NMIH202 Developing Nursing Practice 1


Mrs Lopez is a 45-year-old, obese, Hispanic tourist who presents to the Emergency Department with acute abdominal pain. She has a recent history of abdominal pain over the past two weeks, gradually increasing in intensity. No known family history of any abdominal conditions. Mrs Lopez states she has accompanying symptoms of nausea and vomiting, pain radiating to her right shoulder, sweating and chills. When questioned about her social history, she states her diet has consisted of regular takeaway with an intolerance to fatty food and little exercise. Mrs Lopez is complaining of moderate abdominal pain. She is febrile at 38.2 degrees Celsius, with a blood pressure of 126/72 mmHg, a regular pulse of 128bpm, a respiratory rate of 22 breaths/min, and an oxygen saturation of 97% while breathing room air. The plan for Mrs Lopez is to admit her to the surgical ward for observation, medication management and surgery. Mrs Lopez is anxious and says she feels guilty about her lifestyle, which she considers has contributed to this admission today. Mrs Lopez will require a laparoscopic cholecystectomy
1. Risk Factors and Health Promotion What arc the modifiable and non-modifiable risk factors that may have contributed to Mrs Lopez’s cholelithiasis and acute cholecystitis? Mrs Lopez requests assistance regarding her modifiable risk factors. Outline how you would approach Mrs Lopez regarding these including what health promotion information and referrals you would provide to her 

2. Pathophysiology Briefly describe in your own words (in the way you would explain it to a family member) the pathophysiology behind acute cholecystitis 

3. Homeostatic Mechanisms Outline the homeostatic mechanisms that result in the following symptoms Mrs Lopez is experiencing on your nursing assessment:
*Referred shoulder pain
*nausea and vomiting
4. Nursing Care Outline and justify the nursing care required for Mrs Lopez with her initial presenting symptoms, placing this nursing care in order of clinical priority. 

5. Activities of Daily Living Consider the twelve (12) activities of living outlined in the Roper Logan & Tierney Model of Nursing and specifically discuss which of these activities of living may be influenced or altered for Mrs Lopez post operatively. Outline how the registered nurse could assist the patient to manage them. 
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