Nursing Situation Post-op Complication: Miss. Hootie Owl

Nursing Situation Post-op Complication: Miss. Hootie Owl Miss Hortense (Hootie) Owl is a 72-year-old female with abdominal pain and nausea. CT scan suspicious for bowel obstruction. Patient had an exploratory laparotomy. Surgery revealed small bowel obstruction with resection. EBL=100ml. Patient received general anesthesia and was extubated in the OR. She presents to you on your med-surg unit in stable condition. Patient is lethargic but responds to verbal commands. PARS=7. Her sister is in the waiting room. Past Medical History DM Type II HTN Neuropathy Medications received Isoflurane in OR Propofol in OR Currently on LR at 125 ml/hr Baseline Assessment Findings Temp: 97.2 HR: 92, normal sinus rhythm BP: 110/64 RR: 18 SpO2: 97% on 4L NC Miss Owl arrives from the OR to your unit in stable condition. Describe how you would initially assess her. After your initial assessment she starts to cough and signals to her sister that she is having trouble breathing. Her sister calls you into the room. You hear stridor as she tries to take a deep breath. She is unable to talk and is spitting out what looks like stomach acid. VS: HR: 115 Sinus tachy BP 88/58 RR: 30, shallow, air hunger SpO2: 88% on 4 L NC How will your empiric and personal knowing help you in this situation? Which of the following interventions would you consider and why? (select all that apply) Stop IV fluids Increase O2 administration, due to airway problem Suction the patient, to remove stomach acid or whatever the material is Administer positive airway pressure (BiPap) to open the airway Administer Lasix 20mg IV stat What are Miss Owl’s calls for nursing? How can you respond to these calls? What do you anticipate is the problem with this patient? What might be the precipitating factor? Pulmonary edema Malignant Hyperthermia There is no problem Laryngospasm, due to aspiration of gastric contents Hypotension If the above interventions do not resolve the issue, what do you anticipate are the next actions for this patient and why? Rapid re-intubation with administration of neuromuscular blocking agent Tracheostomy with positive airway pressure Palliative care Miss Owl’s sister is crying in the waiting room. How can aesthetic and ethical knowing influence your interactions with her? What nursing diagnosis(es) would you choose for this patient’s care plan in light of this event?

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