SIM LAB ADMISSION Lou Thao Visit ^N 7 Scenario Post op colon resection

1. Identify competent nursing care for clients with chronic conditions, utilizing evidence-based practice guidelines (SLO 1,2,5). 2. Differentiate care needs of the elderly adult experiencing alterations in health (SLO 2,3,5). 3. Acknowledge legal and ethical issues in healthcare (SLO 3). 4. Prioritize nursing care for patients with chronic alterations in health (SLO 1.2.4.5). 5. Develop an individualized teaching plan for the client with the goal of improving and maintaining personal health (SLO 1,2,3,4). 6. Correctly calculate medication doses appropriate for the population (SLO 1,5). THOROUGHLY ANSWER THE FOLLOWING COMPREHENSIVELY and submit by 0730 the day before Simulation. Incomplete tickets will be returned for redo, and must be returned by the following week’s simulation. **ANSWERS MUST BE paraphrased AND CITE PROFESSIONAL source (Author, year, page). Textbook and NANDA are preferred sources. 1. In your opinion, based on understanding (through research) Buddhism and health care, how might Mr. Thao’s religion and culture affect health care decisions? a. Mr. Thao’s religion of Buddhism plays a major factor in his health care decisions because this religion is very strong minded and believes that if one is in pain that they should not receive much treatment. They believe that they are meant to experience things that happen to them and based off SBAR Mr. Thao does not want to get treated. 2. In a fluid volume deficit, what is the overall effect on labs -- increase or decrease)? Why? a. In a fluid volume deficit, the overall effect on labs would be a decrease because the body is experiencing abnormal loss of bodily fluids and this can be from diarrhea, vomiting, polyuria, or hemorrhaging, etc. (Harding, et al., 2020, p. 274). 3. List 3 possible causes of fluid volume deficit in the post-operative colon resection patient a. There can be an active bleed in the post-operative phase that can cause fluid volume deficit Patient Name: Lou Thao Visit #: 7 Scenario: Post op colon resection SLS: Medical Surgical GI # 24 Allergies: NKDA SIM LAB ADMISSION TICKET b. PONV can cause fluid volume deficit c. If the patient is sweating and in pain this can also lead to a fluid volume deficit as well d. (Harding, et al., 2020, p. 340). 4. Paraphrase your understanding of the pathophysiology of third-spacing. a. Third spacing is when there is fluid that accumulates in the areas where cells cannot push it back and it can accumulate where fluid is not supposed to be in such as the peritoneal space in the abdomen. This can occur with edema, pancreatitis, burns, trauma, etc. (Harding, et al., 2020, p. 272). 5. Using evidence-based research, how long are absent bowel sounds expected throughout in the post op GI patient? When do they return, in what order? How long is a low-grade fever expected? When should the nurse become concerned? a. Within the large intestine it can take 2-7 days for normal active bowel sounds to become present again and then with the small intestine it is several hours after surgery (Harding, et al., 2020, p. 340). With a low-grade fever, it should be expected of 100.4 of 1-2 days because the body is responding to stress the body just went under. The nurse needs to be concerned when the temperature has lasted anything greater than 3 or 4 days which will indicate an infection (Harding, et al., 2020, p.339). 6. Compare the symptoms of hemorrhage and third spacing following gastrointestinal surgery. How are they alike and different? Hemorrhaging would involve patient confusion, feeling light headedness, and having anxiety. Third spacing involves vomiting, diarrhea, and pain. It seems like these are alike because they both involve a huge decrease in patients vital signs and making the patient not feel good. As far as finding a difference I feel like when someone is losing blood then you start feeling very weak and confused which third spacing there is more local pain. (Harding, et al., 2020). 7. Create a Nursing Care Plan using template from (Canvas Module 1  Simulation Materials  General Information) Priority Problem Nursing Diagnosis (NANDA approved) R/T (Pathophysiology of diagnosis, cannot be medical diagnosis) AEB (of diagnosis) Refers to the problem/risk, NOT the R/T. This is assessment data Acute pain Incision Pain level of 6/10 Assessment Data Goal (One goal that is Nursing Interventions Rationale (Provide a Outcome Evaluation SIM LAB ADMISSION TICKET (Include at least three to five [total] objective, subjective, and/or historical pieces of data that would lead to the nursing diagnosis patient focused and SMART; Specific, Measurable, Attainable, Reasonable, and Time specific) (List three nursing and/or order driven interventions that relate to your goal) reason why each intervention is indicated and/or therapeutic, and provide reference for each in APA format, DO NOT COPY AND PASTE) (How will you know when the goal has been met? Provide specific data you will be assessing; what will your evidence be?) Patient has grimacing face expression’s Patient states pain level of 6/10 Patient has a Buddhist religion and causes patient to accept pain differently Patient will Have a pain level of 2/10 by the end of the shift RN will use therapeutic communication RN will provide hot and cold therapy RN utilize massage techniques for pain 1.Using a relaxation response can highly reduce pain and reduce stress levels from the pain (Wayne 2020). 2.Cold therapy reduces pain, inflammation, and muscle spasticity by decreasing the release of paininducing chemicals impulses and heat improves blood flow to the area to reduce pain reflexes (Wayne, 2020). 3. Massaging an area can reduce any edema and The goal was successfully met. The patient reported a pain level of 2/10 by the end of the shift. SIM LAB ADMISSION TICKET can interrupt the pain transmission to the brain (Wayne, 2020). 8. Look up the following medications and fill in the Medication Preparation Log Template (Canvas Module 1  Simulation Materials  General Information) 1 Ondansetron 4 mg IV direct (with dilution, rate in mg/minute) 2 Acetaminophen 1000 mg IV Piggy back. This is not a mistake; IV is correct. Calculate the rate in 100 mL using dimensional analysis) in mL/HOUR 3 Azithromycin 500 mg IV piggy back Show calculation in dimensional analysis) calculate rate in mL/HOUR a. 1:1 500 mg/500 mL x 3 hours b. 2:1 500 mg/250 mL x 1 hour MED LOGS INSERTED H