NR 446 Medical Surgical Assessment

NR 446 Medical Surgical Assessment 1. A nurse is caring for a client following an infratemporal craniotomy. How should the nurse position this client in the immediate post-operative period? • Closely monitor vital signs and neurological status, including using the Glasgow Scale. • Treat pain adequately • Supratentorial surgery - Elevate the HOB 30 degrees; Keep in neutral position to prevent increased ICP. Turn side on side or supine to decrease risk of pressure ulcers and pneumonia. • Infratentorial craniotomy – Lie flat and side-lying. Turn side to side every 2 hours for 24 to 48 hr. • Straining activities (moving up in bed and attempting to have a bowel movement should be avoided to prevent increased ICP. • Postoperative bleeding and seizure activity are the greatest risks. • Periorbital edema and ecchymosis is not unusual. Treat with cold compresses • Assess head dressing every 1 to 2 hr for drainage. 2. A nurse is caring for a client following a bone marrow biopsy. What information should the nurse include in the discharge education? • Education the client on how to check the biopsy site daily. Keep the dressing clean, dry, and intact. • Educate client on the symptoms of an infection. Notify provider if signs of infection or to report excessive bleeding. • If sutures are in place, remind the client to return in 7 to 10 days to have them removed. 3. What dietary education should the nurse provide to a client diagnosed with a hiatal hernia? Clients should consume a soft diet for the first week postoperatively. Avoid carbonated beverages. Ambulate, but avoid heavy lifting. • Avoid eating immediately prior to going to bed. • Avoid foods and beverages that decrease LES pressure (fatty and fried foods, chocolate, coffee, peppermint spicy foods, tomatoes, citrus fruits, and alcohol). 4. What are the recommendations for vaccinations in the adult population? • Herpes Zoster Vaccine: all adults older than 60 • HPV4: Males up to age 21; 26 if known risk factors, medical, occupational, lifestyle • Human papilloma virus (HPV2 or 4): Females up to age 26, not immunized as children. • Influenza vaccine