1. : Med Surge
Topic: Med SurgeMed-Surg II Final Case Study AssignmentMr. Jones a 68 yo male with a
PMHx significant for COPD, IDDM, HTN, and CH.F. He was admitted on 412105 through the
ER with c/o abdominal discomfort. A CT scan revealed a large small bowel
obstruction(SBO) r/t a tumor.His home medications included: Metoprolol, Lisinopril,
Glucophage, and Atrovent inhaler. You receive him from the PACU after his Exploratory Lap
colon resection.PACU report: AOx3, VS RR 28, HR 86 in A-Fib, BP 110170, T 97.5 02 sat 94%
on 3LNC. Lungs: clear, diminished at the bases.GI: No bowel soundsGU: Has a foley to
gravity at bedside.EBL in OR was 500CC. Patient has 2 JP drains yielding small amounts of
bloody drainage.Has an NGT to LCWS yielding green drainage.Pain currently 2110. Has a
Fentanyl/Bupivacaine epidural lwith a basal of 6ml/hr, pt dose of 2ml QlOmin with a l hour
limit of 18mlper hour.IV of D51/2NS + 20KCL@ 125ml/hr, 18# RAC.H/H: pre-op 13.2/ 38,
post-op 11.3/ 30.2.1. What are the key assessment parameters for this patient?2. What are
your nursing priorities going to be (postoperative interventions) and what lab values will
you focus on and why?3. He is on both a beta blocker and an ACE inhibitor, why and what is
the rationale for this treatment regimen?4. His pain is being managed by an epidural CADD
pump. What is this method and what are your key assessment parameters? How do your
findings impact on patient care?5. His accu check in 300, what are three nursing
interventions?6. You check his echo report and it stated his Ejection Fraction is 25%. What
does this mean and how does this impact your plan of care? Provide one complete Nursing
Diagnosis with possible interventionsYou have Mr. Jones the next morning. In report you
hear that his pain remains controlled with the CADD pump. His abdomen is firm and
moderately distended. His NGT put out 300cc and he had only 150cc in his foley in 8 hours.
His temperature is 99. 0. His BP remains in the 110’ ’ s/60-70’ s, but his HR ranges from
90-120. You assess him, his BP is now 80/ 40, HR 130, and T 103. 02 sats are 86% on
2LNC.7. Reassessment: What is causing the increase in heart rate and why did his pressure
suddenly drop? What should your priorities be and what will you do? What orders would
you expect to receive?8. His H/H is 7.8/24.4. You receive as order to transfuse 2 units
PRBC’ s. How much would you expect his hematocrit to rise?9. In between the 2 units, you
note an increase in wheezing, increase in dyspnea, and 1+ edema in the lower extremities.
What is happening? What orders would you expect to receive from the MD and why?10. His
1130 BGM is 200. What are your appropriate nursing actions? What factors can impact on
BG levels?11. You re-assess him at 1400, his color is pale, his temperature is 102, he is cool
and clammy. You review his labs and note an elevated WBC. What is happening? How do
2. you know? What should you do and what orders would you expect?Books to cite: Medical
surgical nursing ninth edition by lewis dirksen and Heitkemper BucherComprehensive
Review for the NCLEX-RN examination edition 3The Basics (Kaplan nursing)
