NURS 303A Simulation Preparation - WC (answered)

NURS 303A Simulation Preparation - WC History / Information: This patient is a 60-year-old male who was admitted to the hospital with fever and weight loss of 10kg in the past month. He also has night sweats and fatigue. His admitting diagnosis is left renal cell cancer. Preoperatively, the patient received ferrous sulfate, epoetin alfa, and vitamin C. The patient is on hydrochlorothiazide 25mg once daily for hypertension. The patient admits to two cups of caffeinated coffee per day. His BP on admission was 136/84 and his preoperative labs revealed Hemoglobin (Hgb) 14 and Hematocrit (Hct) 40%. The patient is a Jehovah’s Witness. The patient was transferred back to the floor following a left nephrectomy. He is only 4 hours post op and his surgical course was uneventful. He has been dozing but responds to verbal stimulation. He was medicated for pain one hour ago. Admitting Diagnosis: Renal Cell Carcinoma, Status Post Left Nephrectomy Equipment: IV 0.9% NS at 150 mL/hr Nasogastric tube Urinary catheter Incentive spirometer 4L O2 via nasal cannula SCDs (Sequential Compression Devices) Bulb-type surgical drain Medication: Cefazolin Morphine sulfate Additional Questions to Consider: 1. Identify and discuss alternatives to blood transfusion when the patient refuses blood products. Offer appropriate care, advice and educate the patient, provide hematologists who can be consulted, Encouraged Patient to carry a signed and witnessed advance directive card refusing blood and stating which blood products they are not willing to receive. 2. What are hemodynamic changes associated with hemorrhage? It decreases in the circulating blood volume and it reduces cardiac output 3. Describe the initial postoperative management of the nephrectomy patient. Assess the patient`s airway, vital signs, level of consciousness, check for proper opening of the drainage tubes, check for urine output and color of the urine. Readings: Huether, S., & McCance, K. (2017). Understanding Pathophysiology, 6th Edition. (N/A) Jarvis, C. (2016). Physical Examination and Health Assessment, 7th Edition. (Review general assessments and vital signs ) Potter, P., Perry, A., Stockert, P., & Hall, A. (2017). Fundamentals of Nursing, 9th Edition. (pg. 900-906)