UNFOLDING REASONING CASE STUDY STUDENT POST-OP PAIN MANAGEMENT 1 & 2 CARDIAC ARREST

100%Complete Graded A+SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC ARREST Post-op Pain Management: Day of Surgery (1/2) Sheila Dalton, 52 years old Primary Concept Pain Interrelated Concepts (In order of emphasis) 1. Gas Exchange 2. Glucose Regulation 3. Perfusion 4. Inflammation 5. ClinicalJudgment 6. Patient Education 7. Communication 8. Collaboration 100%Complete Graded A+SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC ARREST © 2016 Keith Rischer/www.KeithRN.com 100%Complete Graded A+SHEILA DALTON, 52 YEARS UNFOLDING REASONING CASE STUDY:STUDENT POST-OP PAIN MANAGEMENT 1 & 2: CARDIAC ARREST UNFOLDING Reasoning Case Study: STUDENT Post-op Pain Management: Day of Surgery (1/2) History of Present Problem: Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had a posterior spinal fusion of L4-S1 today. She had an estimated blood loss (EBL) of 675 mL during surgery and received 2500 mL of Lactated Ringers (LR). Pain is currently controlled at 2/10 and increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus dose of 0.1 mg and continuous hourly rate of 0.2 mg. Last set of VS in post-anesthesia care unit (PACU) P: 88; R: 20; BP: 122/76; requires 4 liters per n/c to keep her O2 sat >90 percent. You are the nurse receiving the patient directly from the PACU. Personal/Social History: Sheila is divorced and currently lives alone in her own apartment. She has two grown children from whom she is estranged. What data from the histories is RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: EBL of 675 mL 2500 mL of Lactated Ringers Pain 2/10 and increases with movement Posterior spinal fusion of L4-S1 0.2 mg/hr hydromorphone PCA and 0.1 mg of IV bolus Chronic low back pain History of COPD On 4L of oxygen • EBL > 500 mL is an emergency and requires immediate intervention. This combined with 2500 mL Lactated Ringers will significantly lower Ms. Dalton’s Hgb level. • Pain level, even at a low level should continue to be monitored post-op. • Ms. Dalton should be monitored for mild signs and symptoms of oversedation, which include altered mental status and altered consciousness. • Her history of chronic back pain and posterior spinal fusion would indicate a need for positioning after surgery. • I would want to continue monitoring her oxygen saturation so that it stays above 90% as well. RELEVANT Data from Social History: Clinical Significance: She lives alone and has no nearby relatives This indicates a lack of support system; she may need additional assistance upon d/c from the hospital. The patient could be at increased risk for falls due to living alone, chronic pain, and need for oxygen. Possible referral needed to skilled nursing facility or TCU upon discharge What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome: • Low back pain with lumbar compression fracture 1. Citalopram 40 mg daily Antidepressant Narcotic Narcotic Alleviate depression symptoms Alleviate pain 2. Oxycontin SR 40 mg bid 3. Oxycodone 10 mg every 4 hours prn 4. Fluticasone/salmeterol 250/50 diskus 1 puff every 12 hours 5. Sildenafil 20 mg tid • Depression • COPD Bronchodilator