Laparoscopic Cholecystectomy
The aim of this Task is to identify and examine the role of the Registered Nurse (RN Rice) in the case study below. You are to identify all the key events that occurred throughout the patient’s admission. Particular emphasis in your report is to be placed on the legal and professional nursing practice roles and responsibilities.
Mr Rory Symes is a 64 year-old man who underwent a laparoscopic cholecystectomy in a large metropolitan hospital on the morning of 21 May 2015. Mr Symes was transferred to the Extended Day Only Unit (EDOU) at 1430 hours following the procedure. Mr Symes was to stay in the EDOU overnight with discharge planned for the following morning (22 May 2015).
A Medical Officer (MO) assessed Mr Symes at 1630 hours on 21 May due the patient reporting abdominal pain and distension. Mr Symes’ distended abdomen and pain levels were documented in the patient’s medical record by the MO and a phone call was made to report this information to the surgeon who performed the procedure. Analgesia was prescribed (10mg morphine subcutaneously) at 1715 hours to be given PRN 6 hourly in response to the patient’s reports of pain. Ms Celia Rice was the RN working on the 12-bed EDOU with another RN on 21 May. RN Rice had been registered as a nurse for five years. As per hospital policy, RN Rice and the other RN were the only two staff members rostered to the unit on night-shift that commenced at 2245 hours. The EDOU was at capacity on the night of 21 May. Two of the other male patients admitted to the unit were distressed; one was continuously vomiting post-appendectomy and the other was experiencing urinary retention following a Transurethral Resection of the Prostate (TURP).
There was also a female patient admitted to the unit who was very upset at being placed in a room with male patients due to her religious beliefs. This patient, who had very limited English language skills, was continually wailing and expressing anger over the fact that hospital management had not resolved this issue as promised to the patient and her husband on the afternoon shift. At 0210 hours on 22 May 2015, RN Rice documented the following in Mr Symes’ health record: ‘Temp 38.9, P 126, Resp Rate 16 and BP 110/72 (approx)’
These were the only observations documented during the night- shift. There was no evidence of analgesia administration documented on Mr Symes’ medication chart by the time day-shift staff commenced work. The day-shift RN for 22 May did report that RN Rice had verbally stated that she had been “extremely busy” all shift and had not finished her “notes” by the time handover occurred. At 0630 hours on 22 May 2015, Mr Symes’ temperature was recorded by the day-shift RN as being 39 degrees, heart rate 140bpm and blood pressure 80/46mmHg. He was experiencing acute abdominal rebound tenderness and reported that his pain levels had rapidly increased throughout the early morning. Mr Symes was ultimately returned to theatre where a perforated bowel was identified and successfully repaired.
You are to set out your Task in report format. The report is to include an introduction and conclusion. Headings are to be used to break up your main points of discussion (put each ‘issue’ that you identity in the case study as your heading).
Your interpretation and examination of the key issues that occurred for the patient Mr Symes throughout his admission are to form part of your argument. Your argument is to be supported by references to contemporary, scholarly literature obtained through the library databases or official websites. You are to include reference to specific governing nursing codes, policies and documents in your report.
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