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FRACTURED HIP WITH POSTOPERATIVE COMPLICATIONS M.M., a 76-year-old retired schoolteacher, underwent ORIP of his right femur, He has been on bed rest for 36 hours postoperatively. At 0600 VS were 132/84, 80, 18, 37 C . He is AA&Ox3 (awake, alert, and oriented). Normal heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are active in all 4 quadrants, and he is taking sips of clear liquids. An IV of DSNS is infusing TKO in his left hand and is to be saline locked in the AM if he is able to maintain adequate PO fluid intake. His lab work shows Hct 34%, Hgb 11.3 mg/dl, K 4.1mEq/L, PTT 44 seconds. Pain is controlled with meperidine (Demerol) 25mg and promethazine (Phenergan) 25 mg IM q3h. He is also using a Nitro patch, heparin 5000 units SQ bid, and docusate sodium. At 2330 on the second postoperative day, you answer M.M.'s call light and find him lying in bed breathing rapidly and rubbing his R chest. He complains of R-sided chest pain and appears to be restless. 1. What nursing interventions should you take? He is slightly hypotensive, tachycardic, tachypneic, restless, and slightly confused. The pulse oximeter reads 86%, so you start him on 2 liters of O' via nasal cannula. You hear faint crackles in the posterior bases bilaterally: they were clear this AM. 2. What information will you share with the HCP via SBAR? 3. The HCP orders ABGS on room air, continuous pulse oximetry, STAT CXR and STAT 12- lead ECG. What information will the physician gain from each of the above?

FRACTURED HIP WITH POSTOPERATIVE COMPLICATIONS M.M., a 76-year-old retired schoolteacher, underwent ORIP of his right femur, He has been on bed rest for 36 hours postoperatively. At 0600 VS were 132/84, 80, 18, 37 C . He is AA&Ox3 (awake, alert, and oriented). Normal heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are active in all 4 quadrants, and he is taking sips of clear liquids. An IV of DSNS is infusing TKO in his left hand and is to be saline locked in the AM if he is able to maintain adequate PO fluid intake. His lab work shows Hct 34%, Hgb 11.3 mg/dl, K 4.1mEq/L, PTT 44 seconds. Pain is controlled with meperidine (Demerol) 25mg and promethazine (Phenergan) 25 mg IM q3h. He is also using a Nitro patch, heparin 5000 units SQ bid, and docusate sodium. At 2330 on the second postoperative day, you answer M.M.'s call light and find him lying in bed breathing rapidly and rubbing his R chest. He complains of R-sided chest pain and appears to be restless. 1. What nursing interventions should you take? He is slightly hypotensive, tachycardic, tachypneic, restless, and slightly confused. The pulse oximeter reads 86%, so you start him on 2 liters of O' via nasal cannula. You hear faint crackles in the posterior bases bilaterally: they were clear this AM. 2. What information will you share with the HCP via SBAR? 3. The HCP orders ABGS on room air, continuous pulse oximetry, STAT CXR and STAT 12- lead ECG. What information will the physician gain from each of the above?

Phlebotomy Essentials
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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FRACTURED HIP WITH POSTOPERATIVE COMPLICATIONS M.M., a 76-year-old retired schoolteacher, underwent ORÍP of his right femur. He has been on bed rest for 36 hours postoperatively. At 0600 VS were 132/84, 80, 18, 37 C. He is AA&Ox3 (awake, alert, and oriented). Normal heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are active in all 4 quadrants, and he is taking sips of clear liquids. An IV of DS5NS is infusing TKO in his left hand and is to be saline locked in the AM if he is able to maintain adequate PO fluid intake. His lab work shows Hct 34%, Hgb 11.3 mg/dl, K 4.1mEq/L, PTT 44 seconds. Pain is controlled with meperidine (Demerol) 25mg and promethazine (Phenergan) 25 mg IM q3h. He is also using a Nitro patch, heparin 5000 units SQ bid, and docusate sodium. At 2330 on the second postoperative day, you answer M.M.'s call light and find him lying in bed breathing rapidly and rubbing his R chest. He complains of R-sided chest pain and appears to be restless. 1. What nursing interventions should you take? He is slightly hypotensive, tachycardic, tachypneic, restless, and slightly confused. The pulse oximeter reads 86%, so you start him on 2 liters of O? via nasal cannula. You hear faint crackles in the posterior bases bilaterally: they were clear this AM. 2. What information will you share with the HCP via SBAR? 3. The HCP orders ABGS on room air, continuous pulse oximetry, STAT CXR and STAT 12- lead ECG. What information will the physician gain from each of the above? 4. Why would the HCP order a blood gas on room air as opposed to with supplemental охудen? The ABG's returns as follows: pH 7.55, Paco? 24mmHg, HCO 24mEq/L, and Pao? 56mmHg. His Spo? is 86% on room air. Chest x-ray shows a small R infiltrate. VS are 150/92, 110, 28, 37 C. 5. What is your interpretation of the ABGS, and what do you think the HCP will order next? 6. The V/Q is performed, and the interpretation reads "strongly suggestive of a pulmonary embolus." What are the most likely sources of the embolus? 7. Based on the latest PTT of 40 second, the HCP orders a heparin bolus of 5000 units IV followed by an infusion of 1200 units/hour. The PTT 4 hours later is >120 seconds. Based on these results, what action would you take? 8. The next da, the HCP orders read, "Coumadin 2.5mg, PT in AM, DC heparin". What is wrong with these orders? 9. Thrombolytics, such as streptokinase and urokinase, have been beneficial in the treatment of pulmonary embolus. Why would this medication be contraindicated in M.M.'s case? 10. List 3 priority nursing diagnoses for M.M. related to his present status. 11. Several days later, you hear M.M. requesting his son to bring in a "decent razor" because he is tired of the stubble left by the unit's shaver. How would you address this issue?
Transcribed Image Text:FRACTURED HIP WITH POSTOPERATIVE COMPLICATIONS M.M., a 76-year-old retired schoolteacher, underwent ORÍP of his right femur. He has been on bed rest for 36 hours postoperatively. At 0600 VS were 132/84, 80, 18, 37 C. He is AA&Ox3 (awake, alert, and oriented). Normal heart sounds. Breath sounds are clear but diminished in the bases bilaterally. Bowel sounds are active in all 4 quadrants, and he is taking sips of clear liquids. An IV of DS5NS is infusing TKO in his left hand and is to be saline locked in the AM if he is able to maintain adequate PO fluid intake. His lab work shows Hct 34%, Hgb 11.3 mg/dl, K 4.1mEq/L, PTT 44 seconds. Pain is controlled with meperidine (Demerol) 25mg and promethazine (Phenergan) 25 mg IM q3h. He is also using a Nitro patch, heparin 5000 units SQ bid, and docusate sodium. At 2330 on the second postoperative day, you answer M.M.'s call light and find him lying in bed breathing rapidly and rubbing his R chest. He complains of R-sided chest pain and appears to be restless. 1. What nursing interventions should you take? He is slightly hypotensive, tachycardic, tachypneic, restless, and slightly confused. The pulse oximeter reads 86%, so you start him on 2 liters of O? via nasal cannula. You hear faint crackles in the posterior bases bilaterally: they were clear this AM. 2. What information will you share with the HCP via SBAR? 3. The HCP orders ABGS on room air, continuous pulse oximetry, STAT CXR and STAT 12- lead ECG. What information will the physician gain from each of the above? 4. Why would the HCP order a blood gas on room air as opposed to with supplemental охудen? The ABG's returns as follows: pH 7.55, Paco? 24mmHg, HCO 24mEq/L, and Pao? 56mmHg. His Spo? is 86% on room air. Chest x-ray shows a small R infiltrate. VS are 150/92, 110, 28, 37 C. 5. What is your interpretation of the ABGS, and what do you think the HCP will order next? 6. The V/Q is performed, and the interpretation reads "strongly suggestive of a pulmonary embolus." What are the most likely sources of the embolus? 7. Based on the latest PTT of 40 second, the HCP orders a heparin bolus of 5000 units IV followed by an infusion of 1200 units/hour. The PTT 4 hours later is >120 seconds. Based on these results, what action would you take? 8. The next da, the HCP orders read, "Coumadin 2.5mg, PT in AM, DC heparin". What is wrong with these orders? 9. Thrombolytics, such as streptokinase and urokinase, have been beneficial in the treatment of pulmonary embolus. Why would this medication be contraindicated in M.M.'s case? 10. List 3 priority nursing diagnoses for M.M. related to his present status. 11. Several days later, you hear M.M. requesting his son to bring in a "decent razor" because he is tired of the stubble left by the unit's shaver. How would you address this issue?
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