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Answer the 8 questions below
Clinical Judgement
Postoperative Care
Mr. Y (pronouns he/him) is a 79-year-old patient admitted to the surgical unit to undergo partial resection of the ascending colon to remove cancerous nodules. The procedure was longer than anticipated as the colonoscopy demonstrated that the cancerous nodules were more extensive than expected. This is attributable to insufficient preparation of the colon prior to the colonoscopy. Mr. Y is extubated and transferred to the PACU.
Medical history
Hypertension
Left ventricle inferior wall MI X 10 years ago
Heart failure
Medications
Metoprolol 50mg BID
Lisinopril 20mg OD
Furosemide 40mg BID
Assessment
On arrival to the PACU vital signs are as follows:
T 32 C
P 72 bpm
BP 90/55 mmHg
RR 16
O2 sat. 89%
Upon awakening the patient is confused and disoriented to person, place and time. He has no family members available to support him (spouse deceased and daughter unable to get time off work today). Mr. Y needs frequent reminders to reorient him. He attempts to pull his dressing off and states that he “needs to leave to play cards with his friends”. Mr. Y requires wrist restraints to prevent him from disrupting the surgical site.
Questions
1) What is the primary focus during the initial assessment of a postoperative patient?
2) What key assessment findings for this patient indicate an emergency and require immediate intervention?
3) Evaluate the temperature for this patient and discuss its assessment, severity, contributing factors and management.
4) Consider the cognitive function of this patient. Describe the neurological assessment including the utilization of a validated tool and assocociated interventions.
5) Consider the cardiac history and current vital signs of this patient. Discuss important monitoring and interventions needed for this patient.
After 30 minutes of observation in the PACU the nurse notes that the urine output in the foley catheter is only 7 ml and dark yellow in color. The nurse notifies the physician who orders a fluid challenge of 100 ml.
After three hours of observation in the PACU the patient is transferred to the inpatient surgical unit. Vital signs are as follows: T 35 C, BP 115/68mmHg, P 72 bpm, RR 18, O2 sat. 95%. Patient is able to deep breath and cough provided he is given instructions and a blanket to hold to surgical area. Urine output totals 30ml since the end of surgery. The patient is rousable and remains asleep when not stimulated.
6) Based on the PADS or the Modified Aldrete score is this patient ready for discharge to the inpatient unit? Provide rationale.
7) How should nurses assess the surgical site in the postoperative period, and what signs indicate a potential infection?
8) Identify key priority areas for the patient prior to discharge home. What should the nurse include as part of discharge planning and education?
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