Clinical decision making and reasoning

Mr Larry Lyons is admitted to the East Wing surgical ward of University Hospital and scheduled for a cholecystectomy. It is intended that the procedure will be performed by laparoscopy, however a laparotomy may be required. As part of his perioperative care you are required to plan his nursing intervention for perioperative care (see Skill 36-1 in your Dempsey text).

On admission you documented his vital signs as follows:

Vital signs: T 376C, P 106, RR 22, BP 140/94, SpO2 97%, Wt 60 kg, Ht 198cm

UA: + protein, + blood, ++ nitrites, pH 5

Pain score: 6/10

Mr Lyons states to you that although he is willing to have an operation that may involve additional procedures, that is the laparotomy, he is unwilling and fundamentally opposed to providing consent for a blood transfusion.

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