Exhibits

Review H and P, nurse's notes, laboratory values, flow sheet, and prescriptions.

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The client demonstrates effective epidural anesthesia by

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A. Monitor the client's white blood cell count. WBC count is a key indicator of infection and helps monitor the severity of the infection.

B. Institute contact precautions for staff and visitors. MRSA is highly contagious and can be spread through direct contact, so contact precautions are necessary to prevent transmission.

C. Send wound drainage for culture and sensitivity. This is essential to identify the specific pathogen and determine the appropriate antibiotic treatment.

D. Explain the purpose of a low bacteria diet. While a low-bacteria diet is often recommended for immunocompromised patients, it is not a priority in this scenario, where infection management and isolation precautions are more urgent.

E. Use standard precautions and wear a mask. Standard precautions should always be used, but a mask is not necessary unless the client has respiratory symptoms, which is not indicated in this case.

A. Assess the client's pain: The client has experienced significant trauma, undergone surgery, and may be in pain or discomfort as she regains consciousness. Pain assessment is crucial for adequate pain management and to prevent agitation or hemodynamic instability.
B. Increase the propofol infusion: Increasing sedation should not be the first response. Instead, assess the client’s pain and agitation, and if necessary, adjust sedation based on clinical need and provider recommendations.
C. Notify the social worker the client is awake: A social worker may be involved in care planning, but waking up does not require immediate notification.
D. Have the client sign consent forms for procedures already performed: If the client was incapacitated at the time of previous procedures, consent was likely obtained from a legal surrogate. Retroactive consent is not legally valid.
E. Consider extubating the client: The decision to extubate should be based on respiratory assessments, arterial blood gas (ABG) results, and overall stability, not just the client waking up.
F. Determine the client’s decision-making ability: As the client becomes more aware, it is important to assess cognitive function and orientation to determine if she can participate in decisions regarding her care. If the client is alert and coherent, she may be able to provide informed consent for further treatments.
G. Decrease the noise and light stimuli in the room as much as possible: Critically ill patients can become disoriented and agitated as they wake up. A calm environment helps reduce stress and delirium, improving recovery and promoting rest.
H. Explain all procedures: The client is waking up in an unfamiliar environment (intubated in the ICU), which can be frightening and disorienting. Explaining procedures provides reassurance and can help reduce anxiety and agitation.