NU371 HESI Case Study PVD with Amputation
Client Presentation
A disheveled man, appearing to be between 50 and 60 years old, is discovered unconscious beneath a
bridge with a gangrenous and necrotic right foot. Paramedics and police transport him to the emergency
department (ED).
Legal Is...
A disheveled man, appearing to be between 50 and 60 years old, is discovered unconscious beneath a
bridge with a gangrenous and necrotic right foot. Paramedics and police transport him to the emergency
department (ED).
Legal Issues
The client lacks identification, and the police are unable to identify anyone who might know him. Upon
admission to the ED, it’s determined that he requires immediate surgery to amputate his right leg above
the knee. As the nurse responsible for his care, there is no available contact for family members to
obtain informed consent for the surgery, and the client has not regained consciousness.
Which action should the nurse take first in the absence of informed consent?
- a) Call the operating room (OR) department to inform them that the surgery cannot proceed at this
time.
- b) Ask the police department to locate some of the client's family members quickly.
- c) Contact the hospital's legal department to appoint a legal guardian for the client.
- d) Prepare the client for surgery and document that no family member is available.
Correct answer:
- d) Prepare the client for surgery and document that no family member is available.
In emergencies, surgeons may proceed with operations without informed consent. Therefore, the
nurse's priority is to prepare the client for immediate surgery.
Perioperative Care
The client is seen wearing an old Timex watch and wearing a ring on his left index finger.
What should the nurse do with the client's personal belongings?
- a) Place the items in a bag labeled with his name and put it under the stretcher.
, - b) Ask the police to remove the items and take responsibility for them.
- c) Assign two nurses to collect the items, place them in a bag, and secure them in the hospital's safe.
- d) Use tape to secure the items and allow the client to wear them during surgery.
Correct answer:
- c) Assign two nurses to collect the items, place them in a bag, and secure them in the hospital's safe.
Proper hospital policy dictates that valuables be documented and stored in a secure location since there
are no family members available to take responsibility for the items.
Surgical Procedure
In the emergency room (ER), the client's right leg has been marked to confirm the site of surgery. As he
is unconscious, he cannot participate in this marking. When the client arrives in the operating room, he
is positioned on the operating table, intubated, and administered general anesthesia. A "time-out" is
called by the circulating nurse.
What is the purpose of the "time-out"?
- a) To allow the operating team to scrub and gown properly.
- b) So the anesthesiologist can assess the client to verify the correct procedure and individual.
- c) To signal the scrub nurse or certified scrub technician to perform an instrument and sponge count.
- d) For all OR team members to positively identify the client, confirm the correct site, and acknowledge
the planned procedure.
Correct answer:
- d) For all OR team members to positively identify the client, confirm the correct site, and acknowledge
the planned procedure.
The "time-out" procedure is a critical safety measure before initiating surgery, ensuring appropriate
identification and site verification to avoid errors.
Handling the Amputated Limb
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