Xavier University - Ateneo de Cagayan 

College of Nursing 

          

In partial fulfillment of the requirements of Nursing Care Management 112 Lecture

(NCM 112 LEC)

Case Analysis on Concept of Preoperative Care

Submitted by:
Maegan Pearl T. Gantalao
BSN – 3E
 Submitted to:
Mrs. Jennifer O. Asio, RN, MN
Clinical Instructor

July 25, 2020

1. Base on the case presented make a specific pre-operative preparations 24

hours before surgery. (10 points)
- Preoperative Assessment
o History taking should be done during this time
 Ask for civil status
 Religion or beliefs
 Support system
 Medical history
 Previous surgeries, illnesses, trauma
 Allergies
 Bleeding tendencies
 Recreational drug use and alcohol intake
 Chronic illnesses
- Informed consent should be obtained from the client
o The informed consent must contain the following so that the client
understands what’s going to happen to him during the entire procedure:
 Description of clinical procedure which should be explained thoroughly
to the client
 Risks and discomforts regarding said procedure
 Benefits
 Alternative procedures or treatments
 Confidentiality
 Compensation and medical treatment in event of injury
 Contacts
 Voluntary participation
- Verify completion of pre-operative diagnostic testing or laboratory findings
- Verify patient’s understanding of surgeon-specific pre-operative orders:
o Instruct patient to maintain NPO after midnight and inform the client’s
watchers to not allow the client to have any food or liquid.
o If there are medications given to the client, make sure the client is able to take
it as ordered by the physician
o Make sure that the client was able to take a bath and was able to urinate or
void prior to the surgery
- On the day of the surgery or prior to the surgery, make sure that:
o Client is able to take a full bath if able and assist to chapel if there is any
 o NPO should be maintained
o Confirm if the client has cardiopulmonary clearance and has been evaluated
by the doctor other than the surgeon and anesthesiologist
o Check the availability of ordered blood
o Allow client to void to prevent distention of bladder
o Change client into dress or OR gown and if client has long hair, make sure to
tie it or use disposable cap
o Remove dentures and make sure that nail beds are observable and can be
easily observed to make it easier to spot any signs of hypoxia
o Skin should be shaved or cleansed to prepare surgical site
o Jewelries and valuables should be removed and left in the watcher’s care
- Make sure that the pre-operation checklist is filled completely with client and
significant other’s signature
- It should be complied before endorsing the client to the OR nurse
- Before everything goes down in the operating room, vital signs should be obtained
for baseline data
- Make sure to endorse the client to the OR nurse at least one hour prior to the surgery
including his chart
2. What will be your focused physical priority assessment before you start your
care for patient PAS? (10 points)
- My focused physical priority assessment before starting my care regarding patient
PAS would revolve around his initial assessment taken, specifically his respiratory
function. His respiratory rate reached 28 breaths per minute and he even shows
dyspnea upon exertion. These are considered abnormal since the acceptable range
for respiratory rate is 18-20 breaths per minute. A change in the respiratory rate is
often the first sign of deterioration as the body attempts to maintain oxygen delivery
towards the tissues.

Aside from this, the client experiences dyspnea or difficulty in breathing upon
exertion. This is the sensation of running out of air and not being able to breathe fast
or deeply enough during any physical activity. It’s a common symptom in people who
have lung cancer. Dyspnea happen when a person has trouble moving air in and out
of their lungs. However, you can also have dyspnea if your lungs aren’t getting
enough oxygen. The client has also been a smoker for 67 years and cigarette
smoking is by far one of the greatest risk factors for most respiratory symptoms. The
client also experiences wheezing and is even heard on both lungs. This is due to the
narrowing of airways or inflammation and may be a symptom of a serious breathing
problem. The client may have experienced difficulty in breathing due to the narrowing
of his airways and smoking for 67 years is a contributing factor. Due to these, we
need to prioritize our client’s respiratory concerns first and normalize his breathing
pattern.

3. Make an Interpretations/Inferences in every laboratory results of the client and

correlate the significant diagnostic tests findings by making a pathophysiology
of the patient’s condition. (20 points).
ENTITY VALUE/FINDINGS NORMAL RANGE INTERPRETATION
RBC 2.92 L (low) Men: 4.6 – 6.0 mcL Low RBC count due to
Women: 4.0 – 5.0 hematuria wherein blood is
mcL excreted during urination.
patient PAS’ hematuria is
caused by his urinary
bladder malignancy and
 benign prostatic
hyperplasia.
Low hemoglobin count
because of patient’s
hematuria attributed to
Men: 13.5 – 18 g/dL
urinary bladder malignancy
Hemoglobin 8.30 g/dl (low) Women: 12 – 15
and benign prostatic
g/dL
hyperplasia. Patient has
low RBC thus, hemoglobin
production is also affected.
Low hematocrit count due
to patient’s hematuria
where blood is excreted
during urination. Patient’s
hematuria is attributed to
Men: 40 – 54%
Hematocrit 33.40 % (low) urinary bladder malignancy
Women: 36 – 46%
and benign hyperplasia.
His hematocrit count is low
because his RBC and
hemoglobin production is
affected.
3
WBC 9.33 L 4,500 – 11,000/mm Normal Findings
150,000 –
Platelet count 320 L Normal Findings
400,000/mm3
Minutes – 2; Seconds
Bleeding time 2 - 10 minutes Normal Findings
- 20
Minutes – 4; Seconds
Clotting time 2 - 8 minutes Normal Findings
– 29
High cholesterol level due
to lifestyle factors such as
having a sedentary
lifestyle, smoking for
67yrs, and an unhealthy
diet (eating chocolates
after every meal). High
cholesterol level also
indicates some underlying
conditions such as having
high blood pressure
(150/100mmHg). Patient
Cholesterol 5.72 mmol/L (high) <200 mg/dl
PAS is also diagnosed
with diabetes mellitus type
2, and hypertension stage
2 – uncontrolled. Aside
from this, patien PAS is
already 83 years old and
age is a contributing factor
for increased cholesterol
due to body’s aging
process thus, elimination
of cholesterol from the
body is decreased.
Triglycerides 1.89 mmol/L or <150 mg/dl High triglycerides level due
 to sedentary lifestyle.
Patient PAS is also
diagnosed with diabetes
167.40 mg/dl (high) mellitus type 2 which is a
contributing factor as to
why his triglycerides level
is high.
Low HDL levels due to
sedentary lifestyle and
smoking is also a
contributing factor. Lack of
physical activity tends to
.77 mmol/L or 29.76 lower HDL. Patient PAS
HDL 35-65 mg/dl
mg/dl (low) has also been a smoker
for 67 years and cigarette
smoking can oxidatively
modify HDL. Nicotine
weakens the antioxidant
enzymes in HDL.
High LDL levels due to an
unhealthy lifestyle. Patient
PAS has sedentary
lifestyle thus; he does not
do enough exercise. Aside
4.23 mmol/L or from that patient PAS does
LDL <130 mg/dl
163.57 md/dl (high) not have a healthy diet as
stated by eating
chocolates every after
meal. The risk of having
high LDL increases as a
person ages.
High uric acid levels are
linked to the patient having
diabetes mellitus type 2.
High uric acid levels in the
blood are associated with
an increased risk of
developing diabetes. This
583 umol/L or 9.8
Uric Acid 3.4-7.0 mg/dL causes the decreased
mg/dl (high)
ability of the body to
eliminate the substance. A
high level of uric acid can
also be attributed to
malignancy which causes
increased turnover rate of
cell death.
Chest X_RAY Minimal Fibrosis, Both N/A Minimal fibrosis – patient
Lung Apices with PAS has been a smoker
residual for 67 years and smokers
are generally at a high risk
Atherosclerotic Aorta
to develop pulmonary
fibrosis.
Atherosclerotic Aorta –
plaque which composes of
 fat and calcium has built
up in the inside wall of a
large blood vessel. Factors
of this build up can be
patient’s 67 years of
smoking, high blood
pressure (150/100mmHg),
and high levels of
cholesterols.
High levels of glycosylated
hemoglobin is attributed to
patient’s diabetic nature as
he is diagnosed with
Glycosylated diabetes mellitus type 2.
7.9 (high) 4%-5.6%
hemoglobin When blood glucose levels
are high, glucose
molecules attach to the
hemoglobin in red blood
cells.
There is hypertrophy of the
patient’s heart due to his
Concentric left high blood pressure
ventricular (150/100mmHg) and it is
Color flow the common cause of left
hypertrophy with N/A
doppler study ventricular hypertrophy.
segmental wall motion There is also segmental
abnormality. wall motion abnormality
due to his cardiac
hypertrophy.
Weight of the prostate Patient has an enlarged
7-16 g; 25 cm3 in
Ultrasound of is 20 grams, with 35 prostate as evidenced by
size
the prostate cm3 in size. (enlarged) its weight and size.
 4. Identify at least Five priority problem with Nursing Interventions and Rationale. (10 points)

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective cues: Impaired gas Short term: Independent: Short term:

exchange r/t After 1 hour, client is - Assess and record respiratory - it’s important to After 1 hour:
“galisod kog ginhawa inflammation able to: rate and depth at least every monitor any alteration in - client was able to
labi na og masubraan smoking AEB - verbalize feeling of 4hrs the pattern of breathing verbalize relief
og lihok” as verbalize by abnormal comfort when to detect early signs of - client was able to
client breathing rate breathing respiratory compromise breathe without
and dyspnea - respiratory rates difficulty
lowers down within - Evaluate skin color, - Lack of oxygen will - client’s respiratory rate
established limits temperature, capillary refill; cause blue/cyanosis was within acceptable
- demonstrate observe central versus peripheral coloring to the lips, range (20bpm)
maximum lung cyanosis. tongue, and fingers.
expansion with - Position patient with head of - Upright position or
adequate ventilation bed elevated, in a semi-Fowler’s semi-Fowler’s position Long term:
Objective Cues: Long term: position (head of bed at 45 allows increased After 8 hours:
After 8 hours, client is degrees when supine) as thoracic capacity, full - client was able to
- RR: 28 bpm able to: tolerated. descent of diaphragm, maintain an effective
- Dyspnea upon - maintain an effective and increased lung breathing pattern aeb a
exertion breathing pattern aeb expansion preventing respiratory rate of 20
- Wheezing sound relaxed breathing at a the abdominal contents bpm
noted on both rate of 20bpm from crowding. - no dyspnea was noted
lung fields - breathe with the Dependent:
absence of dyspnea - Provide respiratory medications - Beta-adrenergic
and oxygen, per doctor’s orders agonist medications
relax airway smooth
muscles and cause
bronchodilation to open
Collaborative: air passages.
- Refer patient for evaluation of - Exercise promotes
exercise potential and conditioning of
development of individualized respiratory muscles and
exercise program. patient’s sense
of well-being.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective cues: Risk for Short term: Independent: Short term:

decreased After 1 hour, client is - Monitor and record BP. - Comparison of After 1 hour:
“taas gyud kadalasa cardiac output able to: Measure in both arms and thighs pressures provides a - client was able to do
akong bp tapos dali ra r/t ventricular - do light activities and three times, 3–5 min apart while more complete picture light activities without
kapoyon kung mag sige hypertrophy tolerate it without the patient is at rest, then sitting, of vascular involvement presence of dyspnea
og lihok-lihok” as presence of dyspnea then standing for initial or scope of problem.
verbalized by client evaluation. - Presence of pallor;
Long term: - Observe skin color, moisture, cool, moist skin; and Long term:
After 8 hours, client is temperature, and capillary refill delayed capillary refill After 8 hours:
able to: time time may be due to - client was able to
- demonstrate stable peripheral demonstrate adequate
cardiac rhythm and vasoconstriction or cardiac output as
rate within patient’s reflect cardiac evidenced by blood
normal range decompensation and pressure within normal
Objective Cues: - participate in decreased output. parameters.
activities that will - Note dependent and general - May indicate heart - client was able to
- BP: 150/100mmHg prevent stress edema failure, renal or vascular participate in activities
- Dyspnea upon impairment that lessened stress
exertion
- High cholesterol level Dependent:
- Hypertrophy of client’s - Implement dietary sodium, fat, - These restrictions can
left ventricle and cholesterol restrictions as help manage fluid
- atherosclerotic aorta indicated. retention and, with
- pain and swelling in associated
the lower extremities hypertensive response,
decrease myocardial
Collaborative: workload.
- Refer patient for evaluation of - Exercise promotes
exercise potential and conditioning of
development of individualized respiratory muscles and
exercise program. patient’s sense
of well-being.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective cues: Impaired Short term: Independent: Short term:

Urinary After 1 hour, client is - Monitor vital signs closely. - loss of kidney function After 1 hour:
“sige ra ko og ihi-ihi Elimination r/t able to: Observe for hypertension, results in decreased - client was able to
kapila sa usa ka adlaw” diminished - identify cause of peripheral/dependent edema, fluid elimination and identify cause of
as verbalized by client bladder incontinence changes in mentation, maintain accumulation of toxic incontinence
capacity AEB - demonstrates accurate I&O wastes may progress to - client demonstrated
frequency and behaviors and complete renal behaviors and
incontinence techniques to prevent shutdown techniques to prevent
retention or infection - Assess the patient’s usual - Many patients are retention or infection
pattern of urination and incontinent only in the
Long term: occurrence of incontinence. early morning when the
After 8 hours, client is bladder has stored a Long term:
Objective Cues: able to: large urine volume After 8 hours:
- manage the during sleep. - client was able to
- urinary urgency manifestation of the - Encourage adequate fluid - Sufficient hydration manage manifestation
- urinary frequency of at disease intake (2–4 L per day), avoiding promotes urinary output of the disease
least 10-15 times per - maintains balanced caffeine and use of aspartame, and aids in preventing - client was able to
day I&O with clear, odor- and limiting intake during late infection. Aspartame, a maintain balanced I&O
- pain and swelling in free urine evening and at bedtime. sugar substitute (e.g., with clear, odor-free
the lower extremities Nutrasweet), may urine
cause bladder irritation
leading to bladder
dysfunction.
Dependent:
- Administer medications as - These drugs reduce
indicated: Oxybutynin (Ditropan), bladder spasticity and
propantheline (Pro-Banthine), associated symptoms
hyoscyamine sulfate (Cytospaz- of frequency, urgency,
M), flavoxate hydrochloride incontinence, nocturia.-
(Urispas), tolterodine (Detrol).
- Catheterize as indicated.
- Clinical research is
Collaborative: being conducted on the
- Refer for further evaluation for technology of electronic
bladder and bowel stimulation. bladder control.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective cues: Sleep pattern Short term: Independent: Short term:

disturbance r/t After 1 hour, client is - Educate the patient on the - Having full meals just After 1 hour:
“mag mata-mata ko sa urinary able to: proper food and fluid intake such before bedtime may - client was able to
gabii kay mag sige ko’g incontinence - verbalize as avoiding heavy meals, produce gastrointestinal verbalize his
ihi” as verbalized by aeb verbal understanding of alcohol, caffeine, or smoking upset and hinder sleep understanding
client reports of individual appropriate before bedtime. Avoid drinking onset. Drinking too regarding sleep
difficulty falling intervention to too much liquid before bed time much liquid by bedtime promotion interventions
asleep promote sleep may cause urination.

Long term: - Observe and obtain feedbacks - To determine usual Long term:
After 8 hours, client is regarding on the usual sleeping sleeping pattern and to After 8 hours:
able to: pattern, bedtime routine and the compare if there are - client was able to
- obtain optimal usual number of hours of sleep any improvements on obtain optimal amounts
Objective Cues: amounts of sleep and rest. the sleeping pattern of of sleep AEB rested
the patient appearance or
- urinary frequency and verbalization of feeling
urgency at least 10-15 - Limit fluid intake in evening - to reduce night time rested and
times per day elimination improvement in sleep
- difficulty sleeping pattern
especially at night
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective cues: Noncompliance Short term: Independent: Short term:

to medication After 1 hour, client is - Request the patient to bring - This approach After 1 hour:
“dili ko gainom og r/t health able to: prescription drugs to provides objective - client was able to
tambal kay mas chada beliefs AEB - verbalize the benefits appointments; count remaining evidence of verbalize the benefits
ang herbal” as therapeutic and importance of pills compliance. This and importance of
verbalized by client effect not complying to evidence is very useful complying to treatments
achieved or treatments in research protocols. - client was able to
maintained - report compliance or - Assess the patient’s - Views on maintenance report compliance or
agreement with the understanding about his or her vary from each patient. agreement with the
therapeutic plan current condition and the Some may base it on therapeutic plan
importance of health care religious beliefs and
Long term: refuse medical Long term:
After 1 week, client is treatments. Other may After 1 week:
Objective Cues: able to: consider natural - client was able to
- comply with remedies. This comply with therapeutic
- exacerbation of therapeutic plan as approach will provide a plan as evidenced by
symptoms evidenced by proper basis for planning future proper intake of
- worsening of condition intake of medicines care. medicines following the
following the - Involve the patient in planning - Patients who are prescribed dosage and
prescribed dosage the proper treatment for him or included in the planning duration, appropriate
and duration, her have greater stake in pill count, maintained
appropriate pill count, achieving a positive medical appointments,
maintained medical outcome and fewer hospital
appointments, and - Educate the patient and the - This increases admission
fewer hospital family members on the treatment awareness about the - client was able to
admission regimen that the patient will importance of display gradual health
- display gradual undergo completing the restoration with minimal
health restoration with prescribed treatment. It or no complications
minimal or no provides increased developed
complications compliance to such
developed treatment.