Nursing NR 228 week 3 assignment

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Nursing Note: Client working toward completing requirements needed for insurance payment for bariatric surgery.

· 12/06- Initial visit with weight management

· 01/06 – Dietician visit

· 02/12 – Visit with physician assistant for weight management

· 03/19 – Appointment with bariatric surgeon

· 04/10 – Appointment with psychologist for clearance

Today, 05/12 client here for endoscopy for approval pre-bariatric surgery. Gastrointestinal provider will clear client anatomically for surgery as well as a biopsy taken to rule out h-pylori.

Before answering this question, review the client’s health information in the EHR. Complete the sentence using the drop-down choices.

The nurse knows that the client most likely takes hydrochlorothiazide for Choose...hypertensionosteoarthritismorbid obesityurinary tract infection . The nurse knows that client would most likely take Choose...metforminlosartanomeprazolefinasteride for her polycystic ovarian syndrome and prediabetes. The client most likely treats her obstructive sleep apnea with Choose...ventilatormontelukastc-papmeloxicam . The client most likely uses Choose...allopurinolacetaminophenalbuterolaripiprazole for her osteoarthritis.

Feedback

Consider:

1. Why would the client be able to stop taking these medications after gastric bypass surgery?

2. What symptoms occur with polycystic ovarian syndrome?

3. Why does gastric bypass surgery require a long pre-operative process?

Question 2

Complete

Mark 33.33 out of 33.33

Question text

Name: Jenna Batch

Age: 37 years

Provider: V. Michaels, MD

Allergies: NKA

Code Status: Full Code

Admit Wt: 420.2 lbs. (191 kg)

BMI: 64.6

· Nursing

· Flowsheets

· Other

NURSING ASSESSMENT & NOTES
05/12 0730	Nursing Note: Client working toward completing requirements needed for insurance payment for bariatric surgery. · 12/06- Initial visit with weight management · 01/06 – Dietician visit · 02/12 – Visit with physician assistant for weight management · 03/19 – Appointment with bariatric surgeon · 04/10 – Appointment with psychologist for clearance Today, 05/12 client here for endoscopy for approval pre-bariatric surgery. Gastrointestinal provider will clear client anatomically for surgery as well as a biopsy taken to rule out h-pylori.
06/21 0645	Nursing Note: Client admitted this morning for Roux-en-Y gastric bypass surgery. Client has been working with weight management since December and has completed the requirements for insurance authorization. Client has met with surgeon, signed consent on file. Anesthesia will meet with client before procedure. Client reporting that she is “ready for procedure but anxious.” Client has completed two-week liquid diet as prescribed by surgeon. Has had nothing by mouth since midnight.
06/21 0650	Neurologic: Alert, oriented x 4. Cardiac: Regular, S1&S2 present, +1 edema in bilateral lower extremities, +2 pulses in radial and pedal pulses. Respiratory: Lungs clear bilaterally, diminished in bases. Gastrointestinal: positive bowel sounds x4 quadrants. Rounded, soft, non-tender to palpation Genitourinary: indwelling catheter draining clear yellow urine Integumentary: Intact, dry, warm, red discoloration to bilateral lower extremities

Before answering this question, review the client’s health information in the EHR. Determine if the following steps are essential or non-essential to be completed before the procedure. Select one option in each row.

	Essential	Not Essential
Client has nail polish on her toes.
Circulating nurse initiates bedside time out prior to surgery.
Client has highlights in her hair.
Informed consent obtained by anesthesia.
Client removes glasses after consent is signed.
Client taken to the restroom within five minutes of being taken to the OR suite.
Informed consent obtained by surgeon.
Client intubated with no complication.
Client’s family is in waiting room.

Feedback

Consider:

1. Why might a client of larger size be challenging to intubate?

2. What is done during a surgical time-out?

3. Who oversees obtaining consent?

Question 3

Complete

Mark 25.01 out of 33.34

Question text

Name: Jenna Batch

Age: 37 years

Provider: V. Michaels, MD

Allergies: NKA

Code Status: Full Code

Admit Wt: 420.2 lbs. (191 kg)

BMI: 64.6

· Nursing

· Flowsheets

· Other

NURSING ASSESSMENT & NOTES
05/12 0730	Nursing Note: Client working toward completing requirements needed for insurance payment for bariatric surgery. · 12/06- Initial visit with weight management · 01/06 – Dietician visit · 02/12 – Visit with physician assistant for weight management · 03/19 – Appointment with bariatric surgeon · 04/10 – Appointment with psychologist for clearance Today, 05/12 client here for endoscopy for approval pre-bariatric surgery. Gastrointestinal provider will clear client anatomically for surgery as well as a biopsy taken to rule out h-pylori.
06/21 0645	Nursing Note: Client admitted this morning for Roux-en-Y gastric bypass surgery. Client has been working with weight management since December and has completed the requirements for insurance authorization. Client has met with surgeon, signed consent on file. Anesthesia will meet with client before procedure. Client reporting that she is “ready for procedure but anxious.” Client has completed two-week liquid diet as prescribed by surgeon. Has had nothing by mouth since midnight.
06/21 0650	Neurologic: Alert, oriented x 4. Cardiac: Regular, S1&S2 present, +1 edema in bilateral lower extremities, +2 pulses in radial and pedal pulses. Respiratory: Lungs clear bilaterally, diminished in bases. Gastrointestinal: positive bowel sounds x4 quadrants. Rounded, soft, non-tender to palpation Genitourinary: indwelling catheter draining clear yellow urine Integumentary: Intact, dry, warm, red discoloration to bilateral lower extremities
06/22 1000	Nursing Note: Client post-op day 1. Client’s indwelling urinary catheter was removed at 0500 this morning. Client has not voided on her own. Client has a morse fall risk of 35. Ambulating independently in the room. Upon rising this morning, client has started her oral water intake of 15mL per hour. Attempted to ambulate with nurse but after 35 ft became nauseated.
06/22 1000	Neurologic: Alert, oriented x 4. Drowsy Cardiac: Apical rate 110, S1&S2 present. +1 edema in bilateral lower extremities, +2 bilateral radial and pedal pulses. Respiratory: Diminished in bilateral lower lobes. Right upper lobes clear. Left upper lobes with mild wheezing Gastrointestinal: Abdomen tender in all quadrants. Positive bowel sounds in all 4 quadrants, mild distention, rounded, Genitourinary: Indwelling urinary catheter removed at 0500. No post-catheter void. Integumentary: Four surgical incisions on abdomen closed with surgical glue. Edges well-approximated Pain: 4/10 in abdomen.

Before answering this question, review the client’s health information in the EHR. Identify the factors that require intervention by the nurse. Select four (4) that apply.

Nausea

Incision approximation

Lung sounds

Temperature

Last urinary voiding

Level of consciousness

Oral intake

Abdominal tenderness

Pulse oximetry

Feedback

Consider:

1. Why is a mild temperature an expected finding for a post-operative client?

2. Teach a peer how to use an incentive spirometer.

3. What interventions should the nurse implement to facilitate voiding?