Scenario: Susan Lee is a 60 year old female admitted to the medical surgical floor complaining of abdominal pain on and off for 4 months.Her...

Question Answered step-by-step Scenario:Prednisone 10 mg dailyASA 81 mg daily. Her assessment includes the following:Objective:Height : 64 inchesSusan Lee is a 60 year old female admitted to the medical surgical floor complaining of abdominal pain on and off for 4 months. Her complaints were constipation, bloating, abdominal pain and indigestion. Her CT scan diagnosed an abdominal mass. Susan’s past medical history includes COPD, Diabetes type 1, and vascular issues. Her medications include the following:Insulin glargine (lantus) 20 units at bedtimeWeight : 180 lbsVS: BP 138/ 88, 86-20- 97.3Lungs clear with occasional expiratory wheezesHeart regular, positive pedal pulse, weak on left leg, feet cool to touchAbdominal sounds present in all 4 quad, distended and tender to touchVoiding clear yellow urine without difficultyAllergies, seasonal, betadine Subjective:”I am here for the pain in my belly.””I hope it is nothing major.””I usually have my sugar under control.””I do get short of breath at times.””I hope I am not laid up too long, so my husband doesn’t have to do everything.””My husband recently had shoulder surgery and needs some assistance with ADL’s.” Susan is scheduled for an exploratory Laparotomy at 0700 tomorrow. Susan’s pre-op orders include the following: NPO after midnightLabs at 4 am: CBC, complete metabolic panel, type and cross-match, blood sugar on call to ORIV: NS at 50 ml/hrHave patient wash with Phisohex scrub at 9pm the night before surgeryConsult pulmonary medicine regarding COPDPre-op medications: Albuterol nebulizer on call to OR, Ancef 1 gm IV on call to OR, Dilaudid 0.5 mg IV push on call to ORHave consent signed for the procedure and understanding of all it includes. Answer the following questions:Which orders should the nurse question?How could Susan’s medical history affect the perioperative period?How does Susan’s home medications put her at higher surgical risk?Based on the subjective data, identify 2 nursing diagnoses to address the psychosocial needs of Susan. As the nurse, you are going to complete Susan’s preoperative teaching. Based upon what you may know of an exploratory laparotomy, what preoperative teaching will you include?Before administration of pre-op medication, what nursing actions should be done?What side effects can you assess for in the administration of pre-op meds?Discuss the importance of the World Health Organization Surgical Checklist in preventing errors during surgery. Scenario (cont’d)Location: Post-anesthesia care unit (PACU)Susan’s surgery is completed and she is transferred to Post Anesthesia Care Unit ( PACU). Below is your assessment of Susan:Drowsy but arousableVS: 97.2, 76, 14, 120/76Pulse ox 94 % on face mask at 40%Skin cool and paleNormal sinus rhythmAbdominal dressing midline clean and dry.Absent bowel soundsNGT to low intermittent suction/brown-green drainageFoley catheter draining clear yellow urineIV: 1000 Lactated Ringers 100ml/hrInsulin drip of regular insulin at 100 units/hrSituation, Background, Assessment, Recommendation (SBAR) from the intraoperative nurse was that the tumor was removed without difficulty. Susan had general anesthesia with no problems. She had a total of 4200 ml of fluid in, and a urinary output of 2700, EBL was 525ml. The abdominal incision was closed with staples and the dressing is clean and dry. Questions to answer:What are the potential complications of general anesthesia?How might his past medical history add to post-operative complications?What are the primary assessments you will need to complete and follow through while Susan is in the PACU? Scenario (cont’d):Location: Medical Surgical FloorSusan is stable to leave the PACU. SBAR to the medical surgical floor is as follows, and you are now the nurse on the floor taking care of Susan. Post op orders:Vital signs q1h x 4, then q2h x 2, then q4NGT low intermittent suction, irrigate as needed with 30 ml nssNPO I and O q4hFoley CatheterIncentive spirometry q1h while awakeOOB to chair evening of surgerySCD’sReinforce dressing as neededMedications:IV D5 ½ NS at 125 ml/hrSliding scale insulin ( Novolog) Bedside blood glucose ac and HSS: 0-150 =0 units151-200=2 units201-250= 4 units251- 300 = 6 units>300 8 units and call MDMorphine 2 mg IV q2h prn moderate pain < 7Morphine 4 mg IV q2h for severe pain, 7 or >Zofran 4 mg IV q6h prn nauseaLovenox 40 mg SQ daily Questions to answer:Based on knowledge of Susan’s surgical condition, what are the top 3 priorities during her post-op period?Susan asks why she must wear the SCDs and refuses them. What can you do to educate Susan about the rationale of wearing them?You are making your hourly rounds after your initial assessment and note a nickel size bloody area on the surgical dressing. What are your next actions?When listening to bowel sounds, what must you do prior to the assessment?Susan has been in your care for 5 hours post-op. Each hour the NGT has drained 50-75 ml. You notice on this hourly rounds that the NGT has not drained. What is your next action?Susan tells you it is difficult and it hurts to use the incentive spirometry. What education can you provide to her about how and why she needs to use it?Review the following assessment and indicate which complication Susan is at risk for: Complication Is Susan at risk? Rationale InterventionsInfection Hemorrhage Urinary tract infection DVT Pulmonary embolus Pneumonia Ileus Atelectasis Dehiscence/evisceration Constipation Fluid and electrolyte complication Aspiration pneumonia Health Science Science Nursing NSG 303 Share QuestionEmailCopy link Comments (0)