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 tell. He had a very sudden sharp pain in his LUQ 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. 3. State why a splenorrhaphy rather than a splenectomy would be done. obert is 14 years old and heals rapidly. He is discharged home on the 5th 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

Ans) Nursing Care plan for post operative- Ruptured spleen.

Nursing diagnosis:

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

- Lack of exposure/recall, information misinterpretation

- Unfamiliarity with information resources

Possibly evidenced by:

- Statement of the problem/concerns, misconceptions

- Request for information

- Inappropriate, exaggerated behaviors (e.g., agitated, apathetic, hostile)

- Inaccurate follow-through of instructions/ development of preventable complications

Desired Outcomes:

- Verbalize understanding of disease process/perioperative process and postoperative expectations.

- Correctly perform necessary procedures and explain reasons for the actions.

- Initiate necessary lifestyle changes and participate in treatment regimen.

Nursing Interventions & Rationale:

• Assesspatient’s level of understanding.

- Facilitates planning of preoperative teaching program, identifies content needs.

• Review specific pathology and anticipated surgical procedure.Verify that appropriate consent has been signed.

- Provides knowledge base from which patient can make informed therapy choices and consent for procedure, and presents opportunity to clarify misconceptions.

• Use resource teaching materials, audiovisuals as available.

- Specifically designed materials can facilitate the patient’s learning.

• Implement individualized preoperative teaching program:

Preoperative or postoperative procedures and expectations, urinary and bowel changes, dietary considerations, activity levels/ transfers, respiratory/ cardiovascular exercises; anticipated IV lines and tubes (nasogastric [NG] tubes, drains, and catheters).

- Enhances patient’s understanding or control and can relieve stress related to the unknown or unexpected.

Preoperative instructions: NPO time, shower or skin preparation, which routine medications to take and hold, prophylactic antibiotics, or anticoagulants, anesthesia premedication.

- Helps reduce the possibility of postoperative complications and promotes a rapid return to normal body function. Note: In some instances, liquids and medications are allowed up to 2 hr before scheduled procedure.

Intraoperative patient safety: not crossing legs during procedures performed under local or light anesthesia.

- Reduced risk of complications or untoward outcomes, such as injury to the peroneal and tibial nerves with postoperative pain in the calves and feet.

• Expected or transient reactions (low backache, localized numbness and reddening or skin indentations).

- Minor effects of immobilization and positioning should resolve in 24 hr. If they persist, medical evaluation is required.

• Inform patient or SO about itinerary, physician/SO communications. Logistical information about operating room (OR) schedule and locations (recovery room, postoperative room assignment), as well as where and when the surgeon will communicate with SO relieves stress and mis-communications, preventing confusion and doubt over patient’s well-being.

• Discuss individual postoperative pain management plan. Identify misconceptions patient may have and provide appropriate information.

- Increases likelihood of successful pain management. Some patients may expect to be pain-free or fear becoming addicted to narcotic agents.

• Provide opportunity to practice coughing, deep-breathing, and muscular exercises.

- Enhances learning and continuation of activity postoperatively

Positive outcomes:

- Able to understand the post operative care.

- Upates information & monitors for any complications.

Negative outcomes:

- Doubts

- Lack of understanding

- Lack of responding to appropriately

Evaluation:

- The patient is able to verbalize/demonstrate appropriate post operative care.