Preoperative Patient Case Assignment

Preoperative Patient Case Assignment
Patient Profile
F.D., a 72-year-old Hispanic retired librarian, is admitted to the hospital with compromised circulation of
the right lower leg and a necrotic right foot. She has
diabetes and takes insulin to maintain appropriate
blood glucose levels. In addition, she has hypertension and kidney and peripheral vascular disease. She
has been NPO since midnight. It is now 10 AM on the
morning of the surgery.
Subjective Data
• History of type 2 diabetes mellitus for 30 years; states “my blood sugar
is hard to control” and “I just started taking insulin”
• History of hypertension
• History of stage 2 chronic kidney disease
• History of peripheral vascular disease
• History of macular degeneration in right eye; reports poor vision
• Surgical history: cesarean section at age 30, cholecystectomy at age
65; reports poor wound healing after last surgery
• Social Security checks barely cover the cost of living
• States she often runs out of medications and cannot always afford to
refill them right away
• Reports chronic burning pain in both legs and has trouble sleeping at
night
• Lives alone but has family who want her to move in with them after
surgery
• Uses herbs to control blood glucose levels and frequently skips her
insulin
Objective Data
Physical Examination
• Alert, cognitively intact, anxious, older woman with complaints of
numbness and lack of feeling in right leg
• Weight 190 lb, height 5 ft 3 in
• BP 180/94, pulse 84 and slightly irregular
• Wears glasses for close work and reading
• Has macular degeneration in right eye
Diagnostic Studies
• Admission serum blood glucose level 272 mg/dL (15.2 mmol/L); glycosylated hemoglobin (Hb A1C) 14%
• Morning capillary blood glucose level 198 mg/dL (11 mmol/L)
• Doppler pulses for right lower leg weak, absent in right foot
• Doppler pulses in left lower leg present, weak in left foot
• Serum creatinine 2.0 mg/dL (176 mmol/L)
Collaborative Care
• Scheduled for a below-the-knee amputation of the right leg at 1 PM
today
Discussion Questions
1. What factors may influence F.D.’s response to hospitalization and
surgery?
2. Priority Decision: Given F.D.’s history, what priority preoperative
nursing assessments would you want to complete and why?
3. What potential perioperative complications might you expect for F.D.?
4. Priority Decision: What priority topics would you include in F.D.’s
preoperative teaching plan?
5. Priority Decision: Based on the assessment data presented, identify
the priority nursing diagnoses and related interventions. Are there any
collaborative problems?
6. Delegation Decision: Identify appropriate preoperative interventions
that need to be completed and could be delegated to unlicensed assistive personnel (UAP).
7. Evidence-Based Practice: F.D. asks you why she received insulin this
morning when she has not eaten anything since midnight. How would
you respond to her?