Acute Care: Part I

Case Study

Liu Zhang is a 42 year old female. She immigrated to Canada with her husband from Taiwan three years ago. She recently received her Canadian citizenship and her English is at a limited working level. Mrs. Zhang began to have severe abdominal pain one morning. She took acetaminophen at home but the pain did not resolve. She went to the hospital that night.


Mrs. Zhang has no prior experience with the Canadian healthcare system.The Emergency nurse informs Mrs. Zhang that she needs to take her vital signs, bloodwork and insert an IV to hang fluids and medications. Mrs. Zhang also has an abdominal X-ray done. Soon after, a physician arrives and informs Mrs. Zhang that she will need a surgical procedure for a bowel obstruction. Mrs. Zhang is anxious and confused. She has never had a surgery. She is admitted to the pre-operative unit to prepare for the surgery. The surgeon approaches her to obtain consent and the surgical team wheel her into the operating room (OR).


After the surgery, Mrs. Zhang is brought to the post-anesthesia care unit. She is drowsy and can see other clients in the room. She can hear other people starting to wake up or moan in pain. After a few hours, she is transferred again, but this time to a surgical ward to be monitored. She is in a semi-private room with another client. Overnight, Mrs. Zhang calls the nurse and complains of severe abdominal pain. Mrs. Zhang’s temperature is 39°C and is experiencing chills. While the nurse is calling for the surgeon, Mrs. Zhang vomits moderate amount.


Upon assessment, the surgeon tells Mrs. Zhang that they need to take her back into the operating room for possible infection. Mrs. Zhang asks if she can call her husband, but the nurse assures her that they will call him and that they need to get her into the operating room as soon as possible.


Post-op, Mrs. Zhang is intubated, sedated and admitted to the intensive care unit (ICU). When she wakes up, the setting is unfamiliar, and there are machines and monitors everywhere. She feels something in her mouth and reaches for it, but the nurse from outside of the room yells “put your arm down and don’t touch the tube please!”. The nurse explains to her that she had to have a breathing tube inserted because of the sedation that she received during surgery. She tells Mrs. Zhang that the tube will be removed in a day or so. When the surgeon visits Mrs. Zhang to see how she is doing post-operatively, the surgeon tells her that she has an infection and that it is now being treated with antibiotics. Mrs. Zhang’s husband and daughter come to visit. She remains in the ICU for a week before transferring to the surgical ward, where she stays for another week and is finally transferred to a rehabilitation unit.


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Professional Practice in Nursing: Part II Copyright © 2022 by Kateryna Metersky; Roya Haghiri-Vijeh; Jasmine Balakumaran; Oona St-Amant; Leigh Dybenko; Emilene Reisdorfer; Linda Scott; and Anita Jennings is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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