To locate the Special Consideration application forms: https://www.scu.edu.au/current- students/student-administration/special-consideration/ “Special consideration for assessment”. Students must carefully review the grounds for applying for a Special Consideration.