Question

The client is a 98-year-old female, admitted to the ER as a result of falling down her stairs. She has been diagnosed with rheumatoid arthritis, a fractured hip and a sprained arm. She has been moved to the ICU and will have a total hip replacement tomorrow. Lorazepam 1mg IV times one dose has been ordered.

• Describe the four elements of the pre-operative check list: identify the nurse’s priority assessments, diagnostics, and anticipated medical orders?
• What potential complications does the nurse need to assess before and after giving the Lorazepam?  
  • If Lorazepam comes in 2mg/1ml, how many ml does the nurse need to administer?  
• Your client is now post-op and has an order for an anticoagulant. The order is for Enoxaparin 40mg BID. Provide the rational for using this medication versus Heparin?
• Describe postoperative priority assessments for your client given her age, surgery and history.
• Discuss any nonpharmacological treatments that can be used instead of narcotic pain medications and identify if there are any contraindications given the client’s comorbidities.

Answer 1

Preoperarative check list for the patient,

1,Check the consent form for the patient

Arrange the blood for transfussion if needed

Immobilise the patient for preventing further injury

Nill per oral for the preperation of the anasthhesia

Proper analgesia should be accessed

Diagnostic evaluations llike complete blood count,pt inr, screening like hiv,hbsag,hcv,C reactive protien,ESR should be perform.

Before administer lorazepam we should access the potential complications like airway obstruction, respiratiory distress and apnea.

In the above prescription 1mg/iv the nurse should administer 0.5 ml/iv

Some of the medications rheumatoid arthritis medications causes blood coagulation,after hip replacement surgery the chances of blood clot formation will be also there so inorder to prevent such complications we will administer the anticoagulants like heparin.

Postoperative assessment for this patient,

• Access the vital signs periodically
• Access the surgical site for the discharges and bleeding
• Access the conciousness and orientation of the patient
• Access for the reflexes especially gag reflex
• Access the position of the patient and change the position of the patient inorder to prevent bedsore

Non pharmacological management for the pain management are, Diversional therapies like listening music,watching TV, using mobile phones etc, hot and cold compress, Diathermies, accupuncture,Massotherapy, transcutaneous nerve stimulation,these all are effective pain management methods the above patient can practice.

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