Perioperative Nursing Elective: Case Study 2
Directions: Please answer the following questions related to a patient scenario using your textbook and scholarly resources. Use APA (when applicable) for references. Additional information about this patient may be addressed in class or added as the case study unfolds. Pay attention to the point values as a guide for how much information is expected in each answer.
Mary Jones is a 64-year-old woman scheduled for a lumbar 4-5 discectomy. She is 5’2” and weighs 210 lbs. She has a history of diabetes mellitus, hypertension, coronary artery disease (CAD) and used to smoke 1 pack of cigarettes per day for 20 years, but quit smoking 25 years ago. She has a past surgical history of a cholecystectomy in 1997 with no complications.
She currently takes the following medications: Insulin 4 units Regular every AM, subcutaneous. Lisinopril 20 mg every day, PO. Aspirin 325 mg every day, PO.
1) As Ms. Jones enters the OR room, what policy and procedure should be initiated by the circulating RN? What should be “checked-off” during this time? What team members should participate? (3 points)
2) What safety measures should the circulating nurse and/or scrub nurse take to ensure safety in the OR setting? (2 points)
3) What position will Ms. Jones need to be placed in for her scheduled surgery? What are the nurse’s responsibilities during positioning? (2 points)
4) What are some general safety concerns when positioning Ms. Jones? What areas of her skin should you be concerned about in the necessary surgical position? Are there any respiratory, cardiovascular, or neuromuscular positioning concerns? If so, what are they? (4 points)
5) As the sterile field is being prepared for Mrs. Jones’ procedure, the circulating nurse prepares a chemical hemostasis agent, thrombin. What is thrombin? How does it work to produce hemostasis? What special considerations should the RN take when transferring thrombin to the sterile field? Should the circulator anticipate any other hemostatic products? (3 points)
6) What is the difference between monopolar and bipolar electrodes? What nursing considerations would you have for the use of each? (2 points)
7) Surgical wounds are classified by the CDC from I-IV. Please describe each of the four stages.
8) Cefazolin (Ancef) 1 gram in 50 mL NaCl has been ordered to be administered in 30 minutes as a secondary IV medication. The primary IV fluid is 1L NaCl ordered to be administered over 8 hours. What should the infusion pump be set at for both the primary and secondary fluids/medication? (2 points)
Primary: ____________________ mL/hr
9) What condition is an inherited muscle disorder triggered by certain types of anesthesia? It may cause a fast-acting, life-threatening crisis. What are the signs and symptoms? What medication is widely given to counteract the condition? (3 points)