Wounds, Meds and Complex Care in Nursing Practice
1. The preoperative checklist on what needs to be done to take care of a patient can be found on the patient’s chart, usually under the doctor’s orders and/or the patient’s notes. 2. The National Institute for Clinical Excellence recommends that blood tests should be taken prior to having a surgery regardless of patient’s healthy condition, unless contraindicated. This is done to provide information about conditions that could affect the treatment that a patient would need (Lab Tests Online, 2004).
Blood tests to be included in this routine preoperative testing are a full blood count, blood clotting tests, blood typing, blood gasses, blood glucose, and a sickle cell test (Lab Tests Online, 2004). A full blood count will measure haemoglobin and the number of other types of cells in the blood (Lab Tests Online, 2004). Blood typing is for blood transfusion, in case needed. Blood clotting test to determine if blood clots normally and how long it takes to clot (Lab Tests Online, 2004). Blood gasses, measures the amount of oxygen and carbon dioxide in the blood, as well as its acidity, and blood glucose to check for diabetes.
Sickle cell testing if the patient has risk factors. 3. The registered nurse is responsible for reporting any discrepancies in the lab results of the patient to the physician in charge. 4. Preoperative education should include orienting the patient with the surgery that she is going to go through. Ask what she understood from the physician and answer her questions for further clarification. Afterwards, explain the patient what to expect during her recovery period, and what are her postoperative exercises.
Also, enlighten the patient on the risks of post-op recovery like pulmonary embolus, DVT and UTI, and the possible ways on how to avoid these, through deep breathing exercises and wearing of anti-embolic stockings (University of South Australia, 2000). Finally, inform her of what other procedures are to be done after the surgery, for example, utilization of catheters and IV therapy. 5. A preoperative shower employs the use of a 2% chlorhexidine gluconate polyester cloth in scrubbing the patient’s body as a preventive preparation aimed at reducing the patient’s skin colonization before the incision is made (Bjerke, 2001). . The anaesthesiologist is the one to administer the anaesthesia. 7. A general anaesthesia will make Mary unaware of what is happening during the operation, it will make her not feel anything, it will even put her to sleep (Rashiq, 2007). Penthidine is the analgesic of choice postoperative; to not feel pain (JBC Handbook, 1997).
8. An epidural anaesthesia is called an epidural block and requires the injection of anaesthetics in the epidural membrane that surrounds the spinal cord (Sarafino, 2006). Epidural blocks are most commonly administered during labour and delivery (American Pregnancy Association, 2007). . Marking the legs preoperative is done traditionally by estimating the position of the hip joint by palpation of the greater trochanter (The, 2006). 10. Epidural infection, nerve damage, backache, headache and urinary retention (Faure, 2000). 11. a. Ensure patient’s tag is the same with her chart. b. make sure patient is not wearing any metals, jewelleries, etc. c. ensure is certain about undergoing the operation d. ensure that patient has gone through all the necessary diagnostic tests e. ensure that patient is still on NPO. 12. The patient’s chart, diagnostic test results, patient’s consent.
13. Vital sign assessment has to be done every 15 minutes for the first hour and special attention will be brought to the patient’s respiration, due to the anaesthesia, and circulation and sensation of the extremities especially in the affected areas. Output is also monitored. Patient still on NPO until anaesthesia wears off totally. 14. No, this is a common postoperative effect. Continue monitoring output. 15. Decrease in urine output is common postoperative due to opioid drugs, immobility, and decreased oral intake (Merck, 2005). The physician may order Crede’s manoeuvre to be implemented and Betanechol can be administered (Merck, 2005). 6. Neurovascular checks are important to determine if there was nerve damage or internal bleeding and a circulation problem, or even infection, which could have been caused by the surgery. The neurovascular check is comprised of the five P’s, namely pain, paralysis, paraesthesia, pulses, and pallor (Judge, 2007). Check for these in the patient’s limbs. 17. Loss of pedal pulses might mean lack of arterial flow (Judge, 2007). This should be reported immediately to the registered nurse or the physician, whoever is readily available.
18. Any deviation from the normal baseline data regarding neurovascular checks should be reported immediately to the physician to avoid amputation of the affected extremity. 19. Log roll patient with abductor hip in place. To prepare the patient, she should be placed on one side of the bed, and rolled like a log to the unaffected side of the hip replacement. 20. A postoperative wash will make the patient feel comfortable and refreshed, also it will minimize infection. 21. Her pain might increase or decrease and this can signal a change in the source of pain. Also, the narcotic’s infusion rate can be changed if pain is lessened. 2. Two or more nurses to ensure that the correct rate is delivered. 23. As a student nurse, I cannot change infusion rates for narcotic pain relievers because I do not have the license yet that will make me accountable for any unpleasant consequence that might arise from the situation. Even under the watchful eye of my instructor, I cannot do it. 24. Narcotics have to be watched for their side effects, especially respiratory depression. Observations that can be noted when a patient is with a narcotics infusion include clients respiratory rate, confusion and drowsiness (BP Cancer Agency, 2008).
5. Heparin injections are administered as a prophylaxis for blood clots (Science News, 1988). 26. Bleeding can be a complication of heparin use because it prevents clotting. Be wary of the following signs: black, tarry stools and bleeding from gums when brushing or flossing teeth, continued redness or pain after an injection, nosebleeds, red urine, unusual bruising coughing up blood (Drug Information Online, 2008). 27. Positive nitrate may indicate bacterial contamination, and traces of protein and blood are not alarming (Eccles Health Sciences Library, 2008).
28. Yes. This is because catheter removal will help in eradicating any possible bacterial contamination. 29. A urine specimen should be sent for a culture and sensitivity test to determine what bacteria is infecting the patient’s urinary tract. Sample should be sent to the laboratory immediately. 30. The needed equipment shall be gathered. After washing one’s hands and explaining to the patient what procedure is to be done and what the rationale behind it is, the drainage tubing directly below the aspiration port will be clamped with a rubber band or clamp (Integrated Publishing, 2007).
This is to ensure that an adequate amount of urine for a specimen can be taken. A syringe will be used to aspirate the urine specimen. After gathering enough urine, the clamp shall be removed. 31. Inserting an indwelling catheter requires that the equipment needed be gathered first. Then the procedure is to be explained to the patient. She should be placed in a dorsal recumbent position. Using the sterile technique, the patient should be draped with sterile dressings. Sterile gloves will then be worn.
Catheter tip is to be lubricated and placed on the sterile catheter tray. The labia are to be separated with the thumb and forefinger and a swipe of a swab with sterile povidone-iodine shall be done from the meatus toward the rectum. This shall be done thrice discarding each swab after one swipe. Catheter is to be inserted two to three inches into the urethra, and an additional inch once there is urine flowing. Balloon will be inflated once it is inside the bladder. Traction is gently applied to the catheter and drainage is taped to Mary’s thigh. (Kaplan, 2007)
32. To remove an indwelling catheter, a small syringe is attached to the inflation port on the side of the catheter and all the fluid is drawn out (Moore et al, 2007). Afterwards, slowly pull the catheter out (Moore et al, 2007). 33. Patients are on strict monitoring of fluid balance because they are receiving fluids through their IV therapies and postoperative patients are still weaning off from their anaesthesia, making urine retention a side effect. A positive fluid balance occurs when intake is greater than output, and a negative fluid balance happens when intake is lesser than output.
34. Fluid overload can bring about fluid and electrolyte imbalance, dysrhythmia, high blood pressure, non-pitting oedema, diarrhoea, projectile vomiting, among many others (Williams, 2008). Osmotic diuretics can be administered per doctor’s orders, patient should be on strict I&O, IV fluids should be checked hourly, fluids should be restricted (Williams, 2008). 35. The medications should also be reflected on the output of Mary if it is working. 36. total intake: 500ml IVF + 2160 ml tea and Milo + 360ml water = 3020 total output: 1400ml urination + bowel The patient is in a positive balance.