Kevin is a 28-year-old male who recently underwent surgery for the diagnosis of small cell carcinoma of the left, lower lob.

QUESTION

Kevin is a 28-year-old male who recently underwent surgery for the diagnosis of small cell carcinoma of the left, lower lob. He had a left, lower lobectomy to remove the cancerous mass. Kevin’s medical history includes an allergy to pineapple and amoxicillin. Kevin is a self-employed, graphic designer. He is single and has no children.

The recovery room nurse reports that the surgery was uncomplicated. Kevin’s condition is stable and he will be returning to your unit soon. He has IV infusing into his right forearm and a dressing over the left side of his chest which is connected to a chest tube. He is alert and comfortable at this time.

Kevin’s post-operative orders include:

Continue IV Ringer’s Lactate x 24 hours, then to Normal Saline;

Diet: Clear fluids to DAT;

Bedrest until no longer requiring chest tube;

Morphine 10-20mg IV q4-h PRN;

Gravol 25-50mg IV or IM q4-6h PRN;

Cefazolin 1g IV q-8h x 4 doses.

The porter has returned Kevin to his room at 10:00hrs.

Please answer the following questions using point form.

Question 1

What priority assessment would you make at this time?

Question 2

It has been determined that Kevin has a tension pneumothorax.

Define what that is and list four signs and symptoms

Question 3

Kevin is experiencing pain in his chest and requests morphine (refer to the order provided).

How many mL can you give (lowest and highest) based on the order and vial information provided here: Morphine Sulfate Injection, USP 5mg/mL

Question 4

Kevin’s vital signs are: BP 125/80, Pulse 105 BPM, RR 8 RPM, Temp 37.1C.

Based on the findings staed and how the patient presents, what additional assessments would you make and why?

Question 5

8-hours post-op, Kevin has a CBC blood test. The results show his hemoglobin to be at 92g/L, which is abnormally low. Physician has been informed and has ordered one unit of packed red blood cells to be administered.

The need for the blood has been explained to Kevin and he has provided consent for the procedure. You are now getting ready to administer the blood transfusion.

a) What size IV catheter must used for this transfusion?

b) The blood bank has sent O-positive blood for the transfusion. Kevin’s blood type is B-negative. Explain why this blood type can or cannot be used.

ANSWER

Question 1

Priority Assessment

Assess Kevin’s respiratory status, including the rate, depth, and effort of breathing, lung sounds, and oxygen saturation, to ensure adequate ventilation and oxygenation.
Monitor Kevin’s chest tube drainage, assessing the amount, color, and consistency of the fluid to identify any signs of bleeding or infection.
Evaluate Kevin’s pain level and location to determine the effectiveness of pain management and to identify any changes or new pain symptoms.
Assess Kevin’s level of consciousness, orientation, and neurological status to monitor for any signs of neurological complications or changes.

Question 2

Tension Pneumothorax:
Tension pneumothorax occurs when air accumulates in the pleural space, causing increased pressure and compromising lung function.
Signs and Symptoms:
1. Severe respiratory distress, with rapid and labored breathing.
2. Chest pain and tightness.
3. Absent or decreased breath sounds on the affected side.
4. Tracheal deviation away from the affected side.
5. Cyanosis or decreased oxygen saturation.

Question 3

Morphine Dosage Calculation:
The concentration of Morphine Sulfate Injection is 5mg/mL.
Lowest Dose: 10mg/5mg/mL = 2mL
Highest Dose: 20mg/5mg/mL = 4mL

Question 4

Additional Assessments:
Assess Kevin’s oxygen saturation and provide supplemental oxygen if necessary due to the low respiratory rate (8 RPM) and potential for hypoventilation.
Evaluate Kevin’s level of consciousness and neurological status further to rule out any neurological complications that may be contributing to the low respiratory rate.
Monitor Kevin’s blood pressure for any signs of hypotension or changes in perfusion.
Assess Kevin’s temperature for any signs of infection or fever that may be causing the increased heart rate.

Question 5

IV Catheter Size
For blood transfusion, a larger gauge IV catheter is typically required to allow for the smooth flow of blood products. A 20 or 18-gauge IV catheter is commonly used.

Compatibility of Blood Type
Kevin’s blood type is B-negative, and the blood sent from the blood bank is O-positive.
B-negative blood can only receive B-negative or O-negative blood. Therefore, O-positive blood cannot be used for Kevin, as it is incompatible with his blood type.