Peri-Operative Case Study

T.A., a 52-year-old obese white woman, arrives on the nursing unit at 5 AM. She is scheduled to undergo a total abdominal hysterectomy at 8 AM. T.A. appears slightly anxious as you escort her to her room. She is accompanied by her husband of 20 years and her 17-year-old daughter. You give T.A. a gown to change into and a belongings bag for her clothes. As you are preparing to leave the room, T.A. says, “Please make sure that everyone knows I have diabetes. I am so afraid my blood sugar is going to go too high without my usual insulin dose.”

After reviewing T.A.’s preoperative information, you note that all diagnostic tests are within normal limits except for her blood glucose, which is slightly elevated at 140 mg/dL. T.A.’s past medical history is negative except for type 1 diabetes, leiomyomas (uterine fibroids), and dysmenorrhea. A physical assessment reveals no abnormal findings.

You perform a focused physical assessment on T.A. with the following findings:
• Height 5’1″
• Weight 80 kg
• BP 104/60; HR 82; RR 18; Temp 37.1°C
• Awake, alert, and oriented
• Moves all extremities equally; denies numbness or tingling
• +2 peripheral pulses, all extremities
• Lungs clear to auscultation
• Apical pulse regular with no abnormal heart sounds
• Abdomen soft and nontender; + bowel sounds all four quadrants
A current medication/herbal history reveals the following:
• Lispro (Humalog) insulin before meals based on glucose reading
• Glargine insulin 30 units at bedtime daily
• Multivitamin capsule, one daily in AM
• Ginger, 1 teaspoon in 8 oz water, prn for indigestion and nausea
• Kava, 1 capsule, prn at night to help sleep

Discussion Questions:

**When applicable, provide your rationale.

1. What is the significance of performing a thorough patient interview?
2. Briefly provide an overview of what is included in the nursing assessment in the pre-operative phase?
3. Name at least three nursing diagnoses relevant to this patient (can include any phase in the peri-operative process).
4. List significant nursing interventions for each phase of the peri-operative process.
5. What would your response, as a nurse, be to T.A.’s comment about making sure everyone is aware about her diabetes?
6. Prior to going into the Operating Room (OR), the patient asks, “So how long is this surgery going to take?” As the nurse, what is your response or what actions do you take?
7. After T. A. is moved to the PACU, determine what the top three priority assessment areas would be for the primary nurse.
8. What position do you expect the patient to be in during the post-operative phase?
9. List some education content you would review with your patient prior to discharge or admission to the floor.

 

Sample Solution

e used to justify the action, and it is the action itself and the motivation behind it which matter. In general, deontology requires people to behave with principles and duty. Principles are the laws that people apply to themselves and cannot be broken under any circumstances, and duties are the actions motivated by the principles. As an example, an individual’s principle could be not harming others whatsoever, therefore their duties are to restrain themselves from getting into fights with others. Principles are not the same as rules, for that rules are from others, but they do often work together. Deontology indicates that it is moral when people follow their principles all the time, and the action matter much more than the consequences caused by it. Gray and Schein (2012) have set an example that in the centre of deontology, lying should be despised whether it is for a good result or not. Corresponding to principles, duties are what people “ought to do” caused by pure heart instead of benefit. The reason for setting these laws, from famous deontologist Immanuel Kant’s point of view, is humans’ ability to set “ends” and requirements for ourselves is what separates us from other animals. He explained that by resisting temptation caused by our natural instinct, humans are set free from the pressure given by nature, therefore deontology could be called Kantian Ethics. If people give up on morality, there would be no difference between humans and animals who cannot reason. In brief, deontology suggests acting on proper reason motivated by principles, and if something is wrong, it should not be done in any situation.

With utilitarianism and deontology explained, now we can apply them to fictional scenarios. One kind of scenarios is moral dilemmas. These dilemmas are full of paradoxes, most include harm to one group of characters and one action could transfer the harm to another group. The most well-known moral dilemma is probably “The trolley problem”. In this story, a trolley that cannot be stopped is going to run over five people. The good news is, if someone pulls the brake, the track under would be switched to aside. Nevertheless, another person is tied on the track as well, if the person making decision wants to save five people, the redirected trolley would kill him. In general, is one life less valuable than five? For utilitarians, killing the one person does not seem to bother them. As mentioned before, utilitarianism is about maximising the happiness. Saving five lives would be more important for increasing pleasure overall. In Crockett’s (2016) explanation, “The utilitarian perspective dictates that most appropriate action is the one that achieves the greatest good for the greatest number.” Although killing one person seems wrong, the consequence of saving 5 lives would make it moral in utilitarianism. In contrary, deontology insists for no matter what reason, performing murder is always immoral and against basic principles. Crockett (2016) stated that from deontological point of view, killing is simply wrong, even if it brings benefit.

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