PNR201 Perioperative Case Study 10202020 PDF

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Case study perioperative care...

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PNR201 Perioperative Nursing Care Case study

Case Study 1: You are caring for a Spanish-speaking client who had surgery yesterday for a bowel obstruction. The client has intravenous (IV) fluids infusing and a nasogastric (NG) tube is in place, and the client is receiving medication via a patient-controlled analgesia pump for pain management.

List and prioritize six specific nursing interventions the nurse needs to perform when caring for this client. In addition, describe your rationale for order of priority. 1. Airway, breathing, circulation 2. Pain management 3. PCA pump 4. Abdominal assessment (distention) 5. NG tube insertion (aspiration and nutrition) 6. Intake and out put The nurse needs to perform vital signs every 2-4 hours to monitor the patient airway, breathing circulation. Listening to lungs sounds, checking oxygen saturation, and listening for heart sounds can alert the nurse if there is anything wrong with the patient airway and circulation. Next the nurse should perform an abdominal assessment to check for bowel movements and check for distention. The nurse should record the nasogastric tube drainage at least every 2 hours and to check for aspiration. The nurse is responsible to monitor the patient pain since the patient came out of surgery. The nurse can check on the patient to make sure their pain is being relieved by the PCA pump by assessing their pain level from 0 to 10 every 2 to3 hour and looking for cue for nonverbal behaviors by the patient showing pain. The nurse should check the patient IV every 1 to 2 hour and record IV fluids. Lastly the nurse should monitor the patient intake and output because the patient has nasogastric tube inserted. It is to make sure the patient is hydrated and not losing important electrolytes.

Copyright © 2016 by Elsevier Inc.

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Case Study 2: An elderly client who lives independently at home falls and sustains a fractured right hip. The client has an open reduction and internal fixation of the right hip. What postoperative complications is this client at most risk for experiencing? What is the physiological basis for the development of each complication?

Postoperative complications the client is at most for experiencing are pneumonia (hypostatic, aspiration or bacterial), wound infection, and atelectasis. Pneumonia is one of the important risks that affects patient breathing problem after surgery. As fluid and secretions can settle and pool in the lungs, the alveoli can become inflamed and infected. It is a priority to maintain patients airway and breathing to promote oxygenation and ventilation. The effects of anesthesia on the lungs, and the patient being in one position for the duration of surgery can affect the patient breathing pattern when coming out of surgery. Atelectasis may happen after anesthesia because it changes the patient breathing pattern and affects the exchange of lung gases. The nurse should encourage deep breathing and coughing every 2 hours, encourage the use of incentive spirometer and early ambulation to prevent pneumonia and atelectasis. Wound infection can occur after any surgical procedure due to poor aseptic technique or the wound has been contaminated before surgery. Wound infection would develop 2 to 7 days after surgery, by then the patient may be at home when the infection become more apparent. The nurse should monitor the patient white blood cell count to make sure there is no signs of infection. The nurse should use aseptic technique when cleaning patient wound and educate patient on proper nutrition for wound healing. The patient is also at risk for bleeding (due to surgical site and incision in that area), impaired gas exchange(due to anesthesia on the lungs), risk for electrolytes imbalance( due to having NPO and not able to receive proper nutrients) and she has potential for injury because of lack of movement on lower extremities.

Copyright © 2016 by Elsevier Inc....