Question

Susan Lee is a 60 year old female admitted to the medical surgical floor complaining of abdominal pain on and off for 4 months. Her complaints were constipation, bloating, abdominal pain and indigestion. Her CT scan diagnosed an abdominal mass. Susan’s past medical history includes COPD, Diabetes type 1, and vascular issues. Her medications include the following:

• Prednisone 10 mg daily
• Insulin glargine (lantus) 20 units at bedtime
• ASA 81 mg daily.

Her assessment includes the following:

Objective:

• Height : 64 inches
• Weight : 180 lbs
• VS: BP 138/ 88, 86-20- 97.3
• Lungs clear with occasional expiratory wheezes
• Heart regular, positive pedal pulse, weak on left leg, feet cool to touch
• Abdominal sounds present in all 4 quad, distended and tender to touch
• Voiding clear yellow urine without difficulty
• Allergies, seasonal, betadine

Subjective:

• “I am here for the pain in my belly.”
• “I hope it is nothing major.”
• “I usually have my sugar under control.”
• “I do get short of breath at times.”
• “I hope I am not laid up too long, so my husband doesn’t have to do everything.”
• “My husband recently had shoulder surgery and needs some assistance with ADL’s.”

Susan is scheduled for an exploratory Laparotomy at 0700 tomorrow. Susan’s pre-op orders include the following:

• NPO after midnight
• Labs at 4 am: CBC, complete metabolic panel, type and cross-match, blood sugar on call to OR
• IV: NS at 50 ml/hr
• Have patient wash with Phisohex scrub at 9pm the night before surgery
• Consult pulmonary medicine regarding COPD
• Pre-op medications: Albuterol nebulizer on call to OR, Ancef 1 gm IV on call to OR, Dilaudid 0.5 mg IV push on call to OR
• Have consent signed for the procedure and understanding of all it includes.

Answer the following questions:

1. Which orders should the nurse question?
2. How could Susan’s medical history affect the perioperative period?
3. How does Susan’s home medications put her at higher surgical risk?
4. Based on the subjective data, identify 2 nursing diagnoses to address the psychosocial needs of Susan.
5. As the nurse, you are going to complete Susan’s preoperative teaching. Based upon what you may know of an exploratory laparotomy, what preoperative teaching will you include?
6. Before administration of pre-op medication, what nursing actions should be done?
7. What side effects can you assess for in the administration of pre-op meds?
8. Discuss the importance of the World Health Organization Surgical Checklist in preventing errors during surgery.

Answer 1

●The nurse should question for doing the lab orders at 4am ,as the patient is scuedulfor surgery at 7am it can be difficult to get the complete blood panel on time and to cross match keep blood reserved for surgery. These investigations probably should be done a day in advance to avoid errors and hurrying at tte last moment.

●Susan's medical history of vascular issues can risk her for bleeding or any blood vessels issues during the time of surgery .COPD cam alter the respiratory status risking her for respiratory distress during surgery

●The use of prednisone can increase the blood glucose level, more over she is diabetic. This makes her at risk for slow wound healing after surgery

●The nursing diagnosis for her psychosocial needs are

• Anxiety related to the disease condition as evidenced by expressing fear,inability to take care of her husband
• Ineffective coping mechanism related to surgical intervention as evidenced by verbalisation