Question

Scenario It is 1130 and M.N., age 65, is being admitted to your surgical floor after having undergone an open cholecystectomy for acute cholecystitis. She has a nasogastric tube to continuous low wall suction, one peripheral intravenous (IV) line, and a large abdominal dressing. Her orders are as follows. Chart View Physician's Orders Clear liquid diet; progress low-fat diet as tolerated D5 ½ NS with 40 mEq KCl at 125 mL/hr Turn, cough, and deep breathe q2h Incentive spirometer q2h while awake Oxygen per protocol to maintain Spo2 at 95% Dangle in am Morphine sulfate 10 mg IM q4h prn for pain Ampicillin (Omnipen) 2 g IVPB q6h Chest x-ray in am 1. Are these orders appropriate for M.N.? State your rationale. Case Study Progress At 1530, the nursing assistive personnel (NAP) reports the following: Chart View Vital Signs Blood pressure 148/82 mm Hg Heart rate 118 beats/min Respiratory rate 24 breaths/min Temperature 101° F (38.3° C) Spo2 92% 2. Based solely on her vital signs, what could be happening with M.N., and why? 3. You go to assess M. N. What do you need to include in your assessment at this time? Case Study Progress Your assessment of M.N. finds her with decreased breath sounds and crackles in the right base posteriorly. Her right middle and lower lobes percuss slightly dull. She splints her right side when attempting to take a deep breath. Her skin is pale, warm, and dry. She does not have a productive cough, chest pain, or any anxiety. 4. What complication do you suspect M.N. is experiencing? State your rationale. 5. Why is M.N. at risk for developing this complication? 6. What is your nursing priority at this time? 7. Describe six interventions you will perform over the next few hours based on this priority. 8. To promote optimal oxygenation with M.N., which action(s) could you delegate to the NAP? Select all that apply. a. Reminding M.N. to cough and deep breathe b. Instructing M.N. on the use of incentive spirometry c. Assisting M.N. in getting up to the chair d. Taking M.N.’s temperature and reporting elevations e. Encouraging M.N. to splint the incision f. Auscultating M.N.’s lung sounds 9. Identify three outcomes that you expect for M.N. as a result oScenario It is 1130 and M.N., age 65, is being admitted to your surgical floor after having undergone an open cholecystectomy for acute cholecystitis. She has a nasogastric tube to continuous low wall suction, one peripheral intravenous (IV) line, and a large abdominal dressing. Her orders are as follows. Chart View Physician's Orders Clear liquid diet; progress low-fat diet as tolerated D5 ½ NS with 40 mEq KCl at 125 mL/hr Turn, cough, and deep breathe q2h Incentive spirometer q2h while awake Oxygen per protocol to maintain Spo2 at 95% Dangle in am Morphine sulfate 10 mg IM q4h prn for pain Ampicillin (Omnipen) 2 g IVPB q6h Chest x-ray in am 1. Are these orders appropriate for M.N.? State your rationale. Case Study Progress At 1530, the nursing assistive personnel (NAP) reports the following: Chart View Vital Signs Blood pressure 148/82 mm Hg Heart rate 118 beats/min Respiratory rate 24 breaths/min Temperature 101° F (38.3° C) Spo2 92% 2. Based solely on her vital signs, what could be happening with M.N., and why? 3. You go to assess M. N. What do you need to include in your assessment at this time? Case Study Progress Your assessment of M.N. finds her with decreased breath sounds and crackles in the right base posteriorly. Her right middle and lower lobes percuss slightly dull. She splints her right side when attempting to take a deep breath. Her skin is pale, warm, and dry. She does not have a productive cough, chest pain, or any anxiety. 4. What complication do you suspect M.N. is experiencing? State your rationale. 5. Why is M.N. at risk for developing this complication? 6. What is your nursing priority at this time? 7. Describe six interventions you will perform over the next few hours based on this priority. 8. To promote optimal oxygenation with M.N., which action(s) could you delegate to the NAP? Select all that apply. a. Reminding M.N. to cough and deep breathe b. Instructing M.N. on the use of incentive spirometry c. Assisting M.N. in getting up to the chair d. Taking M.N.’s temperature and reporting elevations e. Encouraging M.N. to splint the incision f. Auscultating M.N.’s lung sounds 9. Identify three outcomes that you expect for M.N. as a result oScenario It is 1130 and M.N., age 65, is being admitted to your surgical floor after having undergone an open cholecystectomy for acute cholecystitis. She has a nasogastric tube to continuous low wall suction, one peripheral intravenous (IV) line, and a large abdominal dressing. Her orders are as follows. Chart View Physician's Orders Clear liquid diet; progress low-fat diet as tolerated D5 ½ NS with 40 mEq KCl at 125 mL/hr Turn, cough, and deep breathe q2h Incentive spirometer q2h while awake Oxygen per protocol to maintain Spo2 at 95% Dangle in am Morphine sulfate 10 mg IM q4h prn for pain Ampicillin (Omnipen) 2 g IVPB q6h Chest x-ray in am 1. Are these orders appropriate for M.N.? State your rationale. Case Study Progress At 1530, the nursing assistive personnel (NAP) reports the following: Chart View Vital Signs Blood pressure 148/82 mm Hg Heart rate 118 beats/min Respiratory rate 24 breaths/min Temperature 101° F (38.3° C) Spo2 92% 2. Based solely on her vital signs, what could be happening with M.N., and why? 3. You go to assess M. N. What do you need to include in your assessment at this time? Case Study Progress Your assessment of M.N. finds her with decreased breath sounds and crackles in the right base posteriorly. Her right middle and lower lobes percuss slightly dull. She splints her right side when attempting to take a deep breath. Her skin is pale, warm, and dry. She does not have a productive cough, chest pain, or any anxiety. 4. What complication do you suspect M.N. is experiencing? State your rationale. 5. Why is M.N. at risk for developing this complication? 6. What is your nursing priority at this time? 7. Describe six interventions you will perform over the next few hours based on this priority. 8. To promote optimal oxygenation with M.N., which action(s) could you delegate to the NAP? Select all that apply. a. Reminding M.N. to cough and deep breathe b. Instructing M.N. on the use of incentive spirometry c. Assisting M.N. in getting up to the chair d. Taking M.N.’s temperature and reporting elevations e. Encouraging M.N. to splint the incision f. Auscultating M.N.’s lung sounds 9. Identify three outcomes that you expect for M.N. as a result oScenario It is 1130 and M.N., age 65, is being admitted to your surgical floor after having undergone an open cholecystectomy for acute cholecystitis. She has a nasogastric tube to continuous low wall suction, one peripheral intravenous (IV) line, and a large abdominal dressing. Her orders are as follows. Chart View Physician's Orders Clear liquid diet; progress low-fat diet as tolerated D5 ½ NS with 40 mEq KCl at 125 mL/hr Turn, cough, and deep breathe q2h Incentive spirometer q2h while awake Oxygen per protocol to maintain Spo2 at 95% Dangle in am Morphine sulfate 10 mg IM q4h prn for pain Ampicillin (Omnipen) 2 g IVPB q6h Chest x-ray in am 1. Are these orders appropriate for M.N.? State your rationale. Case Study Progress At 1530, the nursing assistive personnel (NAP) reports the following: Chart View Vital Signs Blood pressure 148/82 mm Hg Heart rate 118 beats/min Respiratory rate 24 breaths/min Temperature 101° F (38.3° C) Spo2 92% 2. Based solely on her vital signs, what could be happening with M.N., and why? 3. You go to assess M. N. What do you need to include in your assessment at this time? Case Study Progress Your assessment of M.N. finds her with decreased breath sounds and crackles in the right base posteriorly. Her right middle and lower lobes percuss slightly dull. She splints her right side when attempting to take a deep breath. Her skin is pale, warm, and dry. She does not have a productive cough, chest pain, or any anxiety. 4. What complication do you suspect M.N. is experiencing? State your rationale. 5. Why is M.N. at risk for developing this complication? 6. What is your nursing priority at this time? 7. Describe six interventions you will perform over the next few hours based on this priority. 8. To promote optimal oxygenation with M.N., which action(s) could you delegate to the NAP? Select all that apply. a. Reminding M.N. to cough and deep breathe b. Instructing M.N. on the use of incentive spirometry c. Assisting M.N. in getting up to the chair d. Taking M.N.’s temperature and reporting elevations e. Encouraging M.N. to splint the incision f. Auscultating M.N.’s lung sounds 9. Identify three outcomes that you expect for M.N. as a result of your interventions. Case Study Progress At 1830, the NAP reports the following. Chart View Vital Signs Blood pressure 136/72 mm Hg Heart rate 104 beats/min Respiratory rate 24 breaths/min Temperature 100.6° F (38.1° C) Spo2 93% 10. Has M.N.'s status improved or not? Defend your response. 11. You need to call the physician regarding M.N.'s status. Using SBAR (Situation, Background, Assessment, Recommendation), what would you report to the physician? 12. The physician orders a chest x-ray examination. Afterward, radiology calls with a report, confirming that M.N. has atelectasis. Should this diagnosis change your plan of care for M.N.? 13. If M.N. had pneumonia, what changes might the physician have made to her plan of care? 14. M.N.'s sister questions you, saying, “I don't understand. She came in here with a bad gallbladder. What has happened to her lungs?” How would you respond?f your interventions. Case Study Progress At 1830, the NAP reports the following. Chart View Vital Signs Blood pressure 136/72 mm Hg Heart rate 104 beats/min Respiratory rate 24 breaths/min Temperature 100.6° F (38.1° C) Spo2 93% 10. Has M.N.'s status improved or not? Defend your response. 11. You need to call the physician regarding M.N.'s status. Using SBAR (Situation, Background, Assessment, Recommendation), what would you report to the physician? 12. The physician orders a chest x-ray examination. Afterward, radiology calls with a report, confirming that M.N. has atelectasis. Should this diagnosis change your plan of care for M.N.? 13. If M.N. had pneumonia, what changes might the physician have made to her plan of care? 14. M.N.'s sister questions you, saying, “I don't understand. She came in here with a bad gallbladder. What has happened to her lungs?” How would you respond?f your interventions. Case Study Progress At 1830, the NAP reports the following. Chart View Vital Signs Blood pressure 136/72 mm Hg Heart rate 104 beats/min Respiratory rate 24 breaths/min Temperature 100.6° F (38.1° C) Spo2 93% 10. Has M.N.'s status improved or not? Defend your response. 11. You need to call the physician regarding M.N.'s status. Using SBAR (Situation, Background, Assessment, Recommendation), what would you report to the physician? 12. The physician orders a chest x-ray examination. Afterward, radiology calls with a report, confirming that M.N. has atelectasis. Should this diagnosis change your plan of care for M.N.? 13. If M.N. had pneumonia, what changes might the physician have made to her plan of care? 14. M.N.'s sister questions you, saying, “I don't understand. She came in here with a bad gallbladder. What has happened to her lungs?” How would you respond?f your interventions. Case Study Progress At 1830, the NAP reports the following. Chart View Vital Signs Blood pressure 136/72 mm Hg Heart rate 104 beats/min Respiratory rate 24 breaths/min Temperature 100.6° F (38.1° C) Spo2 93% 10. Has M.N.'s status improved or not? Defend your response. 11. You need to call the physician regarding M.N.'s status. Using SBAR (Situation, Background, Assessment, Recommendation), what would you report to the physician? 12. The physician orders a chest x-ray examination. Afterward, radiology calls with a report, confirming that M.N. has atelectasis. Should this diagnosis change your plan of care for M.N.? 13. If M.N. had pneumonia, what changes might the physician have made to her plan of care? 14. M.N.'s sister questions you, saying, “I don't understand. She came in here with a bad gallbladder. What has happened to her lungs?” How would you respond?

Answer 1

M.N. (in this case) is a patient with acute cholecystitis. He has undergone open cholecystectomy. The mentioned physician's orers are appropriate and its rationale is mentioned below.

Gall bladder is the storage site for bile juice. Bile plays a critical role in the breakdown of fats. So, it is necessary to follow a low fat diet because the bile juice which used to be stored in the gall bladder gets dripped down continuosly to the small intestine. This can resute into discomfort after meals that are especially high in fats. Bile also becomes less concentrated, which produces a laxative effect and can cause diarrhea.

Generally after a major operation, patient tents to be dehydrated. Dehydration may result from pre-operative prolonged fasting duration, loss of fluid and blood intra-operatively and so on. As a result, rehydration is necessary. For this, D5 1/2 NS (normal saline) with 40 mEq (milliequivalents) KCI(potassium chloride) at 125 mL/hr (milliter per hour) can be provided.

To turn, cough and deep breathe helps in resolving the post-operative pulmonary complications one may suffer. there exercises help in mediating free passage of the airways, thereby helping in easy breathing.

IS (incentive spirometry) includes the use of a device called the incentive spirometer, that helps improving the function of hte lungs. Patients who underwent any type of surgery that could jeopardize the functioning of the respiratory system are provided with the device.

Ambulation and Dagling help in maintaining muscle strength, tone and flexibility of joints. It stimulates circulatory, respiratory and the gastrointestinals system in functioning properly.

Ampicillin is an antibiotic used commonly for treatment of control of bacterial infections. It is found in the form of injectable powder or oral capsule. Morphine is a narcotic drug obtained from opim. It is used to treat pain. It directly acts on the central nervous system and thereby decreases the feel of pain. It is found in the form of oral capsule. So, administering these medicines post-operatively is necessary.

Development of post-operative pulmonary complicaitons is frequent in patients undergoing major abdominal surgery. So, keeping track of the respiratory status through chest X-ray helps in preventing further complications.