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Question 15
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Natasha is a 32-year-old female African American patient arriving at the surgery oncology unit status post left breast mastectomy and lymph node excision. She arrives from the post-anesthesia unit (PACU) via hospital bed with her spouse, Angelica, at the bedside. They explain that a self-exam revealed a lump, and, after mammography and biopsy, this surgery was the next step in cancer treatment, and they have an oncologist they trust. Natasha says, "I wonder how I will look later since I want reconstruction." After screening and assessing the patient, the nurse finds she is AAOx4 (awake, alert and oriented to date, place, person and situation). The PACU staff gave her ice due to dry mouth which she self-administers and tolerates well. She has a in her right hand. She states her pain is 2 on a scale of with 10 being the highest. Her wife asks when the patient can eat and about visiting hours. Natasha also asks about a bedside commode for urination and why she does not have a "pain medicine button". Another call light goes off. The nurse heard in report about a Jackson-Pratt drain but there are no dressing change instructions, so she does not further assess the post-op dressing situation in order deal with everything going on at the moment. She then sits down to document this patient. Medications ordered in electronic health record but not yet administered by PACU: Tramadol . Prn for mild to moderate pain. Oxycodone PO q 4 hrs. Prn for moderate to severe pain (5-7 on 1-10 scale) Fentanyl 25 mcg IV q3hrs. Prn For breakthrough pain (no relieve from PO meds or greater than 8 on scale) Lactated Ringers IV infusion, continuous liters Naloxone 0.4-2 IV/IM/SC; may repeat q2-3min PRN respiratory rate less than 6 bpm; not to exceed BP on Room Air HR 68bpm and regular Ht RR Wt Temp EBL CBC-WNL BMP Potassium - 1. What education should be provided to the patient regarding post-op medications? 2. What are some concerns, if any, about the patient at this time? Should anything be communicated to the surgeon? 3. What are some ways to prevent infection on a post-surgical patient? Please describe how you can educate the patient on these ideas for prevention.
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