Mr. Bane Ka’uhane is a 66-year-old male admitted to the surgical unit with a diagnosis of abdominal mass.

• Mr. Bane Ka’uhane is a 66-year-old male admitted to the surgical unit with a diagnosis of abdominal mass. He has been complaining of vague symptoms

for the past 3 months. These symptoms include inter- mittent indigestion, abdominal pain, and constipa- tion. His medical history includes COPD, PVD, and insulin-dependent diabetes mellitus. He takes the following medications at home:

• • Prednisone (Sterapred) 10 mg PO daily
• • Insulin glargine (Lantus) 24 units SQ at 2200
• • Ipratropium (Atrovent) inhaler 2 puffs QID
• • ASA (Ecotrin) 81 mg PO daily

The nursing assessment/history done on admission includes the following data:

Objective data:

• • Wt/Ht: 213# 70 inches
• • VS: BP 140/88 – 84 – 20 – 97.8
• • Lungs: clear with intermittent expiratory wheeze

left lower base

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• • CV: HR 84 beats/min and regular weak dorsalis pedis pulses bilater- ally, skin warm and dry, feet cool to touch
• • GI: Abdomen round, distended, active bowel sounds
• • GU: Voids adequate amounts of clear yellow urine
• • Allergy: Betadine Subjective:
• • “I’m coming in to find out what’s going on in my belly.”
• • “I’m sure it’s something fixable.”
• • “I don’t want my wife to worry about me; I am not sure she is going to be able to handle all of this.”
• • “I keep my sugar pretty well normal. My breathing problems give me more trouble.”

Mr. Ka’uhane is scheduled for an exploratory laparotomy at 0800 in the morning.

His preoperative orders include:

• • Labs: CBC with differential and a comprehensive metabolic panel
• • NPO at 0600 and begin IV of 1000 NS at 50 mL/hr
• • Prep abdomen with Phisohex scrub × 3. Cover abdomen with sterile towel after prep completed
• • Have permit signed: I have discussed the surgical procedure/risks/expectations/ outcomes
• • Consult Pulmonary Services, re: Respiratory status
• • Pre-op medications:
• • Atropine 0.4 mg with Demerol 50 mg IM on call to OR
• • Nembutal 25 mg IM on call to OR
• 1. In reviewing Mr. Ka’uhane’s orders, which order should be questioned by the nurse?
• • 2. Based on knowledge of his underlying medical problems and risks associated with age, how could these problems and risks affect the perioperative experience?
  • 3. How might Mr. Ka’uhane’s routine meds place him at a higher surgical risk?
  • 4. Based on the subjective data, identify the priority nursing diagnosis to meet the psychosocial needs of Mr. and Mrs. Ka’uhane.
  • 5. You are completing pre-operative teaching regarding the routine nursing measures that Mr. and Mrs. Ka’uhane can expect during the post-operative period. How should you respond to the following questions? (You may need to review what an exploratory laparotomy is to help with this answer.)
  • 6. You are completing the pre-operative checklist. What is the last clinical procedure to be completed before administration of the pre-op medications?
  • 7. What physiological effects can you anticipate secondary to the pre-op medications?

  Mr. Ka’uhane is transferred to the OR table and readied for surgery.

  • 8. Discuss the importance of the Patient Safety Goals and the World Health Organization’s (WHO) Surgical Safety Checklist in preventing mistakes in surgery.