Question

• Mr. Bane Ka’uhane is a 66-year-old male admitted to the surgical unit with a diagnosis of abdominal mass. He has been complaining of vague symptoms

for the past 3 months. These symptoms include inter- mittent indigestion, abdominal pain, and constipa- tion. His medical history includes COPD, PVD, and insulin-dependent diabetes mellitus. He takes the following medications at home:

• Prednisone (Sterapred) 10 mg PO daily
• Insulin glargine (Lantus) 24 units SQ at 2200
• Ipratropium (Atrovent) inhaler 2 puffs QID
• ASA (Ecotrin) 81 mg PO daily

The nursing assessment/history done on admission includes the following data:

Objective data:

• Wt/Ht:                        213#          70 inches
• VS:                                 BP 140/88 – 84 – 20 – 97.8
• Lungs:                         clear with intermittent expiratory wheeze

left lower base

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• CV:                                 HR 84 beats/min and regular weak dorsalis pedis pulses bilater- ally, skin warm and dry, feet cool totouch
• GI:                                  Abdomen round, distended, active bowel sounds
• GU:                                Voids adequate amounts of clear yellow urine
• Allergy:                       Betadine Subjective:
• “I’m coming in to find out what’s going on in my belly.”
• “I’m sure it’s something fixable.”
• “I don’t want my wife to worry about me; I am not sure she is going to be able to handle all of this.”
• “I keep my sugar pretty well normal. My breathing problems give me more trouble.”

Mr. Ka’uhane is scheduled for an exploratory laparotomy at 0800 in the morning.

His preoperative orders include:

• Labs: CBC with differential and a comprehensive metabolic panel
• NPO at 0600 and begin IV of 1000 NS at 50 mL/hr
• Prep abdomen with Phisohex scrub ´ 3. Cover abdomen with sterile towel after prep completed
• Have permit signed: I have discussed the surgical procedure/risks/expectations/ outcomes
• Consult Pulmonary Services, re: Respiratory status
• Pre-op medications:
  • Atropine 0.4 mg with Demerol 50 mg IM on call to OR
  • Nembutal 25 mg IM on call to OR

1. In reviewing Mr. Ka’uhane’s orders, which order should be questioned by the nurse?

2. Based on knowledge of his underlying medical problems and risks associated with age, how could theseproblems and risks affect the perioperative experience?

Answer 1

Mr. Bane Ka'uhane is known diabetic , has history of COPD, PVD, now presenting with abdominal complaints for which he is undergoing surgery.

He is on ecotrin 81mg orally once a day everyday. Ecotrin is aspirin which prevents the clot formation thereby preventing stroke and heart related diseases.  

When the person is on aspirin and it's related compounds the surgery is avoided because it results in heavy loss of blood as aspirin is blood thinning drug. Therefore, aspirin is stopped for atleast two weeks before the surgery to avoid complications such as blood loss during operative phase.

Also the person is known case of COPD and on corticosteroids. There is increased risk of respiratory depression and hence care must be taken not to combine the drugs especially sedatives which enhances the risk. During surgery too, preparing for complications such as respiratory depression is important. The blood glucose levels too has to be monitored to prevent hypoglycemia or hyperglycemia.

Thank you.