Question

After 8 hours on your unit, Ms. Schmidt is attempting to get out of bed and speaking about random things with an inability to focus on your questions. Her skin is hot, RR is 32, pulse is 102 and her BP is 140/78. The pulse ox alarm is going off and reads 89%. She keeps trying to take off her oxygen and the pulse ox probe. Her lungs have crackles bibasilar and in the right middle lobe. She has a nonproductive cough. She is not able to give a subjective pain level. Urine output is sufficient and her IV is intact. What is your next nursing intervention and what MD orders do you anticipate?

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Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient has a colostomy on her left (descending colon) abdomen. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson--Pratt drain intact with minimal serous sanguineous drainage present. The colostomy is not functioning at this time. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate, 110 bpm; respiratory rate, 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time.

Answer 1

Ans) Postoperative delirium – This is a temporary condition that causes the patient to be confused, disoriented, unaware of their surroundings, and have problems with memory and paying attention. It may not start until a few days after surgery, comes and goes, and usually disappears after about a week.

- Confusion is not uncommon after surgery, especially in the first few hours following surgery. General anesthesia, which renders the patient unconscious for the procedure and sometimes for hours afterward, is more likely to cause confusion than other types of anesthesia.

- Psychiatric complications during the course of surgical treatment are well recognized and may include psychosis, depression, mania, disruptive ward behavior or addiction. Postoperative psychosis is associated with increased morbidity and requires acute management.

- Teaching colostomy care- patient may need support.