Subject Case study: 

Mrs. White is a 55 yo female with a PMHx significant for HTN, and DM type 1.  She was admitted for abdominal pain.  A CT scan revealed appendicitis.  Her home medications include: Metoprolol, Lisinopril, and regular insulin.  You received her from the PACU following a lap appendectomy. 

PACU Report: AOx4, VS RR 24, HR 90, BP 125/90, T 99.8, SpO2 95% of 2LNC.  Lungs clear.  No bowel sounds, Has a foley catheter to bedside drainage with light yellow urine.  Est. blood loss in the OR was 500cc.  Pain currently at 4/10 with a PCA pump with morphine sulfate.  The PCA settings are as follows: Basal rate of 3ml/hr, pt dose of 0.5ml Q15min with a 1 hour limit of 5ml/hr.  IV fluids of D5 ½ NS @ 125ml/hr.  #20 RAC.  H/H pre-op 13.5/40, post-op 10.5/32.5

• List 3 priority nursing diagnoses.

• Discuss the initial/priority interventions for this client.  Include dependent and independent actions.

• What lab values are you going to need to focus on and why?

• She is on both a beta-blocker and an ACE inhibitor, why, what is the rationale?
• Her pain is being managed via a PCA pump.  What is the route for this type of pain management? 

• The client has been NPO for the past 18 hours.  Her blood glucose is 250mg/dl. Provide an explanation for the elevation in blood sugar.

• Determine the nursing priorities for this finding.

• Discuss the priority assessments related to this treatment protocol.