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. What are the potential postanesthesia problems that you may expect with E.G.?
2. Priority Decision: What priority nursing interventions would be appropriate to prevent these problems from occurring?
3. Teamwork and Collaboration: Which of these interventions could you delegate to unlicensed assistive personnel (UAP)?
4. What factors may predispose E.G. to the following problems: atelectasis, infection, pulmonary embolism, nausea and vomiting?

Answer 1

1)potenetial post anesthesia problems:

• nausea and vomiting
• hyperglycemia and hypoglycemia
• Hypotension and hypertension
• chance of infection , hematoma and bleeding from surgical site
• Pain
• Deep vein thrombosis
• sore throat and laryngeal damage
• Respiratosy deprresion
• Atelectasisis,pulmonay infection,and respiratory failure
• Anxiety

2)PriorityNursing interventions:

• Provide comfortable position with head elevation
• Monitor the vitals parameters including oxygen saturation
• Blood glucose monitroring
• Asess the pain level
• Bronchodilators and nebulizations to prevent COPD complications
• Asess the nutrional level and give adequate fluid therapy to prevent dehydration
• wathch for respiratory deppression deu to the sedations and analgesics (morphine)
• antiemetics for nausea and vomitig
• Antibiotic therapy for infection prevention
• check the surgical site for any sign of oozing or swelling
• Check the drain bag for any clott formation and proper draing of waste blood.
• Encourage for deep breathing exercie
• Give psuchological support
• consider anticoagulant agent to prevent DVT as per the doctors order

4)Prediposeing factors :

Atelectasis - COPD and general anaesthesia

pulmonary embolism - surgery, prolonged bed rest due to surgerical intervetion,

Infection - age ,prolonged operative time,diabetes mellitus , low nutrional status,presence of drain

Nausea and vomiting - Age , smoking status, anesthesia,anxiety, adverse drug reactions