A female patient has a laparoscopic cholecystectomy this morning she is now complaining of right shoulder pain. The nurse would explain to the patient what Symptoms Is?

Appeared in: PGIMER NO - 2020

Explanation

Right shoulder pain is a frequent and well-documented side effect after laparoscopic procedures due to referred pain.
The pain is caused by residual carbon dioxide (CO₂) gas used to inflate the abdomen, which irritates the diaphragm and the phrenic nerve.
The phrenic nerve shares nerve roots with the shoulder area, causing the brain to interpret diaphragmatic irritation as shoulder pain.
In patient education, stating that a symptom is 'common' is reassuring and helps alleviate patient anxiety about the unexpected pain.
This symptom is temporary and typically resolves on its own within a few days as the gas is absorbed by the body.

Option A: This statement is incorrect and would cause unnecessary anxiety. Right shoulder pain is a very common, not unusual, finding after this procedure.
Option B: The incentive spirometer is used to prevent or treat pulmonary complications like atelectasis (lung collapse) by encouraging deep breathing. Shoulder pain from gas insufflation is unrelated to lung expansion.
Option C: While factually correct that the pain is expected, 'common following this operation' is a better answer from a therapeutic communication standpoint. It is more specific to the patient's situation and uses language that is more reassuring.

Clinical Relevance

Nursing practice connection: Use the key finding related to Post-operative complications and patient education following laparoscopic surgery to guide bedside assessment, documentation, and the next nursing action.
Effective patient education is a key nursing responsibility. Explaining that shoulder pain is common after laparoscopic surgery can significantly reduce patient anxiety and improve their post-operative experience.
Nurses should proactively manage this pain through non-pharmacological interventions like ambulation and positioning (Sim's position) to facilitate gas dissipation.
It is crucial for the nurse to differentiate this common referred pain from other potential causes of shoulder pain, such as cardiac issues or surgical complications like internal bleeding.

How to Approach the Question

First, identify the core elements of the question: the procedure (laparoscopic cholecystectomy) and the patient's complaint (right shoulder pain).
Recall the common physiological effects and side effects associated with laparoscopic surgery. The key is the use of CO₂ insufflation.
Connect the CO₂ insufflation to diaphragmatic irritation and the concept of referred pain via the phrenic nerve.
Evaluate the options based on both medical accuracy and principles of therapeutic communication. The goal is to provide an explanation that is both correct and reassuring to the patient.
Compare the two most plausible options ('Expected' vs. 'Common'). 'Common' is often preferred in patient communication as it normalizes the experience. 'Following this operation' is more specific than the general 'laparoscopic surgery'.
Select the option that best combines accuracy, specificity, and patient-centered communication.

Concept Tested & Keywords

Concept Tested: Post-operative complications and patient education following laparoscopic surgery.
Stem keywords: laparoscopic cholecystectomy, right shoulder pain, post-operative
Lead-in keywords: explain to the patient
Clinical cues: The procedure was a laparoscopic cholecystectomy, which involves CO2 insufflation.
Clinical cues: The pain is specifically in the right shoulder, a classic site for referred pain from the diaphragm.

Q3a1ON_TjAEERo30bf_Jwe

E6 Medicine Harrison 22e Part 2 p. 636-638

E6 Medicine Harrison 22e Part 1 p. 174-176

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 119-121

Practise the full PGIMER NO - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.