Reference no: EM134037691

Question

Jared Griffin is a 63-year-old African American man who underwent a right total knee arthroplasty (TKA) and is being admitted to your surgical unit post-operatively. He is a carrier of methicillin-resistant Staphylococcus aureus (MRSA) and has been placed on contact precautions. He has a history of osteoarthritis and mild hypertension.

1. After getting the hand-off report, the nurse proceeds to go into the patient's room to complete the physical assessment. What PPE should the nurse don before entering Jared's room and why?

2. What potential problems could occur if proper infection control practices are not followed?

3. Describe 5 post-operative assessments the nurse should complete for Jared on admission to the unit and the rationale for your choices.

Practical Nursing Program 

Case Study Assignment

4. On admission to the surgical unit, the nurse notes that Jared has an IV infusion of normal saline per gravity at 125 mL/h. The postop physician's order is for IV Ringer's Lactate at 100 mL/h.

Keeping best practice in mind, identify what the nurse should do with the IV and provide a rationale.

5. Why would the physician order Ringer's Lactate for Jared?

6. After completing the assessment, the nurse notes that Jared's Jackson Pratt right knee drain is almost full. What are three steps the nurse should take next?

7. a) What should the nurse do when an initial post-op assessment reveals that Jared's oral temperature is 35.1 degrees Celsius but other vital signs are within normal limits?

b) What would the nurse attribute as the cause of Jared's lowered body temperature postoperatively?

8. Jared is currently on oxygen at 3 L per nasal prongs. The nurse finds Jared's Sp02 reading to be 88%.

List 3 priority interventions the nurse might perform next and explain why.

9. The physician orders 'arterial blood gases', or ABG's, to be drawn on Jared STAT.

a) Explain why the physician would order ABG's on Jared?

b) The respiratory technician draws ABG's on Jared and the nurse looks over the results as follows; pH 7.34, PaCO2 46 mm Hg, PaO2 78 mm Hg, bicarbonate level 27 mmol/L. What does the nurse interpret the results to mean?

10. There is a standing physician's order to change the right knee dressing on day 1 post-op.

When cleansing the incision site and drain site, what principle of surgical asepsis should the nurse keep in mind and how would this be applied to Jared's dressing change??

11. While completing the dressing change, the nurse observes that the knee incision is slightly reddened and edematous. What should the nurse's priority action be and provide a rationale?

12. Jared had morning bloodwork drawn. What type of bloodwork should alert the nurse to a possible development of an infection?

13. Jared's serum CBC results show a hemoglobin of 70, a decrease from 90 the day before. The physician has ordered 1 unit of packed red blood cells to be transfused over 2 hours.

a) The nurse notices that consent has not been obtained for the blood products but needs to initiate the transfusion order. What should the nurse do next and provide rationale?

b) Once the blood is obtained from the transfusion lab, what does the nurse have to do to safely initiate the transfusion?

c) The nurse notes that the patient's blood type is AB positive and the donor's blood type is A negative. What should the nurse do next? Provide your rationale.

14. After the blood transfusion has been infusing for an hour, Jared calls the nurse for help and states he is experiencing shortness of breath. The nurse does a quick respiratory assessment and notes that there are new course respiratory crackles throughout the lung fields when they had been clear before. Jared's heart rate has elevated to 110 beats per minute, and his BP is now at 180/105.

What is one nursing action that the nurse would implement in response to the above assessment findings and why?

15. On the third day post-op, Jared tells the nurse that he has developed severe lower stomach pain rated 9/10 and is very nauseated. On assessment, the nurse notes that Jared's bowel sounds are now absent, his abdomen is distended and is moderately firm. She notes that Jared has not had a bowel movement since surgery.

a) What is the likely postoperative complication for Jared's symptoms?

b) What are 3 priority nursing actions that the nurse may anticipate performing based on this change in Jared's status?

16. On the fourth day post-operatively, Jared's oral temperature is 39.0 degrees Celsius, and his right knee incision is slightly reddened, warm, and edematous.

The physician orders swabs of the incision to be sent for C&S and prescribes clindamycin 300 mg PO QID. Unfortunately, the hospital pharmacy supplies clindamycin only in 100 mg tablets. How many tablets would the nurse need to order from pharmacy to ensure enough supply for 5 doses?

17. Jared makes a full recovery and is to be discharged home on the seventh post-operative day. He has staples in situ in his right knee which are ordered to be discontinued on postop day 14 with his family physician. What are two discharge instructions that the nurse should provide Jared concerning the care of his knee incision?