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Essay Instructions: Case Study : Amy
Amy is an 8 year old girl who has a past history of chronic tonsillitis. She has had 3+ episodes of tonsillitis each year normally treated by the local GP with a course of Antibiotics and local anaesthetic mouth wash. Amy has been placed on the waiting list for an elective tonsillectomy.
Whilst conducting the pre-admission visit with Amy and her parents, it is noted that there is no relevant immediate family medical or surgical history. Her observations are all within normal limits for her age, and all required pre-admission documentation has been completed.
During the assessment it is noted that both of Amy?s parents work, dad full-time and mum part-time, she also has a younger sibling Ben. It has also been established that Amy and her family are very nervous about the hospital stay and subsequent operation as she has never been away from home before nor had any previous experience with hospitals. With work commitments and Amy?s younger brother needing care neither parent can stay overnight with her in the hospital. Amy is especially worried that she will miss out on the ?fun stuff? they do at school, miss her teacher and playing with her friends in the playground. After some education Amy is reluctant but seems happy to have her surgery.
Amy?s surgery goes to plan and is uneventful during the perioperative stage. The surgeon removed Amy?s tonsils and due to the size of her adenoids also decided to remove those, Amy?s consent had documented tonsillectomy +/- adenoidectomy. On Amy?s arrival to PACU (post anaesthetic care unit) she is still unconscious, positioned in the left lateral position to assist with drainage of secretions; she is oxygenated through a Hudson mask on 6L and is monitored accordingly. Shortly after her arrival in PACU Amy is beginning to rouse and is quite distressed and disorientated, she is complaining of a sore throat, her breathing is short and laboured, and she has uncontrolled rigors. She is quite upset and asking for her mum.
After her 30 minute stay in PACU Amy returns to the ward. Amy is still drowsy but easy to rouse. She has a Sodium Chloride 0.9% infusion running for hydration at 90mls/hr, which is to remain insitu until she is tolerating oral fluids. Amy has also been written up for regular 4-6hrly oral Paracetamol 855mgs. Further PRN pain relief has been ordered consisting of oral Codeine 28.5mgs and IV Tramadol 57mgs. Dexamethasone 5.7mg and Ondansteron 4mgs have been charted. Amy is to have 5 days of post-operative Cephalexin antibiotics; an IV dose has been given intraoperatively however she is to continue the remaining 5 day course on 570mgs oral antibiotics.
During RPAO it is noticed that Amy has unusually noisy breath sounds, which were not evident on PACU handover. Amy?s mum has also suggested that Amy does not seem comfortable and seems to be swallowing excessively. She has also mentioned that Amy has commented on having an upset tummy. Shortly after Amy?s assessment she begins to groan and vomits coffee-ground vomitus.
Amy will be staying in hospital overnight for review in the morning prior to discharge home, as per her admission notes Amy?s parents are not able to stay with her overnight. Amy?s mum has mentioned that she will be leaving shortly, but did not want to upset Amy by telling her in case she became unsettled again.
Answer the following 4 questions
Q1. Identify the psychosocial impact of surgical intervention including the psychosocial impact of elective and emergency admissions, separation, and loss of income and/or loss of control as related to the case study (400 words)
Q2. Explain the recovery process of your chosen patient. Identify and provide rational for airway management as related to the case study (250 words)
Q3. Identify the assessment and nursing intervention involved in addressing the patient?s pain as related to the case study? (250 words)
Q4. Develop a (case report) nursing care plan focusing on the post operative care in the first 24 hours. In order of priority, using evidence based literature, identify and discuss nursing care and rationales as related to the case study (600 words)