1. Type directly on the Word document. Please differentiate the answer section from the question section. That is, please type your answer in a different color font.
2. For each question, a parenthetical reference (in APA format) should be noted at the end of the answer. A reference list (in APA format) should be added to the end of the document. Note: Referencing “class notes” or the “faculty’s lecture” is not acceptable. References must be published documents (e.g. textbooks, journal articles, websites). Up to 5 points will be deducted from the final assignment grade for inappropriate references or inappropriate citing of references.
Abdominal Hysterectomy (Uterus and Cervix)
Mrs. Johnson is a 52 y/o Caucasian, married, mother of two adult sons, ages 22 and 24. She has one sister who lives out of state, who is recovering from ovarian cancer. Mr. and Mrs. Johnson live in a two story home. She has taught second grade at a Lutheran school for 25 years. Mrs. Johnson gets great strength from her faith tradition. When not teaching, Mrs. Johnson helps care for her parents ages 75 & 76. Her responsibilities include grocery shopping and taking her parents to their doctor appointments since neither of her parents are able to drive. Mrs. Johnson takes Lopressor (Metoprolol Tartrate) 50 mg po BID for hypertension, Prem-pro (0.3mg/1.5mg) po daily for her menopause symptoms, and Lorazepam (Ativan) 10 mg po prn/anxiety. In addition to her medications, her primary doctor has encouraged Mrs. Johnson to lose weight since her BMI is 30. Although Mrs. Johnson’s periods have been irregular, she has noticed some vaginal spotting. Mrs. Johnson decides to make an appointment with her gynecologist.
The gynecologist performs a physical exam, obtains a Pap smear, and performs an endometrial biopsy. In addition the physician orders a transvaginal ultrasound, CBC, CMP, CA 125, UA, Chest X-Ray, and EKG. The results of the biopsy show endometrial cancer and the transvaginal ultrasound shows a thickened uterus, ovaries normal. All lab work is within normal limits except an elevated cholesterol level.
Mr. and Mrs. Johnson have a consultation with the physician and nurse regarding surgical options, which are an Abdominal Hysterectomy (Uterus and Cervix) or Total Abdominal Hysterectomy with Bilateral Salpino-oopherectomy (BSO). Mrs. Johnson is unsure of which is the best option. She told her physician she does not want to take hormone therapy ever again because she feels it caused her cancer. Listening to her requests, the physician tells her the Abdominal Hysterectomy would be a “good” option. Therefore, Mrs. Johnson chooses the Abdominal Hysterectomy but Mr. Johnson is encouraging her to have the TAH-BSO because he does not want to take any chances of his wife getting ovarian cancer. Mrs. Johnson decides on the Abdominal Hysterectomy, yet her husband is scared that she could acquire ovarian cancer if she does not have the TAH with BSO.
1. Identify Mrs. Johnson’s risk factors for endometrial cancer.
2. Define and describe the purpose of the testing the gynecologist ordered for Mrs. Johnson.
3. What is a Bilateral Salpingo-oophorectomy?
You are the gynecologist’s nurse and can see the conflict between Mr. and Mrs. Johnson as they prepare to leave the office.
4. In this moral situation, what ethical principle applies?
5. What could the nurse do that would be helpful for the patient and the husband in this situation?
6. Who makes the final decision?
Mrs. Johnson arrives for her Abdominal Hysterectomy accompanied by her husband and two sons. You provide privacy while you review her medical record. You let her know the policy requires a pregnancy test, and that she needs to sign her surgical consent and blood transfusion consent. She also needs a Type and Screen for two units of Packed Red Blood cells. Mrs. Johnson tells you that there is no way she is pregnant. In fact this question gets her talking about how grateful she is for her husband and that she has her two sons. She reminisces about her pregnancies and deliveries, even tells you about how much they weighed and how she chose their names. She also tells you about her breast feeding experiences, and what a joy it has been to be their mom.
7. By being present and listening to Mrs. Johnson, is the nurse providing spiritual care? Why or why not?
You are unsure if Mrs. Johnson needs a pregnancy test. She told you there is no way she is pregnant.
8. Do you think it is appropriate to have Mrs. Johnson take a pregnancy test given her age and that she told you there was no way she was pregnant?
While taking Mrs. Johnson’s pre-op blood pressure you note her B/P to be 150/88. She states she took her Lopressor at 6 am that morning with a small sip of water.
9. Besides the stress that accompanies surgery, what social factors might be contributing to Mrs. Johnson’s elevated B/P?
10. What resources can you let Mrs. Johnson know could help her in regards to her social concerns?
11. What is your best nursing action?
Mrs. Johnson is taken to the pre-surgical holding area. You are her nurse in that area.
12. Identify five priority nursing actions to be completed before sending a patient to the operating room?
In the Recovery Room, Mrs. Johnson has orders for 0xygen at 2 liters/minute per nasal cannula, PCA with Morphine, .9 NaCl IV at 100cc/hr., Ancef 1 gm. IVPB q 6 hrs., Lovenox (Enoxaparin Sodium) 40 mg sq. daily, abdominal dressing, abdominal binder, Foley catheter, peri-pad, TEDS/SCDS, incentive spirometer q 2hrs, ice chips, advance diet as tolerated, CBC in am (call physician if Hg less than 9), up in chair in am.
13. In the recovery room, the patient would be discharged according to what scale?
14. At what number could the patient be discharged from the PACU?
15. You are the nurse caring for Mrs. Johnson on post op day one. You receive her CBC results and the Hg is 9. What are your next best steps? Name four
The surgeon orders one unit PRBC’s. You receive a call from the blood bank that the patient’s blood is ready to be picked up. The patient care tech hands you the unit of blood.
Answer the following questions:
16. What consent must you check before administering the blood to the patient?
17. What IV solution should be used to hang with blood?
18. Are vital signs necessary before hanging blood?
19. How often do you have to assess vital signs while the patient is receiving blood?
20. Can you check the blood alone before administering to patient?
21. What patient identifiers do you need to check with the second RN before giving blood?
22. How long should you stay with the patient after hanging blood?
23. What patient assessments do you perform while the patient is receiving the blood?
24. What is the maximum amount of hours that one unit of blood can be hung for?
25. What teaching should you provide regarding blood transfusion with the patient?
Identify post-op care for Mrs. Johnson related to each of the following:
26. While assessing Mrs. Johnson you notice her left calf is swollen. What do you suspect?
27. What other symptoms might she experience in addition to her leg being swollen?
28. What is your next best step?
29. What test will the doctor probably order due to Mrs. Johnson’s left calf swelling?
30. The patient is requesting to walk to the washroom. What should your next best step be?
31. The patient’s tests are normal. What teaching should you do to promote the patient’s circulation to reduce the lower leg swelling?
The patient’s TED hose have been soiled with urine. The nurse manager has instructed the staff on the importance of fiscal responsibility and unnecessary ordering of supplies recently. You realize TED’s are costly so you decide to remove the TED hose and wash them rather than order a new pair.
32. Is this the best economical decision for the patient and nursing unit?
33. How can you address the patient’s sexuality conce