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NM3710: Post-Operative Care
Introduction
This essay will consider the post-operative nursing care I would give to Sophie Lawrence as a staff
nurse caring for her in the first six hours after a laparoscopy and left salpingectomy for a rupturing
ectopic pregnancy
...
1%,
amounting to 12,000 every year (CMACE, 2011)
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Ectopic pregnancy is defined as a gestation that implants outside of the uterus (womb), usually in
one of the fallopian tubes (NHS Choices, 2014)
...
The planned treatment for this patient is to
have a laparoscopy and a left salpingectomy
...
A salpingectomy is the complete removal of the tube in which the
ectopic pregnancy has embedded (Jurkovic and Wilkinson, 2011); in Sophie, her left fallopian tube
will be removed
...

Decision-making framework
When coming to assess a patient and make clinical decisions, it can be useful to use a framework in
order to help decide on an individualised plan of how to care for them
...
The framework as applied to decisions made in this
scenario is outlined below:

What is it: care for a patient after an emergency laparoscopy and left salpingectomy
to treat a rupturing ectopic pregnancy
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

When: These decisions will need to be made in the first 6 hours post-surgery
...



Why: To help the nurse ensure that the patient is stable and comfortable postsurgery and to enable early detection of any complications such as bleeding
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Postoperative care includes both physical and psychological care given to a patient to ensure safe
discharge from recovery and good care once back on the ward
...
One measure the nurse can take is to use an early warning system
which can alert them if the patient starts to deteriorate (Nicol et al, 2012)
...
This provides baseline observations to compare with pre-operative
and subsequent values as well as giving basic evaluation of the airway, breathing and circulation of
the patient (Resuscitation Council UK, 2010)
...
The combination of the ABCDE assessment
and the use of the early warning system provides a safe and thorough investigation of the issues
identified using the 5 W's
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Airway
First, I would establish if Sophie is able to maintain her own airway (Resuscitation Council UK, 2010)
...
To do this, I would ask her specific questions: If she responds, this
indicates a patent airway (Nicol et al, 2012)
...
If Sophie makes any noises other than talking, this could indicate a partial blockage which
could be attributed to swelling, spasms or the presence of a foreign body (Nicol et al, 2012)
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Breathing
If Sophie's airway is patent, the next step is to 'look, listen and report' on their breathing (Nicol et al,
2012)
...
g
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I would also check her respiratory rate: 12-20 breaths per
minute is considered normal in adults
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I would expect the oxygen saturation (SpO2 ) to be
between 95-10% for Sophie as she is not a smoker and has no chronic respiratory disorders (Chen et
al, 2006)
...
These could respectively indicate narrowed airways, aspiration, or
infection (Nicol et al, 2012)
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I would let the doctor in charge of Sophie know and ask them to review her urgently
...
I would also ascertain if Sophie had any issues with breathing

while in recovery and if she was being given oxygen while in recovery, I would check if she still
requires it when back on the ward
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Circulation
A priority when completing this step is to check Sophie's surgical site for any obvious signs of
bleeding
...
The signs of this can be hypotension, tachycardia and peripheral shut down which
can cause oliguria, confusion or unconsciousness (Tintinalli, 2010)
...
This can help to give an estimation of the amount of blood lost and can
give the doctors a guide as to how much fluid she will need if they need to counteract the loss
through IV fluids or blood
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When taking pulse, an expected value for an adult would be 60-80 beats per minute (Ingram and
Lavery, 2010)
...
When an ectopic pregnancy is
rupturing, a patient can have an elevated pulse rate (NHS Choices, 2014) and therefore it may not be
useful to use her initial observation as a baseline comparison
...
Blood pressure monitoring and the measurement
of capillary refill time can also highlight possible circulatory shock
...
Sophie's blood pressure on admission was 90/60 which may be a normal blood pressure
for her, despite being borderline low
...
Patients returning from
theatre usually have some fluids prescribed until they are able to eat and drink again; if there are
none on the patient's drug chart, I would call the doctor in charge of Sophie and ask them to
prescribe some for her
...
As previously
mentioned, oliguria may indicate hypovolaemia
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Disability, diabetes and drugs
Pain following surgery is also an important consideration (Nicol et al, 2012)
...
There is
usually a pain assessment system on the early warning scores which could help me evaluate Sophie's
level of pain
...
A
commonly used simple tool is the AVPU scale which assesses if the patient is alert, responds to
verbal commands, localises to pain or is unconscious; this scale is found on early warning scores
which are integrated into most hospital observation charts (RCP, 2012)
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Sophie has no previous history of diabetes
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This is especially important if she has any unexplained drowsiness or goes unconscious post-recovery
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However, if this worsens, the theatre and anaesthetist should be
informed
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One aspect of this would be to inspect the calves and legs for any signs of deep vein
thrombosis (blood clot in the vein) which could include redness, swelling, pain and localised heat
(Bates et al, 2012)
...
Sophie may need thrombo-emobolism
deterrent (TED) stockings so a risk assessment will be completed then if she needs them, she will be
measured and offered an appropriate pair
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I would check Sophie's skin integrity and state and calculate a Waterlow score using the
framework laid out by Judy Waterlow (2005)
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I would also take some time to consider if I have
missed anything when assessing Sophie and would ask her if she has any specific needs and wants
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This can help
reduce the risk of thrombosis and pressure ulcers so will be implemented with Sophie
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An anaesthetist will try
to ensure that they are prescribed enough analgesia post-surgery to remain comfortable
...

Further Considerations
Once the ABCDE assessment has been completed, I would go on to consider other aspects of
Sophie's care
...
I would
ensure that Sophie is aware of this and inform her as soon as she can have food and drink, I would
also check if she has any nausea and vomiting; this may be caused by a reaction to the anaesthetic
drugs or any analgesia (NHS, 2013)
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A key issue to consider with Sophie is the fact that she has undergone a potentially traumatic
experience and she may need some psychological support
...
When the pregnancy was not viable,
she may have experienced several different worries or concerns which she may need to talk to
someone about
...
I would also let her know about the outcome of the

operation and invite any questions
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However, it is important to support Sophie in the way that is
best for her
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They point that, while some women may be open to discussing it, other may wish
to deal with it privately without speaking to a healthcare professional
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Jurkovic and Wilkinson (2011) discuss the deep emotional
trauma that some women go through and also anxiety about future fertility
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Conclusion
As discussed, my role in the decision-making process is heavily influenced by several frameworks,
assessment tools and protocols
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During the assessment process, my decisions
and care given would also be influenced by the care given pre-operatively and by the theatre staff in
recovery
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The anaesthetist has a key role
also as drugs administered to the patient during and after surgery are their area of expertise so any
problems or concerns arising from that should be referred to them for review
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Title: Post-operative care, ABCDE approach. Ectopic pregnancy
Description: A 3000 word essay looking at providing post-operative care using the ABCDE approach. Critical appraisal of relevant sources completed at a Class I level, Adult Nursing BSc.

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