Surgical Colectomy Case Studies
Case study #1
A 44-year-old African American male had a partial colectomy to have a cancerous tumor removed. The patient did really well after surgery and was discharged from post op recovery to the surgical unit at a medical center. Approximately one hour after surgery, the patient complained of gas pain and shortness of breath. Providers failed to diagnose a pulmonary embolism that resulted in the loss of the patient’s life
A colectomy is an invasive surgical procedure that predisposes the patient to more complications because of the location of the colon and amount of medication involved with general anesthesia. Therefore, the patient should be observed closely during the procedure, and at least the first 24 to 48 hours after the procedure, and any complaint should be addressed immediately. According to the National Surgical Quality Improvement Program …show more content…
(NSQIP) colectomies are associated with Clavien grade four complications such as postoperative septic shock, postoperative dialysis, pulmonary embolism, myocardial infarction, cardiac arrest, and prolonged ventilator requirements and therefore intensive care unit (ICU) care is needed (Webb, Rubinfeld, Velanovich, Horst, & Reickert (2012).
Although, the patient did well after surgery, one hour later he was transferred to the medical unit, in my opinion the patient should have been in the intensive care unit until he could ambulate. Considering, the type of surgery performed, I would have obtained vital signs, assessed the lung sounds, check the oxygen saturation, and requested for stat chest X-ray and ECG. Most importantly, the stability of the patient’s condition is determined by the cardiac rhythm, and presence of arrhythmia or ischemia. Continuous
cardiac monitoring and assessing the vital signs with special attention to the respiration and oxygen saturation is recommended. However, following appropriate assessment steps will help to determine if the patient is stable or unstable which will in turn, help in making the right diagnosis (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cock (2013). Although, morphine sulfate was administered, unfortunately, the right assessment was not performed. The vital signs, oxygen saturation, the lung sounds were not documented, failing to reveal the patient’s current and actual condition. Some of the reasons that could lead to misdiagnosis include; miscommunication, lack of attention, and the patient work load to mention but a few. Immediate attention to the patient complaint, getting patient’s vital signs with attention to respiration, blood pressure and oxygen saturation, as well as knowing the cardiac rhythm by placing ECG should be the priority. Obtaining an appropriate assessment will prevent misdiagnosis and save the patient’s life. In addition, placing the patient on blood thinner such as heparin 8,000 units every eight hours, and monitor the PTT and CBC is recommended (Arcangelo & Peterson, 2013).
A 44-year-old African American male had a partial colectomy to have a cancerous tumor removed. The patient did really well after surgery and was discharged from post op recovery to the surgical unit at a medical center. Approximately one hour after surgery, the patient complained of gas pain and shortness of breath. Providers failed to diagnose a pulmonary embolism that resulted in the loss of the patient’s life
A colectomy is an invasive surgical procedure that predisposes the patient to more complications because of the location of the colon and amount of medication involved with general anesthesia. Therefore, the patient should be observed closely during the procedure, and at least the first 24 to 48 hours after the procedure, and any complaint should be addressed immediately. According to the National Surgical Quality Improvement Program …show more content…
(NSQIP) colectomies are associated with Clavien grade four complications such as postoperative septic shock, postoperative dialysis, pulmonary embolism, myocardial infarction, cardiac arrest, and prolonged ventilator requirements and therefore intensive care unit (ICU) care is needed (Webb, Rubinfeld, Velanovich, Horst, & Reickert (2012).
Although, the patient did well after surgery, one hour later he was transferred to the medical unit, in my opinion the patient should have been in the intensive care unit until he could ambulate. Considering, the type of surgery performed, I would have obtained vital signs, assessed the lung sounds, check the oxygen saturation, and requested for stat chest X-ray and ECG. Most importantly, the stability of the patient’s condition is determined by the cardiac rhythm, and presence of arrhythmia or ischemia. Continuous
cardiac monitoring and assessing the vital signs with special attention to the respiration and oxygen saturation is recommended. However, following appropriate assessment steps will help to determine if the patient is stable or unstable which will in turn, help in making the right diagnosis (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cock (2013). Although, morphine sulfate was administered, unfortunately, the right assessment was not performed. The vital signs, oxygen saturation, the lung sounds were not documented, failing to reveal the patient’s current and actual condition. Some of the reasons that could lead to misdiagnosis include; miscommunication, lack of attention, and the patient work load to mention but a few. Immediate attention to the patient complaint, getting patient’s vital signs with attention to respiration, blood pressure and oxygen saturation, as well as knowing the cardiac rhythm by placing ECG should be the priority. Obtaining an appropriate assessment will prevent misdiagnosis and save the patient’s life. In addition, placing the patient on blood thinner such as heparin 8,000 units every eight hours, and monitor the PTT and CBC is recommended (Arcangelo & Peterson, 2013).