QuestionThe nurse reviews A. M.’s laboratory results. Laboratory Report…The nurse reviews A. M.’s laboratory results. Laboratory Report Normal 1/1/22 1/2/22WBC 4,000-11,000 uL 9,000 15,000Hemoglobin 12.0-17.0 g/dL 11.0 6.9Hematocrit 36.0-51.0% 35 28RBC 4.2-5.9 cells/L 3.8 2.5Platelets 150,000-350,000 uL 145,000 102,000Calcium 9-10.5 g/dL 8.8 8.7Chloride 98-106 mEq/L 99 98 Laboratory Report Normal 1/1/22 1/2/22Magnesium 1.5-2.4 mEq/L 2.1 1.9Phosphorus 3.0-4.5 mg/dL 3.1 3.0Potassium 3.5-5.0 mEq/L 3.2 3.3Sodium 136-145 mEq/L 142 144Glucose 70-199 mg/dL 189 267BUN 8-20 mg/dL 39 25Creatinine 0.7-1.3 mg/dL 1.3 1.2CPK 30-170 U/L 422 304LDH 60-100 U/L 154 279AST 0-35 U/L 34 33ALT 0-35 U/L 30 32GGT 9-48 U/L 42 36T. Bilirubin 1.2 mg/dL 0.9 1.0Cholesterol <200 mg/dL 259 246Triglycerides <150 mg/dL 198 188 Which laboratory results should the nurse bring to the attention of the healthcare provider prior to surgery? Select all that apply.White blood cellsHgb & HctCalciumPotassiumGlucoseCholesterol/Triglycerides Which additional lab(s) is/are concerning and should be reported to the surgeon prior to surgery?Red blood cellsPlatelet countCreatinine level Liver enzymes After alerting the surgeon of the lab reports, the surgery is postponed. Intravenous antibiotics ae started, potassium is replaced, and the client receives 1 unit of packed red blood cells. Because of poor venous access, a peripherally inserted central catheter (PICC) is placed in the left basilic vein. Additionally, A.M. is started on short-acting insulin to control the blood glucose levels. The next day, 1/3/22, she shows improvement and is taken to surgery for an Open Reduction Internal Fixation of the Left hip. A.M. is now 24 hours postoperative. The nurse reviews her electronic vital sign record. Day Time BP HR RR O2 Sats Temp Pain1/2/22 1310 110/75 105 14 99%O2 2L 100.7 2/10 2050 108/67 100 16 96%O2 1L 99.0 3/101/3/22 0030 145/88 110 22 95% RA 7/10 0200 127/78 88 16 94% RA 97.2 4/10 0815 100/76 90 18 95% RA 3/10 1635 110/72 92 22 94% RA 98 8/10 1905 115/70 88 20 94% RA 100.0 5/10 2200 110/75 86 18 95% RA 97.0 2/101/4/22 0800 118/75 98 20 95% RA 98 4/10 1620 98/56 110 22 92% RA 100.5 6/10 2110 89/50 114 24 95%O2 1L 101.2 5/10 After analyzing the vital sign trends, what information is most concerning to the nurse?Respirations of 14 on 1/2/22BP 145/88 at 0030 on 1/3/22BP 89/50 at 2110 on 1/4/22Temp 101.2 at 2110 on 1/4/22 Based on this information, what should be the nurse's priority action?Increase O2 for respirations of 14 on 1/2/22Administer pain medication for BP at 0030 on 1/3/22Increase IV fluids for BP at 2110 on 1/4/22Deliver acetaminophen for fever at 2110 on 1/4/22 At 1620 on 1/4/22, there is a change in the client's condition. What action(s) should the nurse take? Select all that apply.Deliver pain medication with close monitoringStop IV fluidsApply OxygenPlace a cool cloth on the client's foreheadEncourage coughing and deep breathingHave the client walk in the hall At 2110 on 1/4/22, the nurse decides to contact the provider for additional orders. What additional assessment information should the nurse collect in preparation for the SBAR communication. The nurse notes that there are two providers following A.M. Which provider should the nurse contact first?Dr. BaldwinDr. Schoenberg The nurse communicates with the provider.S- Hi Dr._________, this is the nurse caring for A.M. at JFKUMC. I'm calling because her BP is low at 89/50 mmHg and temperature is up to 101.2.B- She came in on 1/1/22 after falling and fracturing her hip. She returned from surgery 24 hours ago. She has a history of rheumatoid arthritis and takes prednisone daily. She also had an elevated WBC count prior to surgery and has been receiving cefazolin IV.A-Her wound site is slightly reddened with clear, serous drainage, the staples are intact. Her lungs are diminished in the bases, and she has been placed on O2 1L to maintain her saturations at 95%. WBC's are at 13,000. The indwelling catheter is draining concentrated, cloudy urine. Her PICC catheter dressing is intact with an antimicrobial patch covering the insertion site. Based upon the SBA(R) communication, what assessment findings indicate the most likely site(s) of infection? Select all that apply. WoundLungsBloodUrinePICC catheter As the nurse, complete the "R" of the SBAR report. Clinical Hint: It is important for the nurse to clearly articulate what the needs are for each client. Evidence shows that assertive communication reduces health care related errors and client deaths. HealthcareProvider Orders Name: A.M. Martinez Age: 54 yearsHCP: S. Baldwin D. O Allergies: NKDACode Status: Full CodeDATE/TIME HEALTH CARE PROVIDER PRESCRIPTIONS1/4/222200 Urine C & S then discontinue indwelling urinary catheterChest x-rayIV fluids 0.9% NaCl, 500 ml over 2 hoursAcetaminophen 650 mg orally every 4 hours PRN for T>101FCiprofloxacin 400mg IV every 12 hours Which of these prescriptions should the nurse implement first? (Use your clinical judgement to determine the highest risk to safety, coupled with what can be completed quickly when prioritizing a list of prescriptions).Urine C & S, then dc indwelling urinary catheterChest x-rayIV fluids 0.9% NaCl, 500 ml over 2 hoursAcetaminophen 650 mg orally every 4 hours PRN for T>101FCiprofloxacin 400mg IV every 12 hours Reflect on the events that have occurred since A.M. came into the emergency department and apply your critical thinking skills to what events could have prevented the current client situation. The diagnostic and culture reports return for A.M. Her chest x-ray shows bilateral atelectasis and the urinalysis is positive for leukocytes, nitrate, bacteria, blood and protein, indicating she has a bladder and kidney infection. Given this information, what priority action should the nurse take?Implement coughing and deep breathing hourlyAmbulate in the hallway hourlyPlace an indwelling catheter for accurate I & OLimit oral fluidsThe hospital’s quality management and infection control departments notice an increase of catheter acquired urinary tract infections (CAUTI) on the nursing unit where A.M. is a client. A chart review is conducted which leads to a mandatory training session for the nurses and other appropriate health care team members. What information should be included in the educational session about the prevention of CAUTI’s? Select all that apply. Review the Center for Disease Control’s (CDC) criteria for catheter insertionDaily review of need for indwelling cathetersEarly recognition of CAUTI symptomsUse of aseptic technique with catheter careImportance of securing the device and keeping the bag below the level of the bladderFrequency of indwelling catheter care During the training session, the nurse reviews the CDC (2009) Criteria for Indwelling Urinary Catheter Insertion. Using these guidelines, did A.M. meet the criteria for an indwelling catheter?YesNo CDC (2009) Criteria for Indwelling Urinary Catheter (IUC) Insertion:>Acute urinary retention or bladder outlet obstruction>To improve comfort at end-of-life care if needed>Critically ill and need for accurate I & O measurements (hourly monitoring)>Selected surgical procedures (GU surgery/colorectal surgery)>To assist in healing open sacral or perineal wound in incontinent clients>Need for intraoperative monitoring of urinary output during surgery or large volumes of fluid or diuretics anticipated>Prolonged immobilization (potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures) After the training how will the quality improvement and infection control departments identify that their training is effective?Nurses will place fewer indwelling cathetersUAPs will follow aseptic technique when caring for cathetersThe occurrence rate of CAUTIs will decrease on the nurse unitThe team will state having a deeper understanding of the process Health ScienceScienceNursingShare Question
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