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Mrs. Glutton, a 58 year-old female (weight:120 kg),   smoking history: 25 years (two packs per day). She has been drinking alcohol every day since she was 20. She had hepatitis- B when she was 50 years old. She has a sedentary life because she is obese. Mrs. Glutton; was brought to the hospital with complaints of pain in the left upper quadrant, jaundice, itching, nausea, weakness and indigestion. After physical examination and laboratory examinations (blood and urine), she was admitted to hospital for surgery. Her operation is planned under general anesthesia.

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  1. a) What can be the preliminary diagnosis of the patient?
  2. b) What is your reason for making this pre-diagnosis?
  3. c) What might be the significant changes in the laboratory findings of this patient?



  1. d) What are the risks factors in your patient for general anesthesia? Explain how do effect of these risk factors on patient.
  2. e) What can be major problems during surgery for this patient?
  3. f) For Mrs. Glutton, in postoperative care, which complications can be occurred in respiratory system? What should be your nursing interventions to prevent this complications?
  4. g) For which nursing diagnoses or collaborative problems common in postoperative patients has ambulation been found to be an appropriate intervention? (select and explain one by one)
  • Impaired skin integrity related to incision
  • Impaired mobility related to decreased muscle strength
  • Risk for aspiration related to decreased muscle strength
  • Ineffective airway clearance related to decreased respiratory excursion
  • Constipation related to decreased physical activity and impaired gastrointestinal (GI) motility
  • Venous thromboembolism related to dehydration, immobility, vascular manipulation, or injury
  1. h) Plan the postoperative care and discharge training of Mrs. Glutton

Nursing diagnosis

Goals and outcome



  1. i) Is organ transplantation possible for this patient? Explain the reason of your answer. Get Nursing Help Today

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