Patient Introduction
Mr. Watkins is a 69-year-old male who presented to the Emergency Department 4
days ago with complaints of nausea, vomiting, and
... [Show More] severe abdominal pain and was
admitted for emergent surgery for bowel perforation. He underwent a
hemicolectomy. He has a midline abdominal incision without redness, swelling, or
drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are
present in all four abdominal quadrants. He had a bowel movement yesterday. Last
urinary output was 400 ml at 6 a.m. He is reluctant to use the incentive spirometer,
but his wife encourages him to do his deep breathing. Abdominal pain has been
controlled with morphine. He has refused to ambulate this morning because of
fatigue and a sore leg. He is ringing the call light requesting to see his nurse.
Medical-Surgical Nursing Care
Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th EditionMedicalSurgical Nursing
Care of the Postoperative Patient, Chapter 19, pp. 456-476
Pulmonary Embolism, Chapter 23, pp. 614-618
Diagnostics
Expert Clinical Content from Lippincott Advisor
Arterial blood gas analysis
D-dimer test
Prothrombin time
International normalized ratio
Pharmacology
Clinical Content from Lippincott Advisor
Heparin
Morphine
Pre-Sim Quiz
1. Which of the following nursing assessment findings are excluded for a pulmonary
embolism? (Select all that apply.)
2. The nurse understands that heparin acts in which of the following ways?
3. What measure would the nurse take after interpreting the following arterial blood
gas (ABG) results for a postoperative patient on a 40% oxygen face mask?
4. Morphine is administered by the nurse in the patient experiencing pulmonary
embolism in order to accomplish which of the following? (Select all that apply.)
5. The nurse knows that death from an acute pulmonary embolism commonly
occurs within how many hours after the onset of symptoms?
7. Is the following statement TRUE or FALSE? A pulmonary embolism requires
emergency treatment.
Post-Sim Quiz
1. Vernon Watkins was originally admitted through the emergency department with
a diagnosis of bowel perforation. Complications of bowel perforation can include
peritonitis. Which of the following are hallmark signs of peritonitis for which the
nurse should assess?2. In the patient who has had a hemicolectomy, the nurse would expect to find
which type of bowel sounds four hours postoperatively?
10. If Vernon Watkins develops hypotension due to right ventricular failure resulting
from the PE, it may be treated with which of the following medications, since this
medication has an inotropic effect and also causes mild vasodilation therefore
causing decreased afterload for the heart? [Show Less]