Question

1. You are a nurse preparing to receive a new patient, fresh from surgery, to your unit. The patient is a 71-year-old man who underwent a surgical repair of a fractured femur. As you receive a report from the postanesthesia recovery unit, you learn that his medical history includes hypertension, 40 pack-years of smoking, and COPD. His surgical repair was successful but complicated by excessive bleeding, and he is receiving IV fluids to compensate. He is widowed, and his three children are scattered throughout the United States. He lives alone, receives Meals on Wheels, and pays a cleaning service to keep his home clean. (Learning Objective #6)
   1. What data in this scenario are pertinent?
   2. What potential collaborative problem(s) could be applicable in this situation?
   3. Which nursing diagnoses would you expect to be applicable regarding the medical procedures in this situation?
   4. Which nursing diagnoses would you expect to be applicable regarding the nursing/medical history in this situation?
   5. Which nursing diagnoses would you expect to be applicable regarding the discharge planning in this situation?

Answer 1

Answer:

a. COPD is usually caused by smoking. The COPD increases the chances of surgical complications, such as infections and respiratory crises. The survival rate is lower in patients with COPD than others after surgery. Hypertensive patients are high risk category for surgery. Because the amount of IV fluids administered during surgery can elevate the blood pressure. It is a risk factor for cardiovascular problems.

The hypertension increases the risk for heavy bleeding after surgery.

b. Excessive bledding after surgery is the potential problem. The minor bleeding after surgery is common. But the heavy bleeding may leads to hypovolemic shock. The patients have the history of hypertension, smoking and COPD. So here the blood circulation is compromised.Hence it aggrevates the complications.

Hpertensive crisis is also a potential problem after surgery. It may cause rebound hypertension.

c. Fluid volume deficit related to excessive bleeding as evidenced by capillary refill greater than 3 seconds.

The excessive blood reduces the fluid volume. If not treated adequately on time it will cause hypovolemic shock.

d. Ineffective tissue perfusion related to increased blood pressure, breathing difficulty and excessive blood loss as evidenced by delayed capillary refill.

The excessive blood loss and COPD causes poor oxygen supply to the tissues.

e. Risk for infection related to surgical procedure.

After discharge take appropriate precautions to prevent the risk for infection. Bacause the infection is a major complication occurs while returns to home after surgery