Semester 5 CNA250: Post-operative Bleeding and Narcosis Assignment

This nursing assignment focuses on two critical clinical scenarios: post-operative bleeding following a cholecystectomy and opioid narcosis after a hemicolectomy. The assignment includes detailed descriptions of each scenario, including patient histories, presenting symptoms, and vital signs. Students are required to answer multiple-choice questions (MCQs) related to each case, covering topics such as the most common complications of post-operative bleeding, the most sensitive signs of postoperative bleeding, medications used to manage bleeding and opioid overdose, and the A to E approach for managing these conditions. The assignment also incorporates the DRABCDE approach for patient assessment. References to relevant medical literature, including UpToDate, are provided to support the analysis and understanding of the scenarios. The assignment assesses the student's ability to apply theoretical knowledge to practical situations, evaluate patient conditions, and make appropriate nursing interventions. The assignment also includes the marking criteria for each of the scenarios.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author’s Note:

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Description of Scenario 1
Mr Hayes is 65 years old, underwent cholecystectomy and demonstrate post-operation
bleeding that was exposed through blood-soaked dressing, distended and tender abdomen.
There was a redivac drain, which was full of haemoserous fluid. He is a non-smoker, fit and
did not exhibit any respiratory disorder or any sepsis-related problems. He did not have any
problem related to airways, breathing and the patient looked pale and clammy in nature.
According to Febbo et al. (2016), the short of breath and dizziness was observed that
indicated a severe concern. From the vital stats, it can be seen that his blood pressure was low
85/50 and thus, the treatment involves two large-bore cannulas; he was placed in the supine
position with his legs raised. ECG and urgent surgical review need to be done that will
present the condition after the post-operation. Therefore, both the condition demonstrates that
the case is related to post-operative bleeding that occurred after the surgery and requires
attention.
MCQ
1. The most common complication of post-operative bleeding is
a. Deep vein thrombosis
b. sore throat
c. swelling
d. postoperative cognitive dysfunctioning
Answer
a. True because due to bleeding, there is a decreased level of venous blood flow in the lower
extremities; thus, there is a systematic change in coagulation.

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B, c and d are false because these are associate with post-operation symptoms that can occur
to any patient that had undergone a surgery
2. What is the most sensitive sign of postoperative bleeding?
a. visual bleeding
b. tachycardia
c. Raised respiratory rate
d. a decrease in urine output
Answer
It can be seen that all these are signs of postoperative bleeding and occur in a patient while
examination, however, option c is correct because it is the most sensitive sign that involves
hypertension indicating that the patient is not stable.
3. Which medicine can be used for slowing or stopping the bleed after surgery?
a. Opioid
b. Antifibrinolytic
c. Anaesthetic
D. NSAIDs
Answer
a. False because it is used to reduce pain
b. True it inhibits fibrinolysis
c. False it is used for causing short-term loss of sensation

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d. False, it is used for reducing swelling and soreness
4. An A to E Approach can be used for management of postoperative bleeding that will
ensure
a. rapid fluid resuscitation
b. lower blood pressure
c. Adequate IV access
d. All of them
Answer
The answer is (d) all of them as in A to E Approach, the care is taken for ensuring all the
above-stated options. A to E approach is an interventional strategy that is used for managing
the postoperative bleeding among patient.

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Description of Scenario 2:
Faraz Shaukat is a 62-year-old patient who underwent right hemicolectomy. He was
administered with 5 mg IV morphine due to severe pain in the ward. The presenting symptom
that can be observed in this patient is an overdosage of opioid that may lead to slowing or
breathing and in severe cases, may lead to death (Khan et al. 2019). The previous medical
history of the patient includes type 1 diabetes and adenocarcinoma of the bowel that may
complicate the scenario. It can be seen that airway of obstruction that can be treated using
insertion of airway adjunct. The respiratory rate is extremely low; the heart rate is slowing
down, which is 54 per minute. The pupil is constricted and there is the reduction in limb
strength as a result of which, the patient is unable to obey commands. Therefore, fentanyl
patch is observed in the chest of the patient and require administration of naloxone 0.4-2 mg
in an intravenous manner.
MCQ
1. An opioid is used for treating
a. pain
b. hypertension
c. allergies
d. heart disease
Answer
An opioid is narcotic that bind with opioid receptors to reduce the feeling of pain in the body.
Therefore, in some cases, it can be used as a drug, causing a feeling of high or euphoric.
2. The risk factor of opioid

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a. Physical abuse
b. Depression
c. Genetics
d. all of the above
Answer
Opioid are drugs that cause a change in the brain function by releasing endorphins. The
overdose of the drug affects the chemistry of the brain and the risk factors are:
 Personality trait
 Genetic predisposition
 Substance abuse
 Psychiatric disorder
3. The predominant sign of opioid toxicity is
a. toxidrome of apnea
b. high heart rate
c. high respiratory rate
d. depression
Answer
Toxidroma of apnea is the correct answer because of the sedative effect of opioid that
complicates the situation. Both heart rate and respiratory rate decrease and depression is not a
symptom of opioid overdosage in patients.
4. Which drug can mask the effect of opioid

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a. codeine
b. hydrocodone
c. naloxone
d. oxycodone
Answer
Option a, b and d are opioids whereas option c, naloxone is an antidote that is competitive
mu-opioid receptors helping in reversing the signs of opioid intoxication in a patient.

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References
Febbo, A., Cheng, A., Stein, B., Goss, A. and Sambrook, P., 2016. Postoperative bleeding
following dental extractions in patients anticoagulated with warfarin. Journal of Oral and
Maxillofacial Surgery, 74(8), pp.1518-1523.
Khan, N.F., Bateman, B.T., Landon, J.E. and Gagne, J.J., 2019. Association of opioid
overdose with opioid prescriptions to family members. JAMA internal medicine, 179(9),
pp.1186-1192.