Elimination

Elimination

Hx of chronic constipation

last BM

diarrhea

signs of UTI

difficulty initiating a stream – older men

Activity

general muscle strength

limitation to walking, sitting, or moving in bed

Comfort

presence of discomfort (PCA pump – not all pain gone, but make pain tolerable)

perception of expected discomfort

knowledge of medicine routine

expectations regarding alleviation of postop pain

allergy Hx (latex, meds)

check for signs of liver / kidney dysfunction – med metabolism, anesthesia & adjunct drugs

Comfort

prior drug therapy

1. if pt on adrenal steroids, dx before surgery ↑susceptibility to infections, if remove too quickly,

can cause cardiovascular collapse

2. NSAIDs – dx one week prior to surgery, can ↑bleeding

diuretics (hydradiuril) – can get electrolyte imbalance & respiratory depression

3. erythromycin given with muscle relaxant can cause apnea & respiratory paralysis

4. valium – need to dx, can get stress & seizures

5. thorazine – interacts with anesthesia, causes hypertension

6. insulin – stress↑blood glucose, need to be on sliding scale, hold until Dr. order

7. MAO with anesthesia = hypertensive effects

8. coumadin ↑bleeding, (stop 3 days prior to surgery)

9. dilantin – give IV so not get seizure

alcohol intake

1. liver disease – bleeding tendency - ↓vit K, poor wound healing

2. poor nutrition

3. postop meds may be ineffective

may develop delirium tremens

Diagnostic Test MD may order

vary with hospital

40 – EKG, BUN, FBS

respiratory

Circulatory – CBC, electrolytes

renal

metabolic

Elderly Responses – physiologic changes compromise organ function & limit body's ability to adjust to stress

1. more than one chronic illness can ↑risk for postop complications

2. look at liver / kidney tests ie. electrolyte, creatinine, liver panel

3. risk for:

a. ↓ability to ambulate

b. disoriented – fluid & electrolyte imbalance

c. mind not as alert – need to orient as to where they are (reorient to room0

d. ↓fat = chill

e. ↑constipation

f. ↑skin tears / bruising

Nursing Diagnoses

anxiety: fear of death

risk for injury