PREOPERATIVE NURSING

APPLICATION EXERCISES

SCENARIO: A 75 YEAR OLD MALE CLIENT IS SCHEDULED FOR SURGERY FOR THE
REMOVAL OF THE ISCHEMIC BOWEL. HE HAS A PAST MEDICAL HISTORY OF
HYPERTENSION, TYPE 2 DIABETES MELLITUS, AND HYPOTHYROIDISM.

1. Which of the following preoperative client findings should be reported to the client's
primary care provider? (SATA) 
_______Potassium level of 3.9 mEq/L
_______ Sodium level of 145 mEq/L
____X__ Creatinine level of 2.8 mg/dL
____X___ Prothrombin time of 23 sec. 
____X___ Glucose level of 235 mg/dL
____X____ White blood cell count of 17,850/mm3

Potassium level and Sodium level are within NORMAL RANGE.

The typical reference range for serum creatinine is 60 to 110 micromoles per liter
(mmol/L) (0.7 to 1.2milligrams per deciliter (mg/dL)) for men. Elevated creatinine
level signifies impaired kidney function or kidney disease. As the kidneys become
impaired for any reason, the creatinine level in the blood will rise due to poor clearance
of creatinine by the kidneys. Abnormally high levels of creatinine thus warn of possible
malfunction or failure of the kidneys.

The average time range for blood to clot is about 10 to 14 seconds. A number higherthan

that range means it takes blood longer than usual to clot.

Normal blood sugar levels are less than 100 mg/dL after not eating (fasting) for at least
eight hours. And they're less than 140 mg/dL two hours after eating. During the
day,levels tend to be at their lowest just before meals.Hyperglycemia means high (hyper)
glucose (gly) in the blood (emia). Your body needs glucose to properly function. Your cells
rely on glucose for energy. Hyperglycemia is a defining characteristic of diabetes—when
the blood glucose level is too high because the body isn't properly using or doesn't make
the hormone insulin.

The normal range for the white blood cell count varies between laboratories but is

usually between 4,300 and 10,800 cells per cubic millimeter of blood. This can also be
referred to as the leukocyte count and can be expressed in international units as 4.3 -
10.8 x 109 cells per liter. A high white blood cell count isn’t a specific disease, but it can
indicate another problem, such as infection, stress, inflammation, trauma, allergy, or
certain diseases. That’s why a high white blood cell count usually requires further
investigation. 
 2. The morning of the procedure, the nurse records the client's vital signs and
completes an assessment. The nurse finds that the client's temperature is 38.4
degrees celsius. What interventions should the nurse perform?
The nurse should notify the surgeon.

If a patient begins to feel ill or has a fever in the days preceding surgery, the surgeon
needs to be made aware. The surgeon may decide it is safe to continue with surgery or
may optional to postpone the procedure. A fever is a sign of possible infection and should
be disclosed, to prevent wasted time and energy for both the patient and the surgeon.

A patient who presents at the hospital for a scheduled surgery unaware that they have a
fever may be sent home and the surgery appointment changed.

3. What are the nurse's responsibilities regarding informed consent for the procedure?
All clients have the right to be fully informed about their medical condition and they also
have the innate right to knowledgeably consent to or reject all care and proposed
treatments.

Informed consent is defined as the patient's choice to have a treatment or procedure which
is based on their full understanding of the treatment or procedure, its benefits, its risks,
and any alternatives to the particular treatment or procedure. All clients have the legal right
to autonomy and self-determination to accept or reject all treatments and interventions.

As nurses, we deal with informed consent a lot—on admission to a hospital/clinic or before

a procedure/surgery. Nurses typically are assigned the task of obtaining and witnessing
written consent for healthcare treatment. 

Nurses must be able to explain and inform the patient about the risks, benefits, and
alternatives to a treatment. Nurses must secure a signature on the consent form to provide
legal documentation.

Ethically, consent is about patient autonomy, meaning the patient understands and freely

agrees to the treatment.
 
Consent may be withdrawn at any time. Healthcare providers must accept and support
refusal or withdrawal of consent even if they disagree with the patient.