Fundamentals Perioperative Care Case Study

Preoperative Teaching The nurse talks with Ms. Jackson about what to expect the day of surgery and during the immediate postoperative period. The nurse provides instructions regarding cough and deep breathing exercises. Ms. Jackson performs a return demonstration by breathing in through her mouth deeply and exhaling through pursed lips forcefully and rapidly. 4. What action should the nurse implement? A) Advise the client to avoid pursing her lips when exhaling. B) Remind the client to cough after taking two to three breaths. C) Demonstrate the deep breathing and coughing technique again. D) Document successful completion of the return demonstration.

Immediate Postoperative Care Following surgery, Ms. Jackson is admitted to the Post Anesthesia Care Unit. The operative report indicates that Ms. Jackson had a left hip replacement under general anesthesia. The initial nursing assessment reveals that Ms. Jackson is not responding to verbal stimuli. Her vital signs are T 97.6° F, P 88, R 14, and BP 130/70. 14. What action should the nurse implement first? A) Position the client on her side. B) Observe the surgical dressing. C) Place the call bell within reach. D) Remove the oral airway.

Pharmacologic Calculations When Ms. Jackson arrives on the unit, the nurse notes that her IV is wide open. Review of Ms. Jackson's postoperative prescriptions indicates that 0.9% Normal Saline is to infuse at 75 ml/hour, alternating with Lactated Ringer's solution at 75 ml/hour. An infusion pump is not immediately available, so the nurse notes that the infusion tubing has a drop factor of 10 drops/ml and resets the IV. 16. At what rate should the IV infuse? A) 8 drops per minute. B) 10 drops per minute. C) 13 drops per minute. D) 21 drops per minute.

While the nurse begins to assess the client, another nurse finds an infusion pump and prepares a prescribed \"now\" dose of an intravenous antibiotic. The prescription is for 2 grams of cefazolin (Ancef), which arrives from the pharmacy diluted in 100 ml of normal saline and is to be administered over 30 minutes. 17. At what rate should the infusion pump be set? A) 20 ml/hour. B) 50 ml/hour. C) 100 ml/hour. D) 200 ml/hour.

Postoperative Wound Management During the postoperative assessment, the nurse observes Ms. Jackson's surgical site. The left hip dressing has a moderate amount of sanguineous drainage. 20. What action should the nurse implement? A) Apply pressure to the site. B) Elevate the leg on a pillow. C) Observe the linens under the hip. D) Use sterile technique to replace the dressing.

Ms. Jackson is currently receiving Lactated Ringer's solution IV at a rate of 75 ml/hour. 24. In transfusing the 250 ml unit of packed red blood cells, what action should the nurse implement? A) Stop the IV solution and transfuse the packed cells at 125 ml/hour via tubing connected to a bag of saline solution. B) Infuse the Lactated Ringer's solution through the IV tubing concurrently with the blood at a combined rate of 75 ml/hour. C) Flush the IV tubing with a 5 ml bolus of normal saline before and after the transfusion, and transfuse the blood within 1 hour. D) Replace the Lactated Ringer's solution with the unit of packed red blood cells and administer through the tubing at 75 ml/hour.

Nursing Plan of Care The nurse is assisting Ms. Jackson to the bedside commode on the second postoperative day. Ms. Jackson states, \"I have never had to depend on anyone before. I like to take care of myself. I feel so helpless.\" 25. In response to these remarks, the nurse plans care for Ms. Jackson based on the identification of which nursing diagnosis? A) Disturbed body image. B) Altered self-concept. C) Anticipatory grieving. D) Impaired physical mobility.

Dressing Change After Ms. Jackson ambulates with the physical therapist, the nurse prepares to change the surgical dressing. While obtaining supplies, the nurse reviews the sterile procedure to be followed. 27. At what step in the procedure should the nurse don sterile gloves? A) Prior to removing the dressing on the client's hip. B) Before opening the new sterile dressing package. C) Before cleansing the client's hip incision. D) After cleansing the client's hip incision.

While cleansing the incision, the nurse observes that the staples are intact, but a 2 cm gap has opened at the bottom of the incision. http://biology-forums.com/index.php?topic=109414.0 28. How should the nurse document this finding? A) Bottom edges of incision approximated. B) Small area of dehiscence at bottom of incision. C) Evisceration of incision noted at bottom edge. D) Wound healing via secondary intention.