Reference no: EM133226754

Question - Eduardo Lopez, an 82-year-old Hispanic male who speaks limited English, was admitted to the hospital through the emergency department. He fell on an icy patch outside his home and sustained a fracture to his right femoral head of the hip. He has a history of type 2 diabetes mellitus and has a 60-pack-per-year smoking history that is now complicated by chronic obstructive pulmonary disease. He was just transferred from the OR to the PACU, status post internal fixation repair.

Physical exam reveals BP 166/94, diaphoretic and pale skin, R 36 with crackles and expiratory wheeze, thick white sputum noted. Spo2 87%. Pain rated as 10/10 and not relieved with morphine PCA.

Diagnostic studies: Hematocrit 30%; hemoglobin 15 g/dl; WBC 15,000/µl.

PACU Physician Orders

Vital signs per routine, continuous SPo2 and cardiac monitoring

LR at 100ml/hr for 4 hours

Cefazolin (Ancef) 1 g IV once now and again in 12 hours

Supplemental O2 titrated to maintain Spo2 >92%

Intake and output for 48 hours postoperatively

Morphine sulfate per patient-controlled analgesia pump

Zofran 8mg IV every 6 hours PRN nausea

Advance diet as tolerated

Up to bedside commode with assist in a.m.

Physical therapy

Questions -

1. What are your priority PACU nursing assessments, by body system and with rationale? (Do not say a full head to toe.)

2. What are the most likely complications this patient is experiencing and why?

3. What might be the cultural considerations specific to this patient's care?

4. What specific nursing interventions will you implement immediately?

5. Perform a full Situation, Background, Assessment, Recommendation (SBAR) report to the surgeon updating him on the patient's condition.