Nursing Case Study: Comprehensive Care for Mr. Hale's Surgical Needs

This nursing case study focuses on the comprehensive care of Mr. Hale, a patient undergoing several surgical procedures, including amputation, hernia repair, and cataract removal. The assignment details essential pre-operative preparations, such as removing dentures and contact lenses, confirming patient identity, and marking surgical sites. It also addresses the administration of medications like Versed and the importance of vital sign monitoring. The study emphasizes post-operative care, including assessing airway patency, managing pain, preventing complications like pressure ulcers, and addressing potential issues like urinary retention and respiratory difficulties. The case study highlights the significance of patient education, the use of incentive spirometry, and the monitoring of potential medication side effects. Overall, the assignment provides a detailed overview of nursing responsibilities throughout the patient's surgical journey, from pre-operative preparation to post-operative recovery and management of potential complications.

Running head: NURSING CASE STUDY 1
Nursing Case Study
Name
Institution

NURSING CASE STUDY 2
Nursing Case Study
It is appropriate for Mr. Hale to remove contact lenses. However, any dentures should be
removed and family member to hold personal items. He should be asked to void before surgery
and before anesthesia medications are offered. The bladder should be voided to prevent retention
of urine. A full bladder can prevent surgical view (Hovaguimian, et al., 2017). It is imperative to
consider recording some vital signs before surgery. Preoperative vital signs develop a baseline
for postoperative comparison.
When Mr. Hale arrives in the preoperative area, his identification can be confirmed
through checking his identification bracelet and inquiring his name and date of birth. These are
very crucial and safe ways to confirm his identity. The bracelet should contain the date of birth,
full names and assigned identification number. Three procedures would be needed to site mark
the surgical area. The left leg above the knee amputation should be marked at the level of
amputation. For the right inguinal hernia repair, the right side of the abdomen should be marked
(Hovaguimian, et al., 2017). However, for a cataract removal left eye, the skin area which is
adjacent to the left eye should be marked. Versed (midazolam hydrochloride) would perform
three tasks. It would promote muscle relaxation by causing depression of CNS.Secondly, it
would reduce the anxiety of Mr. Hale and finally offer amnesia of perioperative events
(Mortenson & Moriarty, 2015).In regards to the verbal report received from PACU, it should
entail the name of the surgical procedure which Mr. Hale had, it should have appropriate history
of Mr. Hale, the fluid status and IV therapy , the information concerning the anesthesia and drugs
which were administered details of any tube or drains and finally it should contain the condition
of the surgical incision of Mr. Hale.

NURSING CASE STUDY 3
The critical prioritized assessment which should be performed is airway for patency. The
breath sound should be auscultated immediately. Additionally, the next priorities are pulse and
blood pressure (Andrews et al., 2017). Blood pressure represents the adequacy of circulation and
output of cardiac. Evidence of cyanosis should be checked from different body parts. These
include nail beds, lips, are lops and palms of the hand. For Mr. Hale’s temperature, low body
temperature variation should be expected because preoperative patients usually possess low body
temperature which persists even after being discharged from PACU. Moreover, slide-lying is the
very appropriate position when the post-operative patient vomiting or unresponsive. At the
postoperative period, Mr. Hale would experience acute pain after the surgery especially if
medication is not continued. Also, self-care deficit; bathing/hygiene and impaired oral mucous
membrane apply to his care. Due to imposed immobility and difficulty in moving, the patient
would develop pressure ulcers hence risk for impaired skin integrity should help to avoid
pressure ulcers.
Normally, when urine output is less than 30ml per hour volume exhaustion with poor
renal perfusions should be informed. Nevertheless, decreasing blood pressure, tachycardia and
dry mouth are indicators of volume depletion. For Mr. Hale reluctance to utilize spirometer, it is
crucial to motivate him to utilize his incentive spirometer and cough (Washco et al., 2015). Also,
I should suggest his self-administer morphine prior to utilizing incentive spirometer. Because
Mr. Hale is using morphine, effects such as a decrease in respiratory rate, urinary retention,
pupillary constriction and a decrease in blood pressure should be expected.
The suprapubic distention after palpation of his lower abdomen would be due to a
distended urinary bladder. For me to facilitate voiding, I should recommend to the physician that

NURSING CASE STUDY 4
Mr. Hale be allowed to stand and try to void. Also, I should run the water in his room.
Positioning Mr. Hale to dangle in bed would assist him to prevent orthostatic hypotension.
However, the areas of thrombosis can be reddened, painful, warm to touch and swollen. In
response to calf tenderness and welling, I would elevate his legs in order to promote venous
returns. In order to check for GI, I would ask him if he has passed gas and auscultate for bowel
sounds. Finally, Blood glucose levels would now be tested before meals and at bedtimes

NURSING CASE STUDY 5
Reference
Andrews, P., Joseph, J., Li, C. H., Nip, L., Jacques, T., & Leung, T. (2017). A UK survey of
current ENT practice in the assessment of nasal patency. The Journal of Laryngology &
Otology, 131(8), 702-706.
Hovaguimian, F., Köppel, S., & Spahn, D. R. (2017). Safety of Anticoagulation Interruption in
Patients Undergoing Surgery or Invasive Procedures: A Systematic Review and Meta-
analyses of Randomized Controlled Trials and Non-randomized Studies. World journal
of surgery, 41(10), 2444-2456.
Mortenson, J. A., & Moriarty, K. M. (2015). Ketamine and midazolam anesthesia in Pacific
martens (Martes caurina). Journal of wildlife diseases, 51(1), 250-254.
Washco, V., Engel, L., Smith, D. L., & McCarron, R. (2015). Distended bladder presenting with
altered mental status and venous obstruction. The Ochsner Journal, 15(1), 70-73.