Question

PN 200 Fundamentals of Nursing II Concept Map - Care of the Operative Patient A health 14-year-old boy, Robert Kipling, is admitted to the emergency room. Approximately four (4) hours ago, he was rollerblading and fell while jumping over some obstacles. His left arm was caught under him as he fell. He had a very sudden sharp pain in his LUO immediately after the fall. The pain "eased off "gradually, but now is returning. His mother brought him to the emergency room because he fainted every time he tried to stand up. He C/O nausea and vomiting twice, Robert appears somewhat pale and slightly diaphoretic. He denies shortness of breath or dizzy when lying down. VS are 104/52, (supine) P. 92, R. 24 and afebrile. 1. List the key symptoms Robert is presenting with The local emergency room is a Level 2 and cannot appropriately care for the patient. The patient is transported to your emergency department which is five (5) miles away. You are the nurse receiving the patient. 2. State what your first step would be. Robert does not have complaints of dizziness, shortness of breath or nausea or vomiting while lying down. A CT scan is completed revealing a ruptured spleen. He needs to have surgery immediately. 3. Identify additional information that is required prior to sending the patient to the operating room 4. List the laboratory tests that need to be completed before the patient is taken to the operating room Robert is taken to the operating room and undergoes an exploratory laparotomy and a splenorrhaphy 5. State why a splenorrhaphy rather than a splenectomy would be done. Robert is 14 years old and heals rapidly. He is discharged home on the 5" postoperative day after having his sutures removed. 6. State five (5) factors that were in favor of his wound healing quickly. Reviewed 10/19

Answer 1

1.The key symptoms presented by the patient are

• Pain in left upper quadrant of abdomen
• Fainting or dizziness
• Nausea and vomiting
• pale
• diaphoretic
• Hypotensive

2.The first step here while transporting the patient is to increase his blood pressure to normal

3.The additional information required prior to sending the patient to operating room are

• Vaccination:because any damage to the spleen pits one at risk of infection
• Any congenital bleeding problems
• Any allergy to drugs
• His weight and height to be measured, to give the right dose of anesthesia

4.The laboratory test needed are

• HIV,HCV,HbsAg (infectious diseases)
• CBC(hemoglobin level, to arrange for blood if needed)
• Clotting factor(to assess risk of bleeding)
• ECG(hearts ability)
• chest Xray (to assess injury and its abnormality