Perioperative Nursing: An unfolding Case study in Patient Safety by Gerry Altmiller,EdD, APRN, ACNS-BC, FAAN

Perioperative Nursing: An unfolding Case study in Patient Safety by Gerry Altmiller,EdD, APRN, ACNS-BC, FAAN The Case: John Egan, 53. Hx of Type 1 diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound of his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletal 100mg BID. He has an advanced directive and NKDA. Identify the priority nursing care for Mr. Egan: Identify what he needs done before he can go to surgery safely. What preoperative testing is appropriate for Mr. Egan? When completing a medication reconciliation for Mr. Egan the evening before surgery, what in the following orders cause the nurse concern? • Insulin 6 u Regular with 15 u NPH sub- cutaneous q am. • Aspirin 325mg PO qd. • Cilostazol (Pletal) 100mg PO BID • Lorazepam .5mg IVP on call to OR in AM. • The Joint Commission Do Not Use Abbrevi ation List When completing a medication reconciliation for Mr. Egan the evening before surgery, what in the following orders cause the nurse concern? • Insulin 6 u Regular with 15 u NPH sub- cutaneous q am. • Aspirin 325mg PO qd. • Cilostazol (Pletal) 100mg PO BID • Lorazepam .5mg IVP on call to OR in AM. • The Joint Commission Do Not Use Abbrevi ation List ...................................................continued....................................................