Question

Analyze the following situations:

1. A 26-year-old 5-foot woman who weighs 360 pounds was involved in a motor vehicle accident, sustaining multiple fractures. She is stable and is scheduled for surgery immediately. In this situation, what will be some of the considerations for the OR team on arrival of the patient to the OR suite?

2. A 46-year-old man presents to the OR. He is scheduled for a wound debridement of a right calcaneous foot ulceration. His glucose level is checked just prior to surgery and his daily insulin dose is reduced accordingly. What type of diabetes does he have? As an assisting circulator during the case, what considerations should you be aware of as he is positioned on the OR table?

3. A 52-year-old man is admitted to the hospital with a gunshot wound to the left abdomen. He is received in the OR directly from radiology, where his computed tomography scan was completed. His Trauma Score is now a 3. Analyze the situation and describe the priorities of care.

Answer 1

1) Some of the considerations that need to be implement by OR team for obese patient before surgery as follows:   correct instructment and its usage is important such as large tourniquets,airway equipment and the operating table so on.Correct positioning plays an important role in the success of the surgery and it needs to be discussed with other team members before the patient arrive. For transferring patient extra persons or devices need to be arrange.Proper planning between nurses , surgeon .and anesthetics prevents delay of surgery.

2)Type 1 diabetes mellitus.It is a nearly absolute deficiency of insulin(primary beta cell destruction).Wound debrdement is for treating the wound of the skin and the patient should be placed in supine postion in thr OR table.

3)This patient needs immediateattention because his trauma score is 3 .First do the primary survey that is assement of airway,breathing and circulatio.Resitute the patient if needed once the airway and breathing are stabilized monitor for the circulatory system.Followed by primary survey complete the secondary survey which includes head to toe assessment including seriousness of injury ,cjheck vital signs based on this survey provide supplemental oxygen ,control hemorrahge , replaced blood and fluids .Monitor for any hemorrhagic shock syndrome.