Post-operative Nursing Priorities And Assessments

Key priorities in the first 24 hours post-op

1. What do you consider to be the main priorities of care for Mr. Teng in the first 24 hours post-op?

2. Describe the assessments that you would undertake in the post-operative period to enable early detection of potential post-op complications?

3. Day 1 post-op. At 1000hrs you assess Mr. Teng’s vital signs to be?

4. Identify the immediate nursing priorities of care, with associated rationales, for James on admission to the Emergency Department?

5. Explain why rest and reassurance are an important aspect of James’ ongoing care?

6. James asks you if he is having a heart attack. What would your response be?

7. How do pre-existing medical conditions predispose Bill to post-operative complications?

8. What are the most likely post-operative complications to develop for Bill?

9. What pre and post-operative nursing interventions will be essential while taking care of this patient?

10. What are the priority nursing interventions on admission to the ward?

11. What are Mrs Johnson’s risk factors for peripheral arterial disease?

12. Outline the primary nursing responsibilities when caring for Mrs Johnson?

1. The key priority of Mr. Teng in first 24 hours post-op include the pain management, control of patient’s breathing after anaesthesia and proper wound care.

2. The assessments that would be undertaken in post-operative period include:

A-E assessment
Pain score measurement
Consciousness of patients

The assessment of data is suggesting a fluid imbalance of Mr. Teng, as a post-operative complication.

Other data that helped in clarifying findings are a lower BP, 98/65 and 100 ml urination since 12 midnight.

The student nurse will inform the registered nurse, who is patient’s in-charge and administration of fluid retention medication.

4. James would be admitted to the emergency department immediately and then he would be assessed through cardiac MRI and ECG (Doenges, Moorhouse & Murr, 2016). Based on diagnosis, nitroglycerin would be administered, as it helps in widening blood vessel and more blood flow to heart muscle with relieving pain.

5. Sometimes, in case of angina pecortis, chest pain lasts for longer period, in other cases, like exercise-induced chest pain last for less time, however, it becomes difficult to distinguish the cause of chest pain, thus, rest and reassurance of the cause of chest pain is important to be considered for getting proper ECG result.

6. The immediate response to James’s query would be ‘not sure’, prior having the ECG and CT scan reports, which would confirm whether he had an angina or heart attack.

7. Bill has previous history of type 2 diabetes mellitus, smoking history and hypertension and on auscultation, respiratory tract disease. Thus, these medical conditions can pre-dispose to poor immunity, tendency of delayed recovery and breathing problem. Answer 2

8. Bill can have several post-operative complications like delayed wound recovery, blood loss during surgery and risk of revive after anaesthesia.

9. Pre and post operative assessments are required to ensure healthy condition of patient. A-E assessment, fluid balance and consciousness should be assessed during both pre and post operative period.

10. During admission, taking the incident report, medical history and reason for admission should be noted.

11. Risk factors of developing peripheral arterial disease by Mrs. Johnson are her medical history of hypertension, myocardial infarction, smoking history and type 1 diabetes.

12. The key responsibilities of the caring nurse towards Mrs. Johnson include proper wound management, surgical site infection prevention, control of blood pressure and blood sugar level (Gulanick & Myers, 2013).

AM Shift

Patient/time	0700	0800	0900	1000	1100	1200	1300	1400	1500
Mr. Campbel		Atenolol due
Mr. Nash		Oral antibiotic due	Physiotherapy appointment, dressings are stained and peeling			Panadol due		Oral antibiotic due
Mr. Bates		Usual meds		Appointment with hand physiotherapist		Panadol due		Discharge
Mrs. Brason	Sinemet tablet due	Regular meds due			Sinemet tablet due	Regular meds due	Sinemet tablet due	Regular meds due

Patient	Triggers
Bed 1	· What are the complications related to abdominal polyps? · Why doctors ordered to cease IV fluids immediately? · What is the cause behind patient’s infrequent urination? · What is the role of atenolol at this time?
Bed 2	· Why the team doctors of the patient suggested ceasing PCA and starting Oxycotin BD with Endone PRN? · What are the post knee surgery complications? · What others information a nurse should know to ensure proper wound management?
Bed 3	· What complications may the patient experience, while travelling by train after 1 day of left hand surgery? · What complications he can experience during post surgery period? · What is the information, which should be conveyed to patient regarding recovery and follow ups?
Bed 4	· What are patient’s input and output data? · What are the risk factors associated with her symptoms like poor skin turgor and dry mucous membrane? · What is the role of Sinemet tablets in her care plan? · What should be key priorities of a nurse dealing with a patient experiencing parkinson’s disease along with additional complications?

Patient

Triggers

Bed 1

· To ensure ending the IV fluid after receiving the order of doctor

· Assessment of abdominal discomfort and documenting the assessment findings

· Conveying the findings to doctors and work according to the doctor’s orders

· Taking observations of the patient’s vital signs after every 4 hours

· Proper administration of scheduled medications (Kalisch et al., 2011)

· Completing all the documentation prior patient’s discharge

· Communication with the patient and family regarding follow up and further threatments

Bed 2

· Post-surgical wound management and infection control through maintaining hygiene measures

· Dressing to be reviewed and dressed accordingly – ensure wound chart in place (Urden, Stacy & Lough, 2014)

· Ensure patient has been charted for regular Oxycontin BD and Endone PRN regime after PCA has been taken down

· Pain score assessment after scheduled interval

· Keep patient adhered to the physiotherapy sessions at scheduled time

Bed 3

· To ensure proper wound dressing and management

· To ensure proper infection control and hygiene measures while dealing with the surgical wound

· Documentation of pain score

· Communication with the patient regarding complications he may have, while travelling by train at this condition

· Administering due medicines at the scheduled time ordered by doctor(Kalisch et al., 2011)

· Assisting the patient in the physiotherapy session

· Communicating with patient regarding the follow up sessions

Bed 4

· To assist the patient in her ADLs

· To assist the patient with emotional and moral support

· To ensure the patient is consuming required amount of water needed

· To document proper input and output data of the patient

· To assess the patient’s skin integrity and inform the doctor regarding this

· To ensure proper dressing of wound and infection control (Urden, Stacy & Lough, 2014)

· To ensure proper administration of patient’s regular medication at scheduled time

· To document patient’s vital signs at scheduled time interval

Bed 1

Patient name: Mr. Campbell

Sex: Male

Age: 40 yrs

Date and time	Notes
0400 hrs	Temp- 37.2 degree Celsius, HR- 80 bpm, BP- 150/75 mmHg and RR- 14 rpm.
0800	Patient reported mild abdominal discomfort
	BP has been lowered to 120/70 mmHg and there was no complain regarding abdominal discomfort prior discharge
	Passed urine 3 times with a bladder scan result of 40 mls
1400 hrs	Patient’s wife will pick him up upon discharge

Bed 2

Patient name: Mr. Nash

Sex: Male

Age: No information

Date and time	Notes
0600 hrs	Temp- 36.5 degree Celsius, HR-65bpm, BP-110/65mmHg and RR-12rpm, patient appeared to be drowsy but conscious, he was able to communicate
0800 hrs	After PCA has been taken down, he had been administered with Oxycontin and Endone
0900 hrs	Patient visited physiotherapy session and mobilisation would be reviewed in the afternoon
	Dressing was done after physiotherapy session. It was observed that the surgical site is oozing. Gauze and Mepilex border has been used for dressing. Dressing need not to be changed regularly, it should be changed only when needed

Bed 3

Patient name: Mr. Bates

Sex: Male

Age: No information

Date and time	Notes
0800 hrs	His regular medicine has been administered
1000 hrs	Patient had a physiotherapy appointment. Patient is able to elevate his arm as much as possible and recommended to use arm sling, if needed
1200 hrs	Panadol has been administered
1400 hrs	Patient will be discharged after review at hand clinic
	Analgesia script ready for patient
	Discharge forms and instruction provided to the patient

Bed 4

Patient name: Mrs. Branson

Sex: Female

Age: 90 yrs

Date and time	Notes
0700	Sinement administered to the patient
0800	Patient’s regular medicine has been administered
1100	Sinement administered to the patient
1200	Patient’s regular medicine has been administered
1300	Sinement administered to the patient
1400	Patient’s regular medicine has been administered
	Oral intake of the patient has been increased after consulting with speech pathologist and geriatric consult
	The patient appears to be confused and facing difficult in communicating with staff
	The patient needs assistance during shower and incontinence pad applied
	Mrs Branson has been put on a strict fluid balance chart. With the help of assistance and encouragement, she is drinking fairly well
	Patient has been categorized to have falls risk, for this, fall assessment form and Waterlow charts updated

		Information	What do you like to include?
I	Introduction	Parkinson disease is the key concern of Mrs. Branson’s case. In addition, she has undergone a fall.	Information about patient other medical history are needed to be included
S	Situation	Experiencing a fall, Mrs. Branson has been admitted to the hospital since 5 days. She has a poor appetite and appeared confused, she has hearing difficulty also. She is mobile, but she is not willing to drink water. However, no input and output data for the patient has been found. She is being administered with Sinemet tablets at scheduled intervals.	No information regarding current vital sign and pain assessment has been provided to evaluate the situation. These information needed to be included
B	Background	Mrs. Branson is 90 years old. Patient has a medical history of Parkinson’s disease. She is undergoing a poor appetite and confusion and refusing to intake water. The team doctors recommended increasing her oral intake. She has several complications related to her health status including hearing issue. But she is mobile.	No background information about the patient has been provided, her family back ground, family medical history, since when she is experiencing the neurological disorder and other issues has not been included, which are needed to be included. In addition, information regarding her current family members, occupation and social support are also needed to be included
A	Assessment	A- Airway- No information B- Breathing- No information C- Circulation- No information D- Disability- Needs assistance during shower, inconsistency pad application, hearing difficulties, difficulties in communicating with staffs and confused E- Exposure- Poor skin turgor, dry mucous. Dressings on her skin tears were not appropriate. F- Fluids- Refusing to drink water initially, but now she is drinking fairly well, upon assistance and encouragement G- Glucose- No information Neurological- Experiencing Parkinson’s disease, Confusion, communication difficulty, hearing difficulty Respiratory- No information Cardiovascular- No information Gastrointestinal- No significant information found Urology- The input and output information are not available. Patient has urine inconsistency problem, for which she needs to wear pad by taking assistance Musculoskeletal- fall injury, categorised to have fall risk and fall assessment form and Waterlow charts updated Integumentary- Poor skin turgor, dry mucous, dehydrated skin	No particular information regarding the assessment tools has been provided, which has been used for assessing the patient’s vital signs. Patient’s information regarding airway, breathing, circulation, blood glucose level, BP, gastrointestinal and cardiovascular status are needed to be included
R	Recommendation	· Proper information regarding patient’s background and vital signs are needed to include in the progress note · A good moral and emotional support should be provided to the patient to encourage her towards her care plan · Her family members should be involved in the care process · The fall injury should be assessed along with the pain score, after scheduled intervals · A proper speech therapy should be undergone along with geriatric consultation · She should be effectively communicated for encouraging her to adhere with the fluid balance chart for improving her appetite

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nursing diagnosis manual: planning, individualizing, and documenting client care. FA Davis.

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Kalisch, B. J., Tschannen, D., Lee, H., & Friese, C. R. (2011). Hospital variation in missed nursing care. American Journal of Medical Quality, 1062860610395929.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2014). Critical care nursing: diagnosis and management. Elsevier Health Sciences.

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