NURS 111 PVD with amputation Exam. Columbia University. Complete Solution

Legal Issues The client has no identification on his body. The police are unable to locate anyone who knows his full name, but another homeless man tells the police the client goes by "Hans." Upon admission to the emergency room it is determined Hans needs immediate surgery to amputate his right leg above the knee. The nurse caring for Hans has no way to contact family to obtain informed consent for the surgery, and Hans has not regained consciousness. 1. What action will the nurse implement first since informed consent cannot be obtained? A) Call the operating room (OR) department and inform them the surgery cannot be done at this time. INCORRECT The nurse does not make this determination. B) Request that the police department find some of Hans’ family members immediately. INCORRECT The police can try to find family members, but this is not the best initial nursing action. C) Contact the legal department of the hospital to appoint a legal guardian for Hans. INCORRECT This is not the responsibility of the legal department of the hospital. Social services could attempt to do this, but it is not the most immediate priority. D) Prepare Hans for surgery and document that no family member is available. CORRECT When surgery is emergent, the surgeon may operate without informed consent. Therefore, the nurse should first prepare Hans for immediate surgery. Points Earned: 0.0/1.0 Correct Answer(s): D Perioperative Care Hans has on an old Timex watch and a ring on his left index finger. 2. What must the nurse do with Hans' personal items? A) Place the items in a bag with his name on it, and put the bag under the stretcher. INCORRECT This is not a secure place to put Hans' personal items. B) Request that the police remove the items and take responsiblity for them. INCORRECT The police are not responsible for taking Hans' personal items. C) Assign two nurses to place the items in a bag and place them in the hospital safe. CORRECT Two nurses must describe the items, document on the outside of the valuables bag, and place the bag in the hospital safe since there is no family member to take responsibility for the items. D) Place a piece of tape over the items and allow Hans to wear them to surgery. INCORRECT All jewelry should be removed prior to taking Hans to surgery. Points Earned: 0.0/1.0 Correct Answer(s): C Hans' right leg is marked in the ER to ensure that the correct site is operated on. Because he is unconscious, he is not able to participate in this activity. When Hans arrives in the OR, he is positioned on the operating table, intubated, and given general anesthesia. A "time out" is called by the circulating RN. 3. What is the purpose of the "time out?" A) To allow the operating team time to scrub and gown. INCORRECT This is not the purpose of the "time out." B) So the anesthesiologist can wake the client up to ensure the correct procedure is being done on the correct person. INCORRECT This is not the purpose of the "time out." C) As a signal for the scrub nurse or certified scrub technician to perform an instrument and sponge count. INCORRECT Although a count will be done, this is not the purpose of the "time out." D) So all members of the OR team participate in the positive identification of the client, identify the correct site, and identify the planned procedure. CORRECT The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandates the surgical "time out" to ensure client safety. All team members should actively communicate that the patient, procedure, and site are correct. This activity should take place in the location where the procedure will be done. It may occur prior to anesthesia induction, or after anesthesia commences, but before starting the procedure. The client is not expected to participate. In addition, this is a time for the OR crew to ensure that all equipment needed for the case is available and ready. Points Earned: 1.0/1.0 Correct Answer(s): D The operating room nurse asks the surgeon, "What does the client want done with the amputated extremity?" The surgeon informs the operating room nurse that the client was unconscious upon admission and has no family members. 4. What will the operating room nurse do with the amputated limb? A) Place the amputated limb in a biohazard bag and place it in the trash. INCORRECT The amputated limb cannot be disposed of in this manner. B) Keep the limb in the morgue until Hans can tell the staff what to do with the limb. INCORRECT The amputated limb cannot be disposed of in this manner. C) Ensure that the limb is sent to the incinerator so that it can be burned. CORRECT Amputated limbs are disposed of in this manner. If the client makes special requests due to cultural needs, this must be discussed and arranged prior to the surgery. However, Hans was unconscious upon admission and no family members were present, therefore, standard hospital protocol applies. D) Ask the surgeon to prescribe action to be taken regarding the amputated extremity. INCORRECT The nurse can follow the hospital policy when disposing of amputated extremities without the surgeon's prescription. Points Earned: 0.0/1.0 Correct Answer(s): C