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Dear students please contact me (Peta Reid) if you are unsure about the assignment, but here are some guidelines. You will need to bring these guidelines and highlight the areas about which you are still unsure.

Although I am recommending current textbooks on where to find the basic information, the assignment does require you to find current literature/research to use to support your discussion, throughout the case study. Better Health Channel, WedMed, dictionaries, encyclopaedias etc. are not suitable academic sources. Do not use these, you will lose marks. You must follow the APA referencing format as directed by ACU in your case study and in your reference list. This essay should have between 10-20 relevant sources. Textbooks should be a range of medical-surgical, pathophysiology + A and P and pharmacology for specific information e.g. organ function or drugs.

  1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice (i.e. relevant research/review articles from medical and nursing websites e.g. Cinahl, Medline etc. you can also try Google Scholar) explore current treatment options for your patient’s condition, include any pharmacological and non-pharmacological considerati (NB: approx. 700 words for this but this is not exact and the markers are not counting). This is worth 15% of the marks.


  • First give a very brief overview of the anatomy and physiology – uterus, gall bladder, hip joint i.e. what and where is it and how does it function. (see A and P books – full texts not Essentials)


  • Then give a brief definition of the presenting condition i.e. what are fibroids; what is osteoarthritis; what is cholecystitis (pathophysiology textbooks and research)


  • Then discuss the pathophysiology of the condition i.e. how do you get fibroids, osteoarthritis, cholecystitis (pathophysiology books/research)


  • What pharmacological methods can be used e.g. NSAIDs for pain, joint injections etc. (see pathophysiology text, surgical nursing text, pharmacology text/research)


  • Then what non-pharmacological methods can be used, e.g. rest, exercise, diet etc. or surgery e.g. joint replacement, cholecystectomy, myomectomy (pathophysiology books/research)


  1. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Utilize the scale provided on LEO as a resource in your case study. (approx. 600 words for this). This is worth 10% of the marks.


  • Note this says ‘critically discuss’. Do not just say ‘if the patient has a score of 1 he stays in PARU if he has a 2 he can go’. This is not critical discussion and the Aldrete Scale gives this information in any case. You will lose marks if you do this. You need to support your discussion with evidence.


  • Briefly introduce this section with some reasons why do we use the Aldrete Scale (think about safety of the patient & the effects of anaesthesia, other drugs, operation, theatre environment, exposure). The marker wants to know you understand why you do things, not just because it’s what everyone does.


  • Next chose 4 (of the 5 Aldrete scores) to discuss critically


  • You need to think about why these are measured e.g. what is the effect of anaesthetics & opioids e.g. morphine, blood or fluid loss during surgery on the chosen criterion e.g. anaesthetic agents affect the function of the hypothalamus and the result is? Morphine acts on the brain stem and the result is? This is covered in your lecture on anaesthetic agents and the lecture on analgesics.


  • Finally link each one of your chosen criteria to your chosen patient e.g. Arthur is shivering this could be due to … this means…. Jin is tachypnoeic this could be due to … this means… Maree is unconscious this is due to…


  • An example if you chose Respiration:
  • When a patient has an anaesthetic (describe the effect of the anaesthetic on breathing).They may also have morphine which acts on (state correct part of brain which controls breathing) and this causes (state effect of morphine on respiration). The patient can become (what is the term for low blood oxygen?). Jin’s rate was…X breaths/min. Normal is Y breaths/min so Jin is……This might be due to this or that reason (state reason for abnormal breathing if it is given in the case study for the patient. NB not all cases have abnormal breathing).


  1. Develop a discharge plan to support your patient on dischar Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale. (approx. 400 words). This is worth 10% of the marks. This section should be supported by literature/research also. In order to understand the discharge needs of the patient you must understand their condition e.g. Arthur with is hip replacement will have specific requirements for this type of surgery


  • The discharge plan must be linked & specific to your patient e.g. think about the patient’s condition, surgery and situation and decide what referrals are appropriate to your chosen case and their surgery. Inappropriate referrals show you do not understand the patient’s condition and therefore cannot give safe care and you will lose marks.


  • You can discuss the general patient discharge needs e.g. letters, specific education e.g. what would Arthur need to know about preventing dislocation of his hip; follow-ups; contacts.


  • Please give a title to your essay e.g. Case Study – Jin Wong. Although you do not need a conclusion or introduction, and are answering each question, you must write in sentences not point form as this does not show critical thinking.


  • Do not use abbreviations e.g. i.e. etc. in your essay. Write for example if you need to explain something further.


  • You must explain any terms you use not just copy them out of a book/article/research. The markers need to know that you understand your chosen patient’s condition and management for safe care.






Subject Nursing Pages 8 Style APA


Cholecystitis – Laparoscopic Cholecystectomy     

The Pathophysiology of the Condition and Possible Current Medication


            The gallbladder is a section of the digestive system, which, surprisingly, the body can function without. It is made up of layers of tissues that includes the mucosa, muscular layer, perimuscular layer, and serosa. Its function is to store and secrete bile that help to digest bile salt (Pepingco et al., 2012). Cholecystitis is the inflammation of the gallbladder that takes place mostly because of an obstruction of the cystic duct from the cholelithiasis of the gallbladder. Mild Cholecystitis can easily be predicted through the development of complications such as perforation.  From the case study, the condition has several pathophysiological conditions.

Myles et al., (2004) puts it that gallstones are the major reason for Acute Cholecystitis development. The process involves the obstruction of the gallbladder in the cystic duct, which increases pressure in the gallbladder. In fact, there are two processes that lead to the severity of Cholecystitis. They include the degree and duration of the obstruction.

Stages of Pathophysiology

  1. Edematous Cholecystitis

It is the first stage of the pathological process, which takes place between 1 to2 days.  During this time, the gallbladder depicts interstitial fluids with dilated capillaries and lymphatic nodes. In addition, the gallbladder wall is edematous. However, though the bladder itself is intact without any damage, it has edema in the subserosal layer (Myles et al., (2004).

  1. Necrotizing Cholecystitis

This takes place between 3 to 5 days. During this time, the gall bladder has edematous changes in the areas of hemorrhage and necrosis. Indeed, when it is exposed to increased internal pressure, the blood flow is blocked. The patient would then have histological evidence of vascular thrombosis and occlusion (Pepingco et al., 2012).

.iii.     Suppurative Cholecystitis

 It is the third stage where the gallbladder has white blood cells present, with the areas of necrosis and suppuration. During this stage, the repair process of inflammation is clear. In addition, the enlarged gallbladder starts to contract, and its walls become thickened because of fibrous proliferation. Finally, the intra-wall abscesses begin to emerge (Jet al., 2007).


PACU Component Discharge Criteria outlined in the Alderate

            Alderate score is a medical scoring system used for measurement of the recovery after anesthesia. The components include activity, respiration, consciousness, blood circulation and color (Philips et al., 2013).

  1. Consciousness

After the surgical operation, the patient can become unconscious due to anesthetic effect. Therefore, before the patient should be tested to ascertain the level of consciousness.  From the cases study, the patient scored 0, she was unconscious after the surgery. Therefore, the patient could not be discharged for it is mandatory for the patient to achieve a minimum score of 1 for discharged to be allowed to go home.

  1. Respiration

The respiration is the ability of a person to burn food to produce energy for the body. It involves breathing to take in oxygen used in burning. Evident from the study the patient scored 0 since she exhibited signs of dyspnea. She refused to breathe deeply to take oxygen. She was drowsy and was reluctant to take deep breaths. In fact, her vital sign were: HR75 (Sinus rhythm). BP 110/70, RR 12, Temp 36.5 degree Celsius, capillary refill<2seconds.

  • Heart rate

 Heart rate is a crucial component for the post-anesthetic recovery. The heart rate should be + or – 20 the pre-anesthetic level. The case study indicated that the patient heart rate was normal since the heart rate needed for discharged should be at least 1. She scored two since her rate was + or – 20 the pre-anesthetic level. In fact from the case study the patient had a heart rate of 75.

  1. Circulation: Blood pressure

The circulation of the blood is fundamental in ensuring that the patient recover well from the anesthetic effects. The patient should score + or – 20mm Hg for the discharge to be allowed. From the case study, the patient scored 2 since her blood pressure was +or – 20mm Hg the pre-anesthetic level. The patient recorded blood pressure of 110/70. (Philips et al., 2013).


A Discharge Plan for the Patient


            Discharge plan starts from the time a patient visits a healthcare unit to the time discharge is due. Maree will have to know where to go after being discharged, that is home and she will need home based health care nurse for regular check-ups and to offer any medication that may be needed. According to Hegney et al., (2006), Discharge plan should involve two phases. The First phase involves post Anesthesia care that requires that the patient, Maree is fully awake, alert and responds to commands appropriate as given by the doctor. The plan also needs that the oxygen concentration is greater than 95% or pre-procedure baseline on room air for 30 minutes without airway support. In addition, the patient should be able to sit with minimal assistance from the caregivers and should have a pain score of <4 at rest. Finally, the patient should be capable of sit in an upright position without signs and symptoms of orthostatic hypotension. In case the patient does not meet the minimum requirement then an anesthesiologist should be consulted for further action (Moss et al., 2002).

            The Second phase of the discharge plan should involve home care management.  The patient should be given discharge medication prescription. Moreover, the patient teaching and written instruction should also be provided to the patient or a companion.  Finally, plan should be made for a responsible adult to accompany the patient home. In Sherman, (2014) argues that The family should also be educated on how best to take care of the patient such as ensuring that the patient takes medication as prescribed and finally, conducting a follow-up or home visit to check on the recuperation of the patient (Clare & Hofmeyer,(1997). The patient Maree will need a special care including special diet and changes in bandage dressing that resulted from surgery she underwent. Home care nurse or even family member may perform these cares. The prescriptions of the new medications that might have been started already at the hospital should be known; their side effect as well and more importantly, the reason as to why they were prescribed to Maree. Different types of physical activity fit for Maree should be identified so as to keep the body fit and to maintain basal metabolic rate.

            The family health care professionals of Maree should be certain of all the treatments the patient received and types of physical therapy involved thereafter. The report summary should be analyzed and followed promptly.

            In conclusion, Cholecystitis is a serious condition that affect people worldwide. Indeed, about 700 000 people have had their gallbladder removed due to obstruction. Therefore, people should be educated on the early signs before the condition complicates to seek quick medical attention. Finally, people should receive awareness on possible causes of the condition so as to adopt a healthy life. Sherman (2014) and Hedges et al., (1998) argue that families should also be educated on how best to take care of their patients such as ensuring that they take medication as prescribed and finally, conducting a follow-up or home visit to check on the recuperation rate and progress.



Clare, J., & Hofmeyer, A. (1997). Discharge planning and continuity of care for aged people: indicators of satisfaction and implications for practice. The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation, 16(1), 7-13.

Hedges, G., Grimmer, K., Moss, J., & Falco, J. (1998). Performance indicators for discharge planning: a focused review of the literature. The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation, 16(4), 20-28.

Hegney, D., Buikstra, E., Chamberlain, C., March, J., McKay, M., Cope, G., & Fallon, T. (2006). Nurse discharge planning in the emergency department: a Toowoomba, Australia, study. Journal of Clinical Nursing, 15(8), 1033-1044.

J, . K., K, . H., & L, . C. M. (April 01, 2007). Post-operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime. Acta Anaesthesiologica Scandinavica, 51, 4, 464-471.

Karamanos, E., Sivrikoz, E., Beale, E., Chan, L., Inaba, K., & Demetriades, D. (October 01, 2013). Effect of Diabetes on Outcomes in Patients Undergoing Emergent Cholecystectomy for Acute Cholecystitis. World Journal of Surgery : Official Journal of the International Society of Surgery/société Internationale De Chirurgie, 37, 10, 2257-2264.

Moss, J. E., Flower, C. L., Houghton, L. M., Moss, D. L., Nielsen, D. A., & Taylor, D. M. (2002). A multidisciplinary Care Coordination Team improves emergency department discharge planning practice. The Medical Journal of Australia, 177(8), 435-439.

Myles, P. S., Leslie, K., McNeil, J., Forbes, A., Chan, M. T. V., & B-Aware Trial Group. (2004). Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. The lancet, 363(9423), 1757-1763.

Pepingco, L., Eslick, G. D., & Cox, M. R. (January 01, 2012). The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis. The Medical Journal of Australia, 196, 8, 509-10.

Phillips, N. M., Street, M., Kent, B., Haesler, E., & Cadeddu, M. (December 01, 2013). Post-anaesthetic discharge scoring criteria: key findings from a systematic review.International Journal of Evidence-Based Healthcare, 11, 4, 275-284.

Sherman, S. C., In Weber, J. M., In Schindlbeck, M. A., & In Patwari, R. G. (2014). Australian Clinical emergency medicine.







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