When a patient with asthma who is on a budesonide hand-held inhaler reports difficulty, what should the nurse do?

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.
• The surgical team completes the time-out procedure.
• The surgeon states the estimated blood loss at 300 ml.
• The anesthesiologist reports a stable blood pressure of 120/64.

Postoperative Care:

• Mr. Smith is transferred to the Post Anesthesia Care Unit (PACU) for close monitoring of his recovery from anesthesia.
• Once fully recovered from surgery, Mr. Smith is transferred to the orthopedic unit where the orthopedic unit nurse starts the ordered morphine PCA.

Which medication should be held before surgery? Select all that apply.

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.

Who is responsible for documenting the patient's vital signs during the intra-operative period?

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.

Which pre-op abnormal lab value would be the most concerning?

Your spinal cord injury (SCI) patient complains of a throbbing headache and nausea. You observe the patient has marked diaphoresis, and you think the patient may have autonomic dysreflexia. Place the following interventions in the order you would complete them.

Neurologic Case Study

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus
• Medications: Lisinopril, Metformin
• Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Which condition is the patient most likely experiencing?

Patient Profile:

• Age: 68 years
• Gender: Male
• Medical History: Hypertension, Type 2 Diabetes Mellitus
• Medications: Lisinopril, Metformin
• Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Choose two actions the nurse should take to address the condition identified in the previous question.