i'm struggling on this case study on a make believe pt, due on monday and would greatly appreciate any feedback, critiquing, help, thoughts, etc. been working on this all day and i'm tired so maybe i'll think of some better answers hopefully in the morning. this semester is med surg 1 and emphasis is on the perioperative interventions.
a 70 year old female is admitted for changes in bowel/bladder function. initial lab work was wnl. baseline vital signs were 124/62, hr 84, rr 20, t 98.4. a bowel resection is performed after the pt was diagnosed with colon cancer. postop, the pt is taken to a med surg unit. post, she has an iv of ns at 100ml/hr., an ngt to intermittent suction, a foley catheter, and a midline abdominal dressing that is d/i.
you are the nurse caring for this pt her first post op day. at 0700, the bp was 100/60, hr 104, rr 24, t 99.2 orally. the pt is a & o; her color is pale. the ngt tube is draining brownish-green mucous, abdominal dressing is d/i, and the iv is at 100 ml/hr. the pt says, "i'm so tired and i feel so nauseous, and it hurts to move."
- what would you do first with this pt? list 3 priority interventions you would implement at this time.
i would call the surgeon to report a decreased bp and increased pulse rate which could indicate hemorrhage, or shock. interventions should assess the position of person for patent airway, safety, and comfort. assess the urine output and color. check foley catheter site for signs of infection.
- list 2 categories of medications that you may be administering to this pt. give an example in each category. (remember, the pt has an ng tube)
it doesn't say pt is npo, but not sure why she stressed the ng tube.
narcotic possibly morphine sulfate sr and msir for breakthrough pain.
antiemetic: reglan or metoclopramide liquid for neausea
- state 2 priority nursing diagnoses and 2 collaborative problems that you identify for this pt.
impaired gas exchange r/t the effects of anesthesia, pain, opioid analgesics, and immobility
impaired skin integrity r/t surgical wounds, decreased mobility, drains and drainage, and tubes.
this is the 2nd part of the case study
the physician ordered the pt to be out of bed. when sitting at the bedside at 1000, the pt states, "i don't feel very well." after waiting 30 seconds, the nurse assists the pt to the chair. the pt becomes dizzy and her bp is 90/64, hr 114, and the urine output has been 70 ml since 0600.
- what could be happening to the pt in relation to this new data and what data supports your conclusions? what would you do first in this situation?
at first i thought orthostatic hypotension, but 30 secs at the bedside should have been enough time, and the bp decrease is typically greater than 20/10 mm hg. because of the decreased urine output of 70 ml in 4 hrs when it should be 30 ml every hour would suggest dehydration, along with the increased hr and decreased bp. i would contact the physician for a new order to increase iv fluids??
this is the 3rd part of the case study
labs pre-admission labs from the first post-op day
rbc 4.3 rbc 3.29
hgb 12.5 hgb 9.2
hct 37.5 hct 48.8
bun 16 bun 35
cr 0.8 cr 1.0
serum osmo 280 m/osmo/l serum osmo 345 m/osmo/l
spec. gravity 1.024 spec. gravity 1.034
- on the first post-op day, what could be happening to this pt? address each lab value that is abnormal to support your conclusions.
decreased rbc's is symptom of blood loss. decreased hemoglobin symptom of blood loss, or anemia. increased hematocrit is a symptom of dehydration. increased bun is a symptom of dehydration. increased omsolarity and specific gravity is when the urine is concentrated another symptom of dehydration.
- what orders do you anticipate the physician giving to manage this pt now? what nursing interventions do you anticipate implementing?
physician would get the patient rehydrated by increasing iv fluids.
nurse would continue to monitor labs, maybe give ice chips and provide frequent oral care.
- based on evidence to achieve positive surgical outcomes, what other issues will address in the subsequent days in taking care of this pt to prevent complication?
other issues that need to be addressed are pulmonary complications after surgery, so the pt need to be assisted out of bed and to ambulate as soon as possible to help remove secretions and promote lung expansion, and to also keep blood flow going to prevent dvt. assess the incision, tube, and cath sites for signs of infection. to prevent forceful coughing, emphasize importance of early deep breathing exercises.