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Patient Profile:

  • Name: Mr. John Smith
  • Age: 68 years
  • Medical History: Osteoarthritis of the hip, Type 2 diabetes, hypertension, and atrial fibrillation
  • Current Medications: Lisinopril, Metformin, Warfarin
  • Surgical Procedure: Total hip replacement (THR) due to severe pain and limited mobility.

Preoperative Care:

  • The nurse conducts a comprehensive assessment, including a physical examination, vital signs, and a review of Mr. Smith's medical history.
  • Preoperative labs are ordered with the following abnormal values noted:
    • Complete Blood Count (CBC):
      1. Hemoglobin: 12.0 g/dL (normal range: 13.5-17.5 g/dL)
      2. Hematocrit: 36% (normal range: 38.8-50%)
    • Basic Metabolic Panel (BMP):
      1. Serum Creatinine: 3 mg/dL (normal range: 0.6-1.2 mg/dL)
      2. Blood Urea Nitrogen (BUN): 24 mg/dL (normal range: 7-20 mg/dL)
    • Coagulation Studies:
      1. INR: 5 (normal range: 0.8-1.1)

Intraoperative Care:

  • The scrub nurse assists in positioning Mr. Smith on the operating table.

During the post-op period, what four potential complications should be monitored?

A.

Dementia

B.

VTE

C.

Fluid overload

D.

Infection

E.

Unrelieved pain

Answer and Explanation

Correct Answer : B,C,D,E

Choice A reason: Dementia is not a typical complication directly related to the post-operative period of a total hip replacement. While elderly patients may have underlying cognitive issues, dementia is not considered a direct post-op complication.

Choice B reason: Venous thromboembolism (VTE) is a common post-operative complication, particularly in orthopedic surgeries like total hip replacement. Due to immobility and surgical stress, patients are at higher risk for blood clots forming in the veins, which can be life-threatening if they travel to the lungs.

Choice C reason: Fluid overload can occur due to the administration of intravenous fluids during surgery. Monitoring for signs of fluid overload, such as swelling, shortness of breath, and increased blood pressure, is crucial to ensure proper fluid balance and prevent complications like heart failure.

Choice D reason: Infection is a significant risk after surgery, especially in procedures like total hip replacement. Monitoring for signs of infection, such as fever, increased pain, redness, swelling, and drainage from the surgical site, is essential to detect and treat infections early.

Choice E reason: Unrelieved pain is a critical aspect to monitor post-operatively. Effective pain management is crucial for patient comfort, mobility, and recovery. Uncontrolled pain can impede rehabilitation and recovery, increasing the risk of complications.


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Related Questions

Correct Answer is C

Explanation

Choice A reason: Hypoglycemia typically presents with symptoms such as sweating, trembling, hunger, confusion, and in severe cases, loss of consciousness. The patient's symptoms of sudden right-sided weakness and difficulty speaking are more consistent with a neurological event rather than low blood sugar levels.

Choice B reason: Hemorrhagic stroke involves bleeding within the brain. Although it can present with similar symptoms to ischemic stroke, the diagnostic tests indicate no evidence of hemorrhage. This makes a hemorrhagic stroke less likely.

Choice C reason: Ischemic stroke occurs when a blood clot blocks a blood vessel in the brain, leading to reduced blood flow and oxygen to a part of the brain. The patient's symptoms of sudden right-sided weakness and expressive aphasia are classic signs of an ischemic stroke, and the absence of hemorrhage on the head CT scan supports this diagnosis.

Choice D reason: Multiple sclerosis (MS) is a chronic, progressive disease that affects the central nervous system. It usually presents with episodic neurological symptoms rather than the sudden onset seen in this patient. MS symptoms develop over time and can vary widely, whereas the patient's acute presentation is more indicative of a stroke.

Correct Answer is D,A,B,C

Explanation

Choice D reason: Elevating the head of the bed to 45 degrees is the first intervention the nurse should perform. This position helps lower the patient's blood pressure by promoting venous pooling in the lower extremities and reducing the return of blood to the heart. It also aids in better breathing and overall comfort.

Choice A reason: Checking the blood pressure is crucial in this situation to confirm if the patient is experiencing autonomic dysreflexia, which is characterized by a sudden and severe increase in blood pressure. This step helps in assessing the severity of the condition and guiding subsequent interventions.

Choice B reason: Obtaining a bladder scan is important because a full bladder is a common trigger of autonomic dysreflexia. By identifying and addressing the cause of the distension, the nurse can help alleviate the symptoms and prevent further complications.

Choice C reason: Notifying the doctor is a critical step, as autonomic dysreflexia is a medical emergency that requires prompt medical intervention. The healthcare provider can give additional orders and may administer medication to control the patient's blood pressure and relieve symptoms.

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