2/17/2021

Case Study: Perioperative Nursing

Questions:
1. In reviewing Mr. Ka’uhane’s orders, which order should be questioned by the nurse?
❏ The NPO order prior to surgery should be questioned by the nurse. We have to keep in
mind that Mr. Ka’uhane is a diabetic, his blood sugar will go down. All things
considered, he could possibly have more complications than what’s currently presented at
hand. Also, the use of Atropine should be questioned as well, it reduces mucus, salvia, or
within the airway. All and all, it will cause more complications.

2. Based on knowledge of Ka’uhane’s underlying medical problems and risks associated

with age, how could these problems and risks affect the perioperative experience?
❏ Based on an understanding of underlying health disorders of Diabetes Mellitus, COPD,
and PVD, these could harm the effect of perioperative experience by danger for
atelectasis, pneumonia, and problems healing. Reviewing the patient’s case history, vital
signs could also be a concern

3. How might Mr. Ka’uhane’s routine meds place him at a higher surgical risk?
❏ ASA (Ecotrin) can cause seizures , abdomen pain, and GI bleeding. The patient is taking
Prednisone 10mg PO daily. Long term use can decrease the healing time of any wounds.
Due to it being classified as a corticosteroid it suppresses the immune system, this
medication can cause SOB, decrease glucose level, hypertension, and increased
infectious risk.

4. Based on the subjective data, identify the priority nursing diagnosis to meet the
psychosocial needs of Mr. and Mrs. Ka’uhane.
❏ I personally believe Knowledge deficit is the priority nursing diagnosis to meet the
psychosocial needs of Mr. and Mrs. Ka’uhane. Furthermore, Mr. Ka’uhane mentioned
that his wife does not need to be worried about his health. He seems fearful and
unintentionally secretive because he is unsure how his wife will react. The nurse should
highly educate them about the patient's medical condition and surgery. They should be
presented with ways to determine and cope with their anxiety.

5. You are completing pre-operative teaching regarding the routine nursing measures that
Mr. and Mrs. Ka’uhane can expect during the post-operative period. How should you
respond to the following questions? (You may need to review what an exploratory
laparotomy is to help with this answer.)
❏ Exploratory laparotomy is surgery to open up the belly area . This surgery is done
to find the cause of problems that testing could not diagnose. It is also used when
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Case Study: Perioperative Nursing

an abdominal injury needs emergency medical care. This surgery uses one large
cut. Recovery time will vary for each person. It may take as long as 4 to 6 weeks.
Pt should limit activities, daily walks are encouraged, wear loose clothing, take
medications as prescribed.

6. You are completing the pre-operative checklist. What is the last clinical procedure to be
completed before administration of the pre-op medications?
❏ On completing the pre-operative checklist, it’s vital that the client has voided completely
before surgery. It is very essential in the last clinical procedure to be completed before
administration of the pre-op medications. If a person has a bladder full of urine prior to
surgery, he or she might feel discomfort. Also, the nurse should make certain the patient
signed the consent form, and fully understands the surgical procedure. All things
considered, the nurse should use antiembolism stockings for this patient because they
help to prevent emboli and thrombi by compressing superficial veins and capillaries,
redirecting more blood to deeper and larger veins where it’s flow is effective towards the
heart.

7. What physiological effects can you anticipate secondary to the pre-op medications?
❏ The physiological effects I can anticipate secondary to the pre-op medications would be
❏ Respiratory depression because the client is taking Demerol.
❏ Urinary retention.
❏ Dry mouth.
❏ nausea and vomiting, constipation.
❏ Hypotension, blurred vision, and etc.

8.Discuss the importance of the Patient Safety Goals and the World Health Organization’s
(WHO) Surgical Safety Checklist in preventing mistakes in surgery.
❏ Patient safety goals are crucially important in every healthcare setting. In essence, it is
why the World Health Organization (WHO) checklist is in collaboration with patient
safety goals. It's essential to make sure that sterility is maintained in all required
procedures.Vital to have a maintained and clean environment. Surgical sites should be
marked correctly, and the patient is identified using two identifiers. In Addition, the
surgical team communicates properly during the procedure. All these measures prevent
mistakes in surgery.

9. He received general anesthesia throughout the procedure. The PACU nurse should assess for
what frequent complaints related to this type of anesthesia?
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Case Study: Perioperative Nursing

❏ The PACU nurse should monitor for periods of complaints of chills, dry mouth, sore
throat, headache, nausea and vomiting, or confusion after he received general anesthesia.
Because general anesthesia makes an individual unconscious, the client does not feel any
pain or move during surgical procedure.

10. In light of Mr Ka’uhane’s medical history, how might the anesthesia contribute to the
development of post-operative complications?
❏ The anesthesia assists in the development of postoperative complications like
cardiovascular dysfunctions, and development of respiratory dysfunctions. Due to the
fact, Mr. Ka’uhane has a medical history of diabetes mellitus, COPD, and PVD. Since he
is getting anesthesia, it could affect his respiratory tract and might cause infections like
pneumonia. If his condition gets worse, he might become dependent on a ventilator.

11. In reviewing the data above, which data, if any, need to be brought to the attention of the
surgeon?
❏ Patient has absent bowel sounds, which needs to be brought to the attention of the
surgeon. Since he is a postoperative client, bowel movement may take some time.

12. Identify the sites most at risk for pressure compromise secondary to surgical positioning.
❏ The sites most at risk for pressure compromise secondary to surgical positioning would
be Occiput (part of skull bone), scapula (shoulder bone), elbow, sacrum (triangular bone
at spine’s base), heels, and buttocks. In essence, the patient will be in a supine position
most of his time, which explains why he may have complications of back pain.

13. Based on knowledge of client condition and surgical procedure, what is the number one
priority for Mr. Ka’uhane during the post-operative phase of his experience?
❏ Mr. Ka’uhane has COPD in his medical history, that is why airway clearance would be
the utmost priority for him during the post-operative phase of his experience. The
patient's respiratory status should be monitored closely to make sure that he is breathing
effectively, and his oxygen saturation levels at least be equal to 94% or 95%. In addition,
the nurse should make sure to maintain adequate circulation, proper positioning, and
functions of IV infusions, drains, and tubes should be properly cared for. Also, the nurse
should constantly check on his condition. He had general anesthesia, so that puts him at
risk for pulmonary complications like atelectasis and pneumonia.

14. How can nursing help with Mrs. Ka’uhane’s role as facilitator of Mr. Ka’uhane’s recovery?
❏ I believe this is where patient teaching should become very effective, so Mrs and Mr.
Ka’uhane both understand. The nurse will play a role as an educator for the patient. In
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Case Study: Perioperative Nursing

these circumstances, the nurse plays a role to teach Mr. Ka’uhane’s wife and himself
about the surgery of Mr. Ka’uhane’s, his condition to ease her anxiety. The goal is to
educate her so she can take good care of her husband. As well as, promoting Mr.
Ka’uhane to contribute self care for himself during and after recovery. I would also
recommend adhering to his Mr. Ka’uhane’s treatment.
15. The nurse aide taking Mr. Ka’uhane’s vital signs reports to you that Mrs. Ka’uhane is very
upset over how often they are being done and verbalized that “something must be wrong!” How
would you respond to Mrs. Ka’uhane?
❏ First and foremost, vital sign monitoring is vitally important. I would tell Mr. Ka’uhane
that taking vital signs is normal especially in his condition although he is afraid.
Checking vital signs every 15 minutes in the first hour of surgery, also every 30 minutes
in 2 hours is essential after surgery to remain cautious of any complication. If your vital
signs remain stable, the duration of taking vital signs will reduce to every 4 hours for 24
hours.

16. The sequential compression device is in place when you receive Mr. Ka’uhane from
the PACU. How will you check for proper fit to eliminate excess pressure and
overcompression?
❏ To check if the sequential compression device is in place, and properly fitted to eliminate
excess pressure and over compression, two fingers would be placed between Mr.
Ka’uhane legs and sleeves to validate for correct fitting.

17. You note that there is a small amount of drainage on the surgical dressing. The order reads
that it is not to be changed prior to morning rounds. What is the appropriate action in this
situation?
❏ It must be assessed by the Dr. before going any further. I would make an outline of what
the drainage looks like and document it because Dr’s order must be followed. In the
meantime, as the nurse I would just place extra gauzes on top of the surgical dressing. I
would not remove the dressings.

18. You tell your preceptor that you are familiar with the policy of the NG irrigation proce- dure
but that you have never done it. She offers to demonstrate it to you. Before completing this
procedure she checks for bowel sounds and documents active bowel sounds 4 quadrants as
she can hear intermittent rhythmic “whooshing” upon auscultation. Prior to instilling the
irrigant into the nasogastric tube she discon- nects the NG tube from the suction source, pulls up
the ordered amount of NSS and instills it into the tube using the piston action of the syringe.
After this she reconnects the tubing to the suction source telling you, “It’s pretty simple.”
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Case Study: Perioperative Nursing

Critique the steps of the assessment and procedure as you saw it done. What would you do
differently, if anything? Give a rationale.
❏ I notice she did every step correctly. If I could do anything differently, I would make
sure that I have an appropriate size syringe to apply an accurate amount of pressure. In
essence, after irrigation I will unclamp and clamp tubing draining.

19. In using his flow-oriented incentive spirometry Mr. Ka’uhane is proud that he is able to take
brisk low-volume breaths that snap the balls to the top of the chamber. What is the appropriate
response to his use of the IS?
❏ I will acknowledge his accomplishment and encourage him to keep up the good work.
Furthermore, I will say to him that I am glad that you did well, and you are feeling more
comfortable. In essence, I’m glad you are satisfied with your improvement; but keep in
mind that you should inhale deeply and exhale slowly.

20. Based on Mr. Ka’uhane’s history and present assessment data, he is at high risk for which
major post-operative complication(s)? Give a rationale for the choices that you made. Identify
collaborative interventions (interdisciplinary) that can help prevent these complications.
❏

Complication At Risk Rationale Interventions

Aspiration Impaired gas Patient had Suction airway

pneumonia exchange, general secretions.
ineffective anesthesia and elevate the head of the
breathing had a bed periodically.
pattern laparotomy. assist the patient with
deep breathing
techniques.

Atelectasis Impaired gas Because he is Encourage deep

exchange obese. Also, he breathing exercise
has recent techniques. Use an
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Case Study: Perioperative Nursing

surgery. Also, incentive spirometer.

general Also, helps in patient’s
anesthesia ambulation.
affects COPD
patients.

Pneumonia Ineffective He has COPD Breathing exercises such

airway history, old age, as an incentive
clearance, and diabetes. spirometer would help
impaired gas Also, his cough him. Moreover, ambulate
exchange, ability is him by getting up and
ineffective suppressed moving. Assist him with
breathing chest physiotherapy to
pattern loosen his secretions.

Pulmonary Ineffective Because the Administer

embolism peripheral patient had a anticoagulants as
tissue recent surgery prescribed. Keep
perfusion, for a changing client’s
risk for laparotomy. position, high fowler’s
shock, acute Which may position strongly
pain cause recommended.
pulmonary Encourage pursed lip
embolism. Also, breathing and deep
long-drawn-out breathing exercises.
bed rest due to
his
postoperative
phase.
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Case Study: Perioperative Nursing

Thrombophlebitis Altered He is obese and

Elevate his legs when
peripheral in old age.
resting or sitting in a
tissue Inflammatory
chair. Provide adequate
perfusion, process usually
hydration to decrease
acute pain, causes a
hyperviscosity of blood.
anxiety blockage in one
Also, apply mechanical
or more veins
devices such as
especially in
sequential compression
legs.
stockings,
thromboembolic (TED)
stockings as indicated to
prevent thrombophlebitis.

Hypovolemia Risk for Because the Administer IV fluids,

metabolic patient had blood transfusion, assess
acidosis, blood loss blood pressure and
deficient during surgery. perform ECG as per
fluid volume, physician’s order.
ineffective
tissue
perfusion

Hemorrhage Deficient because of his Administer IV fluids as

fluid volume, recent surgery. prescribed. Moreover,
risk for He had a Apply pressure to the site
infection laparotomy. if possible and apply
Chance of bandage or dressings
severe blood
loss is present.
Also, the wound
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Case Study: Perioperative Nursing

healing process
might get
complicated.

Nausea/vomiting Fluid Patients might Avoid strong scents and

imbalance have smells.
and dehydration; monitor temperature of
dehydration medications fluids and room. Offer
being given on ginger or ginger ale to
an empty patient. Also, administer
stomach. antiemetics medications
Common side prescribed by the
effects of physician.
general
anesthesia

Abdominal Pain, Common after Restrict dairy products

distension discomfort, surgery because intake of the patient.
swelling, the abdomen is administer IV fluids
bloating, usually altered
feeling like by surgery.
stomach is Patient went
full, and under
inflammation laparotomy also.

Ileus Abdominal General side Administer IV fluids and

cramps, effects of nasogastric intubation to
bloating, anesthesia. the patient.
nausea, Furthermore,
vomiting and deceleration of
constipation. intestinal
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Case Study: Perioperative Nursing

motility due to
general
anesthesia.

Constipation Decrease in The patient has Assess fluid intake of the

normal taken a client. Offer foods high in
frequency of painkiller like fiber.
defecation, opioids after administer laxatives, or
difficult or surgery, or enemas if prescribed.
incomplete general
passage of anesthesia.
stool Also, decreased
peristalsis due to
zero physical
activity.

Renal failure Acute pain, Because the Assess patient’s input and
impaired patient had outputs, heart rate
renal tissue History of frequently. Also look for
perfusion diabetes any signs or symptoms of
mellitus and edema.
COPD.

Urinary retention Impaired Usually a client Insert urinary catheter.

urinary may experience Offer more fluids,
elimination urinary retention positioned the patient in
and infection after a surgery. an upright position. Urge
Inability of him to void every 3 to 4
bladder hours.
contraction as a
side effect of
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Case Study: Perioperative Nursing

anesthesia.

Urinary tract Impaired He is immobile Keep the catheter patent

infection urinary due to his recent and clean. Moreover, also
elimination surgery, also he look for any signs and
has a urinary symptoms of any
catheter which infections. Take good
prone him to care in maintaining
UTI infection. sterility during catheter
changing.

Dehiscence Infection risk, Because he has Wound edges should be

Impaired recent surgery, reinforced, and bandages
tissue also he has would be applied because
integrity, surgical there is a chance of
incision/open incision separation.
wound Assess the wound for any
changes if it occurs.

Evisceration Risk for Because he has Reapproximate wound.

injury, a laparotomy, he
infection, Is having a
pain dressing on the
wound. That is
why he is at risk
of surgical
incision.

Wound infection Impaired Due to his Keep the wound site

tissue recent surgery. clean.
integrity, He has a wound monitor the wound for
acute pain, which is prone odor, drainage, color,
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Case Study: Perioperative Nursing

risk for to infections. secretions, or size

infection continuously. Maintain
sterile techniques when
changing wound
dressing. Also, monitor
skin around wound for
any irritation or
inflammation