Question

A nurse is caring for a client following a laparoscopic cholecystectomy.

Exhibit 1: Nurses' Notes
1030:
33-year-old client is 1 hr postoperative following a laparoscopic cholecystectomy. Alert and oriented to x 3. Skin warm and dry. Lungs clear auscultated throughout all lung fields. Normal sinus rhythm. Denies nausea and vomiting, bowel sounds hypoactive in all four quadrants. Peripheral pulses +2 bilaterally. Incision dressing clean and dry, incision upon inspection intact, no redness, swelling, or drainage noted.

Exhibit 2: Client Education
1230:
Discharge instructions given to client. Instructions on incision/wound care and proper hand washing. Client to report swelling, redness, drainage, bleeding, or warmth at operative site to surgeon. Client expected to experience carbon dioxide retention in the abdomen. Instructed the client to rest for 24 hr following surgery. Client can bathe or shower the day after surgery. Instructed the client to avoid lifting 2.3 kg (5 lb) or more for 1 week. Diet as tolerated.

Exhibit 3: Provider Prescription
1030:
Acetaminophen 500 mg PO every 4 hr as needed for pain
Cefaclor 250 mg PO every 8 hr

Exhibit 4: Vital Signs
1030:
Temperature 36.0° C (96.8° F)
Heart rate 82/min
Respiratory rate 16/min
Blood pressure 122/64 mm Hg
Oxygen saturation 96% on room air

Answer 1

The patient's postoperative status following a laparoscopic cholecystectomy is stable with appropriate vital signs and no signs of infection at the incision site. It's important for patients to adhere to postoperative instructions, including wound care and recognizing signs of complications, such as infection or changes to the incision site.

Step-by-step explanation:

Clinical Focus on Postoperative Care

The provided case study details the postoperative care of a 33-year-old client who underwent a laparoscopic cholecystectomy. This minimally invasive surgery involves the removal of the gallbladder, which is a small organ that stores bile produced by the liver. The vital signs and nursing notes indicate the patient is stable post-operation, with the nurse's notes confirming normal findings like warm and dry skin, clear lungs, no nausea or vomiting, and the absence of redness, swelling, or drainage at the incision site. However, the hypoactivity of bowel sounds in all four quadrants is typical soon after abdominal surgery and should improve with time.

Clinical focus cases like Barbara's or Roberta's emphasize the importance of postoperative monitoring for complications such as infection or organ dysfunction. For example, Barbara developed a localized infection at the site of her central venous catheter, necessitating further treatment. In contrast, Roberta experienced postoperative symptoms like abdominal pain and fever, warning signs that should be promptly reported to a healthcare provider.

It is also critical to educate clients on proper wound care and recognizing signs of complications, as outlined in the discharge instructions. Adherence to postoperative instructions is key for recovery, as is the use of prescribed medications, such as acetaminophen for pain and cefaclor as an antibiotic, as noted in the provider prescription. The client's experience with carbon dioxide retention is common after laparoscopic procedures and generally resolves without intervention.