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. 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?
2. Before administration of pre-op medication, what nursing actions should be done?
3. What side effects can you assess for in the administration of pre-op meds?
4. Discuss the importance of the World Health Organization Surgical Checklist in preventing errors during surgery.

Answer 1

●The preoperative teaching to be given to the patient are

• Informing about the type of surgery and its indication
• The will be kept NBM for at lo east 12 hours
• High fiber diet to be followed for 1 to 2 days before surgery
• Laxatives will be provided to empty the bowel ,this can reduce the rate of infection in abdomen after surgery
• Medication as per order before surgery
• To sign the informed consent

●Monitor the patient's blood pressure and pulse rate because Dilaudid can alter the cardiac function

Insert IV line and administer antibiotics

Check the blood glucose as per order preoperative

●The side effects of the pre operative drugs are

• Assess for the intensity of pain
• Alteration in respiratory rate,blood pressure and pulse
• Increased bowel movements
• Mental changes

●This has greatly reduced the number of mortality and morbidity .Thus is categorized into three namely preanesthesia,before skin incision and the patient before leaving the operation room.To reduce the Disability Adjusted Life Years.To prevent infection ,reducecpost operative complications.