Case Study

Overview: Immediate postoperative abdominal hysterectomy

This case presents an immediate postoperative patient that has just arrived in the recovery unit.

Doris Bowman is a 39 yr old female patient who has undergone total hysterectomy with bilateral salpingoopherectomy under general anaesthesia.

Doris tolerated the procedure without complications and has an abdominal incision covered with a 4×4 gauze dressing and no drainage. Estimated blood loss during surgery was 400mls. 2Ltrs of Hartman’s fluid was administered intraoperative and Doris has an IDC insitu which has drained 200 millilitres of clear straw coloured urine.

Past medical history includes painful and heavy periods, pelvic ‘pressure’, bloating, fatigue and anaemia. Doris has no other significant past history and takes no other medications other than Iron tablets that have been prescribed for anemia related to her menorrhagia.

Activity

Watch the simulation of Doris’ immediate postoperative care in relation to assessment and pain management and then answer the essay question.
Important information:

When you review Doris’ document you will assume that all dates are all correct. This means that the procedures, charts and olther associated information all occured on the same day and this is the day that you are experiencing.

Essay Question

Apply clinical reasoning to the management of Doris Bowman and discuss the actions that could have been undertaken to reduce the risk of opioid intoxication.

In your answer ensure that you:
Identify the legal and ethical issues that relate to the administration of opioids to Doris Bowman.
Discuss a structured approach to the management of Doris’s pain with a focus on the clinical reasoning process. You will also need to discuss the benefits and risks associated with your management.
Discuss an appropriate pain management regime for Doris based on high level evidence sources.
Apply the use of relevant best-practice decision making tools in your answer.

This assessment task is to be written as an essay and an academic writing style is required.

Marking Criteria

Degree to which legal and ethical issues in relation to the administration of medications specific to the case study are identified and discussed
Degree to which clinical reasoning is applied to client assessment and the administration of medications in the case study
Degree to which best-practice decision resources related to the administration of medications are applied to the case study
Level of academic writing