NU371 WEEK 3 HESI CASE STUDY: ADVANCED CARDIAC LIFE SUPPORT (ACLS): SEPSIS - 25 QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED

NU371 WEEK 3 HESI CASE STUDY: ADVANCED CARDIAC LIFE SUPPORT (ACLS): SEPSIS - 25 QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED Terms in this set (30) A 68-year-old client who is admitted to the medical-surgical unit with acute cholecystitis and is scheduled for a laparoscopic cholecystectomy in the morning. He is ambulatory without the use of an assistive device. His medical history includes hypertension (HTN) and type 2 diabetes mellitus (DM). His surgical history consists of an appendectomy in childhood and he reports no complications. He is independent and lives with his spouse in a retirement community. Client reports that he has not eaten in the last two days due to nausea, vomiting, and abdominal pain. The client is alert and oriented x3. His lungs are clear bilaterally, heart sounds are regular, and bowel sounds are active in all quadrants. His skin is intact and blood glucose is 124 mg/dL (6.88 mmol/L). Vital signs § Temp 97.6° F (36.4° C) § Heart Rate 92 beats/min § Respirations 18 breaths/min § Blood pressure 138/88 mmHg Admission lab results § WBC 16,000 /ul (16.0 x 109/L) § Albumin 3.0 g/dL (30 g/L) § BUN 24 mg/dL (8.57 mmol/L) § Creatinine 1.6 mg/dL (122.0 umol/L) § HgA1C 7.0% (53 mmol/mol) Preoperative Prescriptions § Activity as tolerated § Diet NPO except medications § Sodium chloride 0.9% at 125 mL/hour § Ondansetron 4 mg IV every 4 hours prn nausea/vomiting § Acetaminophen 650 mg po every 4 hours prn fever/mild pain § Hydromorphone 0.5 mg IV every 4 hours severe pain § Metoprolol 25 mg po twice daily § Metformin 500 mg po twice daily Section 1 The nurse is aware that the older adult client is at an increased risk for surgical complications due to normal physiological functions and comorbidities. Which risk factors place the older adult client at increased risk for surgical complications? o Decreased respiratory muscle strength. o Increased glomerular filtration rate. o Enhanced elasticity of the arterial walls. o Rigidity of the arterial walls increases the client’s risk for complications. o Decreased respiratory muscle strength. · A decrease in respiratory muscle strength predisposes the older client to postoperative respiratory complications. Upon completing the client’s assessment, the nurse determines that the client has which surgical risk factors? Select all that apply o Metoprolol. o Poor appetite. o Diabetes Mellitus. o Albumin 3.0 g/dL (30 g/L). o Marital status. o Metoprolol. · Metoprolol has the potential to increase the risk of bradycardia when used in conjunction with anesthetics. o Poor appetite. · Poor appetite places the client at risk for surgical complications due to inadequate nutrition. o Diabetes Mellitus. · Preexisting conditions, such Diabetes Mellitus (DM), increase the client’s risk for surgical complications. o Albumin 3.0 g/dL (30 g/L). · Low albumin places the client at risk for surgical complications. What is the priority preoperative nursing action to prevent postoperative atelectasis? o Administer pain medication as needed. o Instruct on incentive spirometer use. o Obtain baseline pulse saturation. o Turn and position every 2 hours. o Instruct on incentive spirometer use. · The nurse should teach the client how to use an incentive spirometer in the preoperative period to help decrease risk of atelectasis. The nurse should also ensure that learning has occurred through client verbalization and return demonstration. Which is the likely reason for the elevated serum creatinine in the absence of kidney disease? o Anemia. o Hypertension. o Increased pain. o Dehydration. o Dehydration. · Dehydration can temporarily increase creatinine. The client is aware that he needs to cough, take deep breaths, and use the incentive spirometer in the postoperative period. He is prepared for surgery and his spouse is sent to the surgical waiting area while the client is transferred to the operating room. Upon attempting the laparoscopic cholecystectomy, the surgeon discovers that the client’s gallbladder is necrotic, resulting in the surgeon performing an open cholecystectomy. The client is transferred to the post anesthesia care unit (PACU) where he is extubated. The nurse is caring for the client who has just been extubated. What should the nurse do first, after the client is extubated? o Administer supplemental oxygen. o Auscultate bilateral lung sounds. o Encourage cough and deep breathing. o Notify the spouse of extubation. o Administer supplemental oxygen. · Administering supplemental oxygen allows for adequate perfusion.