Laparoscopic Cholecystectomy (08 Questions)

1.1 Mr. Ryan, 58 years old, had surgery today for a laparoscopic cholecystectomy. He is returned to the day surgery unit.

His orders are:
*Acetaminophen 300 mg with codeine 30 mg (Emtec) 2 tab. PO q 4 h PRN
*Discharge at 18:00.
*Appointment at outpatient surgery clinic in one month.

He was given two analgesic tablets at 14:30. At 15:30, you do the monitoring required when an opioid is administered. Mr. Ryan says: " My abdomen does not hurt as much but my right shoulder hurts, the pain is rated at 3/10."

Question:
What do you suggest to Mr. Ryan to relieve his shoulder pain? *
1.2 He asks you what is the cause of his shoulder pain.

Question:
What do you tell him? *
1.3 At 17:30, Mr. Ryan goes to the washroom on his own without any difficulty and passes 400 ml of straw-coloured urine. You observe the four compresses on Mr. Ryan's abdomen: two are clean, one is 25% soiled with a yellowish discharge and one is soiled with a trace of dried blood. Mr. Ryan tells you that he drank a little water and that he does not feel nauseous. He says that he has diffuse abdominal pain rated 3/10.

His vital signs are: BP: 128/88 mmHg; P: 80 beats/min., rhythm regular; R: 16 breaths/min., rhythm regular, depth normal, SpO2: 97%, T: 36.6 degrees C.

Question:
Mr. Ryan's partner asks if they can leave the hospital now. *
2. Mme. Sophie Lavoie, 60 years old, was scheduled for a laparoscopic procedure, but due to complications, it was converted to an Open Cholecystectomy. She returns to the unit with a T-Tube in place. On Day 2, the nurse is teaching her about the tube care.

Medical Orders:
*Monitor T-Tube output.
*Clamp T-Tube for 1 hour before and after meals.
*Unclamp if nausea/vomiting occurs.

Question:
Mme. Lavoie asks, "Why do you clamp this tube when I eat?" What is the correct explanation? *
3. M. Robert Roy, 65 years old, is 6 hours post-op. He is drowsy and taking shallow breaths because he says his abdomen hurts when he breathes deeply. His SpO2 is 93% on room air.

Medical Orders:
*Incentive Spirometry q1h while awake.
*Hydromorphone 1 mg PO q4h PRN.
*O2 to keep Sats > 92%.

Question:
What is the nurse’s priority intervention to prevent respiratory complications? *
4. Mme. Claire Bouchard, 50 years old, is preparing for discharge. She asks the nurse, "Now that my gallbladder is gone, can I eat whatever I want? Or do I still need to be careful?"

Medical Orders:
*Discharge home.
*Follow up in 2 weeks.

Question:
What is the most appropriate dietary teaching? *
5. M. Pierre Tremblay, 58 years old, is 1 day post-op. During the morning assessment, the nurse finds M. Tremblay lying perfectly still with his knees flexed. He reports that his abdominal pain has worsened significantly (9/10) and is now diffuse across the whole belly. The nurse notes that his abdomen is rigid and board-like to palpation, and he guards against touch.

Medical Orders:
*Regular diet.
*Discharge home today if stable.
*Notify Surgeon for signs of complications (fever, severe pain, rigid abdomen).

Question:
What condition should the nurse suspect? *
6. Mme. Julie Gagnon, 44 years old, is 4 hours post-laparoscopic cholecystectomy. She rings the call bell in distress. When the nurse arrives, Mme. Gagnon is clutching her right shoulder and reports severe, sharp pain (8/10) in that area. She is worried she is having a heart attack. The nurse assesses the abdomen, which is soft and non-distended, and the incision sites are dry.

Medical Orders:
*Vital signs q4h.
*Diet as tolerated.
*Acetaminophen 650 mg PO q4h PRN.
*Encourage early ambulation.

Question:
What is the nurse’s best explanation and intervention? *