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Perioperative nursing. case study Questions and Answers Fully Solved
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Perioperative nursing. case study
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Perioperative nursing. case studycase study information - answer-John Egan, 53 y/o male, Hx of Type 1 DM, cigarette
smoking 40 pack years, CAD, and PVD.
-Six weeks ago, he developed a wound of his left heel which measured 4cm by 2cm
when he discovered it. Despite IV antibiotics and chemical debridement, the wound
developed a gangrene infection. He is scheduled for a BKA of the left lower extremity
tomorrow at 10:00am.
-His meds include daily insulin, aspirin 325mg/day, Pletal 100mg BID.
-He has an advanced directive and NKDA.
identify the priority nursing care - answer-complete preoperative testing/preparation
-maintain normal glucose levels
-ensure informed consent
-ensure correct surgical site
-prevent postop infection
-complete preop teaching to prevent complications
-address psychological comfort
what preop testing is appropriate? - answer-chest xray
-electrocardiogram for older than 40
-complete blood count
-electrolyte levels
-urinalysis
-xray lower extremity
When completing a medication reconciliation for Mr. Egan the evening before surgery,
what in the following orders cause the nurse concern? - answer-insulin (High Alert Med)
(NPO after Midnight)
-Aspirin (bleeding potential)
-Cilostazol (bleeding potential)
-Lorazepam .5mg IVP on call to OR in AM.
(s/b 0.5mg)
How does the nurse ensure informed consent? What must the patient consent to for the
procedure to be done? - answer3 requirements:
1.Adequate disclosure of diagnosis-purpose, risks, and consequences of treatment,
probability of success, prognosis if not instituted
2.Understanding & comprehension -patient must be drug free prior to signing consent
3.Consent given voluntarily -patient must not be persuaded or coerced to undergo the
procedure
, informed consent information - answer-Description of procedure and alternative
therapies
-Underlying disease process and its natural course
-Name and qualifications of person performing procedure
-Explanation of risks and how often they occur
-Explanation that the patient has the right to refuse treatment or withdraw consent
informed consent and the law - answer-Must be 18 years old or emancipated minor
-Parent signs for dependent children
-Must be deemed competent to sign own consent
-Must be alert & oriented; Consent may not be signed by patient after receiving
narcotics or sedatives
-Not necessary if threat to life and patient or legally authorized person unavailable-2
physicians sign
-Nurses role: advocate, witness, appropriate person signs
What does it mean that Mr. Egan has an advance directive?
How will it apply to his surgical procedure? - answer-living will
-pt may be a full code for 24 hours following surgery
-signed form releases liability
-allows family to know pt wishes in the event of serious complication
-durable power of attorney for healthcare
-POLST
POLST - answer-Physician order for life sustaining treatment
-portable, legal document that is the result of conversations between pt and HCR,
providing orders for EOL care
During the admission assessment, the nurse questions Mr. Egan to determine if he has
a latex allergy or sensitivity. Why is this essential to the patient's safety? What
symptoms would the nurse question Mr. Egan about in order to determine this? -
answerS & S
-Urticaria
-Rhinorrhea
-Bronchospasm
-Compromised respiratory status
-Circulatory collapse & Death
Management
-identify those at risk
-Latex free environment
-Latex free equipment
people at risk for latex allergy/sensitivity - answer-At Risk:
-Genetic predisposition
-Hx of multiple surgeries
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