case study/help

  1. I have a case study to do yet have little it is

    mrs littleton is in recovery room following outpatient surgery.She recieved a general anesthetic and is now awake,breathing deeply,and talking to the staff. She has recieved meperidine (demerol) intravenously and is quite comfortable. Before being discharged home from the surgery center. Mrs littleton rests in an easy chair in transitional recovery area.The nurse taking care of her notices that she asks questions about things that have already been discussed and has even asked one question three times.

    This is not a real patient just assignment.
    1. after making observations what nursing diagnosis and goals might the nurse identify
    2. list interventions to be performed for mrs littleton
    3.identify teaching aproaches.

    there is no age or VS listed. I was thinking possibly fluid volume deficit,and fatigue, acute confusion,thought process altered. yet have no info what should i do? thank you so much for your help
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    About x-tremestudent

    Joined: Aug '06; Posts: 11


  3. by   Daytonite
    The patient's age or VS are not necessary to know. You cannot begin randomly picking out nursing diagnoses without determining what your assessment data is. What do you have to support using a nursing diagnosis of Deficient Fluid Volume? What do you have to support using a nursing diagnosis of Fatigue? What is supporting the use of a nursing diagnosis of Acute Confusion?

    The nursing process (and care planning) always starts with assessment. You use assessment data to determine nursing diagnoses. Then, nursing interventions address each of the symptoms that were identified in the assessment process. You need to get these steps burned into your brain. All the data of these three stages links together.

    You need to go through the scenario and carefully pull out the symptoms they have given you. You have been told this patient received a general anesthetic. What are the common side effects of general anesthesia? You were told the patient received IV Demerol. What do you know about the effects and side effects of Demerol? Is the behavior they describe the patient exhibiting a result of the Demerol or the anesthetic? From all that information you will be able to develop a list of symptoms, or abnormal data assessment items, that this patient has. From that list you can then begin to choose nursing diagnoses. Any interventions you choose will be based on these symptoms. Identify her symptoms and her teaching needs will be more clear. Teaching needs will also be identified by reviewing your textbook for the care of surgical patients, particularly discharge instructions and teaching.

    Can't help you much more than this, dude. I'm leaving for vacation and will be offline for 4 days.
  4. by   x-tremestudent
    the only thing I can come up with is Disturbed sensory perception R?T anesthesia, and acute painR/T surgery am I on the right track?
  5. by   VickyRN
    The first nursing diagnosis is more appropriate for conditions such as visual/ auditory distortions, hallucinations, bizarre thinking.

    A more appropriate high-priority nursing diagnosis would be:
    Acute Confusion r/t anesthesia/ surgery, and possible medication reaction secondary to IV meperidine AEB pt reportedly asks questions about things that have already been discussed and asked one question three times

    Acute Pain is no longer an issue, since the patient has just received IV meperidine and is resting comfortably.

    Think about risks associated with surgery, risks associated with anesthesia, risks associated with meperidine (Demerol) use. Then, remember your ABC's and Maslow's (Safety concerns top priority).

    So, what about:
    Risk for Aspiration?
    Risk for Falls?
    Risk for Injury?
    Can you think of any others?

    Hope this helps
  6. by   VickyRN
    Last edit by VickyRN on Dec 28, '06