Dela Cruz, Maria Stephany R.

BSN3A1 - 5S
Medical and Surgical (RLE)

Case Study:
Mrs. Campana has just been transported to your surgical nursing division from the PACU. She is 80
years old and had a right colectomy (right-sided large bowel resection) for removal of tumor. Vitals signs were
stable in the PACU. Receive her via a stretcher, T-36.8 C, PR- 86bpm, RR- 22cpm, BP- 130/80mmmHg.
Contraptions are the following: O2 regulated @ 4L/min, nasogastric tube connected to bedside bottle with
greenish output @50cc, an ongoing IV line of D5LR1L received at 750cc level regulated at 125cc/hr. Infusing
well at her (right basilic vein) arm, and a Foley catheter connected to a urine bag. She received a total of 5mg
of morphine sulfate IV in the PACU and now has morphine patient- controlled analgesia with a demand dose of
1mg every 10 minutes connected to her IV line. When you assess her, seems to respond slowly in queries,
with facial grimace and guarding her operative site.

1. Describe the condition of Mrs. Campana.

➔ Ms. Campana may be slow to respond because she was receiving an opioid pain
reliever in the PACU and therefore has a tendency to metabolize opioids slowly as she
is 80 years old and older adults metabolize to opioids more slowly. So we have to adjust
her morphine to a lower dose. she may experience a delay in renal clearance of
surgically administered anesthetics relative to her lower morphine dose.

2. What are your priority assessment findings upon receiving Mrs.

Campana’s? What is your nursing diagnosis & nursing assessment?
➔ My main assessment of Ms. Campana's current decreased responsiveness is that I
should always monitor her vital signs, particularly her pulse, to immediately confirm that
the patient is not hypoxemic. I must also evaluate the results of the neurological
examination to be able to determine if there are any abnormal results related to
orientation, pupillary response, gag reflex and movements of all extremities in order to
eliminate a neurological event that causes a decrease in capacity. response. You can
also reduce the PCA dose or temporarily stop the medication until Ms. Campana
becomes more excitable. If you find any unexpected or normal findings, simply notify
the appropriate nurse or surgeon.

3. Mrs. Campana’s daughter enters the room and seems to be very concerned
about her mother’s current condition. How will you respond in this
situation?
➔ When the daughter enters the room, I will provide factual information here about her
mother's vital sign results, oximetry, and any laboratory results from her mother. I will
explain the reasons for the normal postoperative sleepiness in patients, related to
anesthesia administered in the operating room and opioids in the PACU. I will also give
instructions on her mother's medication. Finally, give the teachings so that the daughter
and mother know what to do if an emergency arises.