Question

Perioperative Care

Patient Profile

E.G., a 74-year-old, African American, retired college professor, has just undergone surgery for a fractured hip. He fell off a ladder while painting his house. E.G.'s medical history includes type 2 diabetes and COPD. The surgery, performed while the patient was under general anesthesia, lasted 3 hours.

Subjective Data

• Active walker in his home community
• Smokes 1 pack of cigarettes per day × 58 years
• Always had problems sleeping
• Difficulty hearing, wears hearing aid
• Upset with injury and its impact on life
• Is a widower and has no relatives nearby or friends to assist with care
• Reports pain is 8 on a 0 to 10 scale on arrival to PACU

Objective Data

• Admitted to PACU with abduction pillow between his legs, one peripheral IV catheter, a self-suction drain from the hip dressing, an indwelling urinary catheter
• O₂ saturation 91% on 40% O₂ face mask

Interprofessional Care

Postoperative Orders

• Vital signs per PACU routine
• Capillary blood glucose level on arrival and every 4 hours. Call for blood glucose level <70 mg/dL or >250 mg/dL. Follow agency guidelines for management of hypoglycemia.
• 0.45 normal saline at 100 mL/hr
• Morphine via patient-controlled analgesia 1 mg q10min (20 mg max in 4 hr) for pain
• Advance diet as tolerated
• Incentive spirometry q1hr × 10 while awake
• O₂ therapy to keep O₂ saturation >90%
• Respiratory: Albuterol 2.5 mg via nebulizer every 4 hours PRN for wheezing
• Neurovascular checks q1hr × 4 hr
• Empty and measure self-suction drain every shift
• Strict intake and output

Discussion Questions

1. How can you determine when E.G. is sufficiently recovered from general anesthesia to be discharged to the clinical unit?
2. What potential postoperative problems on the clinical unit might you expect?
3. What are risk factors for this patient developing postoperative delirium? What are the signs and symptoms of delirium?
4. Why is drug toxicity a potential problem for E.G.?

Answer 1

1. Nurse continuously monitor the E.G heart rate and breathing functions also regularly check all vital signs , pulse rate, B.P, temperature, respiratory rates etc when all comes into normal state then E.G is fit to shift in clinical unit. And also the recovery condition depends on the surgery it will take 2-3 hours to 24 hours.

2. The patient has higher chances of infection, septicemia, blood clot, dislocation and change in length of leg.

3. Patient having 70+ age high chances of risk factors:

· Also he is having hearing impairment is a risk factor.

· Also he is suffering from COPD and diabetes contributes major part in risk factor.

· And how much blood and fluid loss from the body is also a major factor.

· The dosage of analgesic giving for pain relief is also a risk factor.

· Low postoperative hematocrit count is also risky.

Sign and symptoms

· Disturbed attention and awareness

· Fragmented sleep

· Memory impairment

· Frontal release signs

· Abnormalities of language

4. Drug toxicity is happened when over doses of drugs given to a patient. The drug toxicity in case of E.G is depends upon the various factors like his age, diseases and also he is a chronic smoker so adverse reaction of drug would be happened if it is also given in correct quantity.