Week 1 Learning Activity
In this case study, you will learn about the nursing skills utilized in both
preoperative and postoperative nursing care. This lesson will focus on utilizing the
nursing process, the basis for applying clinical judgment in caring for patients.
Pre-surgery:
Nurse Casey works on a surgical unit. She is preparing her patient Jose for surgery.
Nurse Casey applies clinical judgment in the clinical setting constantly. While
utilizing the nursing process, she makes decisions, engaging the patient, educating,
advocating, and intervening when necessary.
Scenario:
Nurse Casey is caring for a patient that has been admitted with acute appendicitis
with a possible abscess. It is determined that the patient needs surgery.
Jose is a 37-year-old male with a history of anxiety, migraines, and irritable bowel
syndrome, and currently uses recreational marijuana.
Jose is reporting pain, rating the pain an 8 out of 10. He is nauseous as well. The
patient has had no food or drink since the previous evening.
The patient is alert and oriented, able to answer questions, and follow directions.
Lungs are clear on room air. His blood pressure is elevated and his pulse rate is
elevated. The abdomen is tense and painful with increased pain upon palpation. His
last bowel movement was the previous night. He is able to urinate but does show
some signs of dehydration. He is able to walk independently, but the pain is a
limiting factor. The patient is expressing quite a bit of anxiety as well.
Vital signs are as follows: Temperature 99.8 F; Pulse 120; Respiratory Rate 18;
Blood Pressure 137/84; Oxygen Saturation 98% on room air.
Labs are as follows: White blood cell count 15; Lactic acid 2; Hemoglobin 11;
Hematocrit 37.
Answer the following questions:
1. Assessment: What cues do you recognize?
Pt Hxt of anxiety, Migraines, IBS
Pain level 8/10
Nausea
Elevated Bp – 137/84
Elevated HR – 120
Abdominal tense and painful
Dehydrated
WBC elevated
Lactic acid level 2 (high)
Hemoglobin level 11 (Low)
Hematocrit level 37 (Low)
2. Analysis: How can you interpret the data?
WBC elevated - suggest infection or inflammation.
Lactic Acid elevated – suggest tissue hypoxia or stress.
Hemoglobin & Hematocrit low – suggest anemia.
Dehydration – need to manage electrolytes and fluids.
3. Planning: What hypotheses can you form? List 2.
Dehydration – due to patients’ inability to eat or drink due to nausea.
Pain & Stress – could be causing tachycardia and hypertension.
4. Planning: What solutions do you have? List 2 per hypothesis, total of 4.
Pain management
o Administer pain medication.
o Administer benzodiazepine.
Fluid and electrolyte management
o Initiate IV fluids.
o Administer nausea med.
5. Implementation: What are your interventions? List 2 per solution, total of 4
Pain management – administer pain medication.
Pain management – assess pain level regularly.
Fluid & stress – initiate IV fluids.
Fluid & stress – monitor I & O’s
6. Evaluation: How do you measure how effective the interventions were?
Manage pain scored & manage pain comfort – a reduction in pain score and improved comfort are
indicators or effective pain management.
Measure urine output- for adequate urine output.
Monitor vital signs- stabilization of heart rate and blood pressure.
Monitor lab values- normalize of electrolytes and possibly decreased lactic acid levels.
