Question

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

Answer 1

●The potential post anesthesia problems that can be expected in the patient are

• Nausea and vomiting
• Decreased blood pressure

●The priority nursing intervention to prevent this complications are

• Administer oxygen to prevent respiratory complications
• Administer intravenous fluid to raise blood pressure
• Administer antiemetics to prevent nause and vomiting

●The works which can be delegated to unlicensed assistive personnel are

• To monitor vital signs as per routine
• Incentive spirometry to be provided when patient is awake
• Maintain oxygen therapy
• Nebulizer procedure can be delegated

●The factors which can predispose for the condition is the smoking habits of the patient

●Some of the ways to identify the sufficient recovery from the from general anesthesia are

• Maintaining normal oxygen saturation
• Maintaining normal blood pressure ,respiratory rate and rhythm
• Regaining of consciousness
• Regaining of gag reflex
• Orientation to person, place and time

●The potential postoperative problems which can be expected on the clinical unit are

• Infection
• Bleeding
• Fever
• Atelecstasis
• Deep vein thrombosis
• Pulmonary embolism
• Retention of urine

●The risk factor for developing post operative delirium smoking , hearing problems

The signs and symptoms of delirium are

• Confusion
• Disorientation
• Memory impaired
• Restless or aggresive
• Anxiety
• Irrelevant speech

●Drug toxicity can make the patient very high risk for respiratory distress because of COPD.