Reference no: EM133851890

Question

M. C. is a 71-year-old male patient who has been admitted to the hospital for complaints of abdominal pain and fever. M. C. was diagnosed with chronic myelogenous leukemia last year and receives a round of chemotherapy approximately once per month. His other medical history includes mild hypothyroidism and gastroesophageal reflux disease.

Upon admission, M. C. complains of right upper quadrant pain rated as an "8" on a 0 to 10 scale. He has significant tenderness with palpation and his abdomen is guarded. His temperature is 101.9 ? F and he is alert and oriented. He is accompanied by his wife and daughter.

Further diagnostic testing through an abdominal CT reveals that M. C. has a severely inflamed gall bladder with the presence of a number of small stones in the common bile duct. M. C. is scheduled to undergo a laparoscopic cholescytectomy that same day.

Prior to his surgery, the nurse inserts an indwelling catheter and administers 2g of ampicillin IV as a prophylactic antibiotic as ordered by the physician. M. C. continues to wait in his hospital room for the time when he will go to surgery. The nurse notes through his routine vital sign checks that M. C.' s blood pressure is dropping and he appears listless.

1. After the nurse notes these signs and symptoms from M. C., what actions should the nurse should perform next?

2. Describe how this patient's condition puts him at higher risk of complications associated with his surgery.

The nurse contacts the physician about M. C.' s status; the physician orders that the patient be placed on continuous hemodynamic monitoring with blood pressure checks every 5 minutes. The physician has also ordered several lab tests, including a CBC, blood glucose, and blood culture. The results of the blood tests are as follows: WBC: 2,800 cells/ mcL, RBC: 4.0/ mcL, platelets: 55,000/ mcL, Hgb: 10.2 g/ dL, Hct: 35.8%, glucose: 167 mg/ dL. The blood culture is pending.

3. Describe the difference between systemic inflammatory response syndrome (SIRS) and sepsis.

4. Explain why M. C. most likely has these lab results.

5. Based on the results of these lab tests, which action of the nurse would be most important?

The nurse receives an order to administer 2 units of fresh frozen plasma and M. C. is taken back to surgery before waiting any longer. Following the cholecystectomy, M. C. is intubated and sedated, but he is having a difficult time waking up. His vital signs are as follows: HR 108 bpm, RR 16/ minute (on a timed cycle of the ventilator) BP 86/ 50 mmHg, T: 100.9 ? F. He is taken to the ICU where he is cared for on a ventilator and placed on a hemodynamic monitor. The physician inserts a Swan-Ganz catheter to monitor internal blood pressure and also orders levophed to be added to the IV. The nurse continues to closely monitor M.C.' s condition and is assigned as a 1: 1 nurse-to-patient ratio because of his condition.

6. What is the purpose of administering levophed IV?

7. Why would the nurse administer fresh frozen plasma to this patient before surgery?

8. What type of complications is M. C. at risk of?

9. Describe the purpose of a Swan-Ganz catheter and why it would be most useful in this situation.