Question

Basic Metabolic Panel (BMP):			Current		High/Low/WNL?			Prior
Sodium (135–145 mEq/L)			134					136
Potassium (3.5–5.0 mEq/L)			3.8					3.9
Glucose (70–110 mg/dL)			148					98
BUN (7–25 mg/dl)			20					22
Creatinine (0.6–1.2 mg/dL)			0.9					1.1

3. What BMP results are RELEVANT and must be recognized as clinically significant by the nurse?

RELEVANT Lab(s):	Clinical Significance:	TREND: Improve/Worsening/Stable:

4. What is the primary problem that your patient is most likely presenting with?

5. What is the underlying cause/pathophysiology of this primary problem?

Provider Orders:

6. Please Review the orders written by the provider and give a rationale for each order as well as the expected patient outcome for the order.

Care Provider Orders:	Rationale:	Expected Outcome:
Hydromorphone PCA– Settings: *Bolus: 0.1–0.3 mg every 10 minutes *Continuous: 0.1–0.3 mg *Max every 4 hours: 6 mg Continuous pulse oximetry Ondansetron 4 mg IV push every 4 hours prn nausea Titrate O2 to keep sat >90% Incentive spirometer (IS) 5–10x every hour while awake 0.9% NS 100 mL/hour IV Clear liquids/advance diet as tolerated Apply lumbar orthotic brace when up in chair or ambulating

7. Which orders would you implement first and why?

Care Provider Orders:	Order of Priority:	Rationale:
1.Hydromorphone PCA 2.Continuous pulse oximetry 3.Ondansetron (Zofran) 4 mg IV push every 4 hours prn nausea 4.Titrate O2 to keep sat >90% 5.Incentive spirometer (IS) 6.Apply lumbar orthotic brace when up in chair or ambulating 7.Clear liquids/advance diet as tolerated

Nursing Care

8. What three nursing diagnoses will guide your plan of care? (list in order of PRIORITY)

9. What interventions will you initiate based on your nursing diagnoses?  Please provide a sound evidence-based rationale with citation and expected outcome for each nursing intervention. (This must be completed for all three).

Nursing Diagnosis	Nursing Interventions	Rationale	Expected Outcome

10. . What body system(s) will you most thoroughly assess based on the primary/priority concern?

11. What is the worst possible/most likely complication to anticipate?

12. What nursing assessments will identify this complication EARLY if it develops?

13. What nursing interventions will you initiate if this complication develops?

14. What psychosocial needs will this patient and/or family likely have that will need to be addressed?

15. How can the nurse address these psychosocial needs?

Answer 1

BMP result indicates Sodium 134 which indicates border Hyponatremia.

BMP Value Glucose 148 need to be monitored closely as it has increased from previous test results

Patient is primarily presented with probable compliants of Pain,Nausea and Vomiting

Dehydration related to post surgery fluid loss

Hydromorphone PCA acts on postoperative pain therapy.PCA titration is suitable for drug intolerance.

Pulsoximeter monitoring enhances patient O2 saturation levels.Close monitoring is requred

Ondansetron acts for Nausea and Vomiting

Incentive Spirometry and Lumbar orthotic brace will be useful on conservative management measures

Nursing Diagnosis;

Fluid imbalance

Altered mobility

Impaired Breathing Pattern

What body system(s) will you most thoroughly assess based on the primary/priority concern?

Body system to assess Skin torgour

1. What is the worst possible/most likely complication to anticipate?

dehydration

1. What nursing assessments will identify this complication EARLY if it develops?

assesement of fluid imbalance

1. What nursing interventions will you initiate if this complication develops?

Fluid replacement

1. What psychosocial needs will this patient and/or family likely have that will need to be addressed?

1. How can the nurse address these psychosocial needs?

Anxiety.Assurance and psycological support