SV_GI_____Patient_THAO

Lou Thao is a 43-year-old Vietnamese American male who has just been transferred from the postanesthesia care unit (PACU) to the medical-surgical unit for recovery following laparoscopic sigmoid colon resection. The sc ...

Lou Thao is a 43-year-old Vietnamese American male who has just been transferred from the postanesthesia care unit (PACU) to the medical-surgical unit for recovery following laparoscopic sigmoid colon resection. The scenario takes place on Tuesday at 1930, at which time Lou is hypotensive and tachycardic. During this scenario, students will have the opportunity to assess and manage care for a postoperative patient experiencing hypotension due to fluid volume deficit. Your goals as nurse care giver:  Conduct a focused postoperative assessment  Provide individualized teaching  Notify provider of patient status change using SBAR  Recognize abnormal findings:  Prioritize and implement appropriate interventions:  Initiating 1000 mL normal saline IV fluid bolus per order  Recognize and promptly treating physiologic changes  Follow the 6 rights of medication administration  Evaluate patient's responses to interventions  Evaluate effectiveness of communication and teaching  Access patient data, including prior care  Document care in the electronic health record (Use Word to create nursing documentation as you go through scenario) Location: Inpatient, Medical-Surgical Unit Patient name: Lou Thao Medical record #: 7349185 Date of birth: April 17 Age: 43 Sex: Male Admitting provider: Robert Preston, MD Scenario start day: Day 1, Tuesday Scenario start time: 1930 Chief complaint upon admission: Diverticulitis Primary diagnosis: Diverticulosis with chronic diverticulitis Secondary diagnosis: Hypothyroidism Patient: Lou Thao Lou Thao is a 43-year-old Vietnamese American male who has just been transferred from the postanesthesia care unit (PACU) to the medical-surgical unit for recovery following laparoscopic sigmoid colon resection. The scenario takes place on Tuesday at 1930. During the scenario, Lou is experiencing fluid volume deficit and has low blood pressure and an increased heart rate. He is dizzy, thirsty, and groggy. He feels scared and vulnerable. He explains his symptoms very clearly but has no idea what is going on. His wife May is at the bedside and is supportive. She voices concern regarding Lou's condition. Patient response guide: Explain each of these developments, why they have occurred, and necessary management. General  Please call me Lou.  My birth date is April 17.  I don't have any allergies. During initial assessment Lou is experiencing fluid volume deficit. He is also beginning to experience postoperative pain, but his primary complaints are related to fluid deficit. Until fluids are given, Lou should express worsening dizziness, thirst, and weakness.  I am dizzy and feel like I could pass out. The room is spinning around.  I feel groggy.  I am very thirsty.  I don't feel right.  Oh! I am so dizzy. Lou's pain increases throughout the scenario.  The pain is about 6 on a 10-point scale and constant.  It hurts when I breathe deeply. It especially hurts in my lower abdomen.  My pain is getting worse. Is the anesthetic wearing off?  The nurse in the recovery area told me I would get to use a button to give myself pain medication. Can you give me that now? If IV fluid bolus is initiated Why does he have these responses?  I feel less dizzy.  What is going on? Why did I feel so strange? If IV fluid bolus is NOT administered Why does he have these responses?  Oh! I am so light-headed! I think I'm going to faint! Lou becomes unresponsive.  Time: 1930-1939 Physiologic State 1 T = 97.4 F (36.3 C) BP = 78/42 P = 132 RR = 22 O2 Sat = 95% (2 L/min via nasal cannula)  Heart sounds: Regular  Lung sounds: Clear  Bowel sounds: Absent  Pulses: 1+ bilaterally  Pain: 6/10  Lou states, "I am dizzy and feel like I could pass out. The room is spinning around. I am very thirsty." Situation/Transition Lou Thao is lying in bed with the head of bed at 15 degrees. He is alert and oriented but groggy after surgery. He is complaining of dizziness, weakness, and light-headedness related to fluid volume deficit. Vital signs indicate hypotension and tachycardia. Urine in indwelling catheter bag is concentrated and amber. Lou's anxious wife is in the room asking many questions. When notified, the provider gives the following orders:  Administer 1 liter normal saline bolus x 1 now over 1 hour.  I'll be in to evaluate him shortly.  Call me immediately if he gets worse before I get there.  I'll enter the order in the EHR. Expected Student Performance 1. Conducts initial and focused assessments. 2. Recognizes abnormal findings: Pulse is high, BP low, RR high, O2 kind of low, bowl sounds absent, 1+ bilaterally pulses, pain 6, pt states being dizzy, and thirsty. 3. Notifies provider of patient status using SBAR: S: Mr. Lou is groggy, coma playing of dizziness , weakness, and light headedness B: Lou Thao is a 43-year-old Vietnamese American male who has just been transferred from the postanesthesia care unit (PACU) to the medical-surgical unit for recovery following laparoscopic sigmoid colon resection. A: vital signs indicate hypotension and tachycardia, urine is concentrated and amber due to fluid volume deficit R: push fluids and monitor 4. Describe use of therapeutic communication with patient and wife: Prioritize the physical , mental and emotional well being of the pt , provide with support and information while maintaining a level of professional distance and objectivity.