Question

Scenario: You are working on the postoperative surgical unit and admitted Mrs. X, a 58-year-old client with a history of obesity, hypertension, hypothyroid and sleep apnea. Mrs. X who lives independently at home falls and sustains a fractured right hip. The client will have an open reduction and internal fixation (ORIF) of the right hip this afternoon. Her preoperative weight was 190 pounds (86 kg), and she is 5 feet, 5 inches (165 cm) tall. Current Home Medications: Toprol 50 mg daily, Levothyroxine 0.137 mcg daily

1. Identify 3 factors creating risks for Mrs. X undergoing surgery.

2. What will you include in your pre-op teaching? (3 priority topics)

3. In preparing the room for Mrs. X’s admission, what equipment would you ensure is in place to eliminate embarrassment and promote patient safety? Explain your rationale.

4. You receive Mrs. X from the recovery room. How will you focus your initial assessment, and why?

Answer 1

1. Identify 3 risk factors for Mrs. X undergoing surgery.

Answer:

1. History of sleep apnea disorder is itself an important risk factor. Performing surgeries under general anesthesia in such patients increases the risk of upper airway collapsibility and so the postoperative complications.
2. Hypertension and obesity: It is observed that with an increase in obesity there is an increase in sleep apnea episodes.
3. Hypothyroidism

Hypertension, obesity, hypothyroidism are associated with Sleep apnea disorder. During episodes of sleep apnea disorder, blood pressure increases with an increase in the activity of the sympathetic nervous system. Increasing age, obesity increases the risk of sleep apnea episodes and risk for developing the disorder.

3. In preparing the room for Mrs. X’s admission, what equipment would you ensure is in place to eliminate embarrassment and promote patient safety? Explain your rationale.



Screening questionnaires such as the Berlin, STOP-BANG, or ASA checklist used preoperatively to evaluate the severity of the patient. Depending on the severity, duration of surgery, anesthesia, and other surgical procedure planned. Sedation, anesthesia, opioids are used cautiously.

Perioperative interventions to improve oxygenation are as follows:

• CPAP (Continuous Positive Airway Pressure)  acts as a pneumatic splint. It improves functional residual capacity (FRC) and oxygenation with a reduction in work of breathing.
• Maintainance of positive end-expiratory pressure (PEEP), and the vital capacity maneuver, high tidal volume.