NU371 HESI Case Study PVD With Amputation With Complete Solution.

NU371 HESI Case Study PVD With Amputation With Complete Solution. Meet the Client - ANSWER A disheveled man who appears to be between 50 and 60 years old is found unconscious under a bridge with a necrotic right foot that is gangrenous. He is brought to the emergency department by the paramedics and police department. Legal Issues - ANSWER The client has no identification on his body. The police are unable to locate anyone who knows his full name. Upon the client's admission to the emergency department (ED) it is determined that he needs immediate surgery to amputate his right leg above the knee. The nurse caring for the client has no way to contact family to obtain informed consent for the surgery, and the client has not regained consciousness. Which action will the nurse implement first since informed consent cannot be obtained? a) Call the operating room (OR) department and inform them that the surgery cannot be done at this time. b) Request that the police department find some of the client's family members immediately. c) Contact the legal department of the hospital to appoint a legal guardian for the client. d) Prepare the client for surgery and document that no family member is available. - ANSWER d) Prepare the client for surgery and document that no family member is available. - When surgery is emergent, the surgeon may operate without informed consent. Therefore, the nurse should first prepare the client for immediate surgery. Perioperative Care - ANSWER The client is wearing an old Timex watch and has a ring on his left index finger. What must the nurse do with the client's personal items? a) Place the items in a bag with his name on it and put the bag under the stretcher. b) Request that the police remove the items and take responsibility for them. c) Assign two nurses to place the items in a bag and place them in the hospital safe. d) Place a piece of tape over the items and allow the client to wear them to surgery. - ANSWER c) Assign two nurses to place the items in a bag and place them in the hospital safe. - Document the items, document on the outside of the valuables bag, and place the bag in the hospital safe according to hospital policy since there is no family member to take responsibility for the items. The client's right leg is marked in the ER to ensure that the correct site is operated on. Because he is unconscious, he is not able to participate in this activity. When the client arrives in the OR, he is positioned on the operating table, intubated, and given general anesthesia. A "time out" is called by the circulating nurse. - ANSWER - What is the purpose of the "time out?" a) To allow the operating team time to scrub and gown. b) So the anesthesiologist can wake up the client up to ensure the correct procedure is being done on the correct person. c) As a signal for the scrub nurse or certified scrub technician to perform an instrument and sponge count. d) So all members of the OR team participate in the positive identification of the client, identify the correct site, and identify the planned procedure. - ANSWER d) So all members of the OR team participate in the positive identification of the client, identify the correct site, and identify the planned procedure. - Surgical procedures that are site specific, such as left, right, or bilateral, require patient identification before surgery. As required by The Joint Commission's NPSGs, to ensure that the correct site is selected and the wrong site is avoided, the site is marked by a licensed independent practitioner and, whenever possible, involves the patient. The surgeon is accountable and should be present during the procedure. The nurse is an important part of this SAFETY measure. Before starting the operative procedure, facilities use a "time-out" procedure to verify the correct site, patient, and procedure. The perioperative nurse is in a position of ensuring that these SAFETY measures are implemented immediately before the procedure is started (AORN, 2015). The "time-out" involves the participation of all members of the procedure team, including the surgeon, anesthesia provider, circulating nurse, scrub person, and any other active participants. The operating room nurse asks the surgeon, "What does the client want done with the amputated extremity?" The surgeon informs the operating room nurse that the client was unconscious upon admission and has no family members. - ANSWER - What will the operating room nurse do with the amputated limb? a) Place the amputated limb in a biohazard bag and place it in the trash. b) Keep the limb in the morgue until the client can tell the staff what to do with the limb. c) Ensure that the limb is sent to the incinerator so that it can be burned. d) Ask the surgeon to prescribe action to be taken regarding the amputated extremity. - ANSWER c) Ensure that the limb is sent to the incinerator so that it can be burned. - Amputated limbs are disposed of in this manner. If the client makes special requests due to cultural needs, this must be discussed and arranged prior to the surgery. However, the client was unconscious upon admission and no family members were present, therefore, standard hospital protocol applies.