T.A., a 52-year-old obese white woman, arrives on the nursing unit at 5 AM. She is scheduled to undergo a total abdominal hysterectomy at 8 AM. T.A. appears slightly anxious as you escort her to her room. She is accompanied by her husband of 20 years and her 17-year-old daughter. You give T.A. a gown to change into and a belongings bag for her clothes. As you are preparing to leave the room, T.A. says, “Please make sure that everyone knows I have diabetes. I am so afraid my blood sugar is going to go too high without my usual insulin dose.”
After reviewing T.A.’s preoperative information, you note that all diagnostic tests are within normal limits except for her blood glucose, which is slightly elevated at 140 mg/dL. T.A.’s past medical history is negative except for type 1 diabetes, leiomyomas (uterine fibroids), and dysmenorrhea. A physical assessment reveals no abnormal findings.
You perform a focused physical assessment on T.A. with the following findings:
- Height 5’1″
- Weight 80 kg
- BP 104/60; HR 82; RR 18; Temp 37.1°C
- Awake, alert, and oriented
- Moves all extremities equally; denies numbness or tingling
- +2 peripheral pulses, all extremities
- Lungs clear to auscultation
- Apical pulse regular with no abnormal heart sounds
- Abdomen soft and nontender; + bowel sounds all four quadrants
A current medication/herbal history reveals the following:
- Lispro (Humalog) insulin before meals based on glucose reading
- Glargine insulin 30 units at bedtime daily
- Multivitamin capsule, one daily in AM
- Ginger, 1 teaspoon in 8 oz water, prn for indigestion and nausea
- Kava, 1 capsule, prn at night to help sleep
Discussion Questions:
**When applicable, provide your rationale.
- What is the significance of performing a thorough patient interview?
- Briefly provide an overview of what is included in the nursing assessment in the pre-operative phase?
- Name at least three nursing diagnoses relevant to this patient (can include any phase in the peri-operative process).
- List significant nursing interventions for each phase of the peri-operative process.
- What would your response, as a nurse, be to T.A.’s comment about making sure everyone is aware about her diabetes?
- Prior to going into the Operating Room (OR), the patient asks, “So how long is this surgery going to take?” As the nurse, what is your response or what actions do you take?
- After T. A. is moved to the PACU, determine what the top three priority assessment areas would be for the primary nurse.
- What position do you expect the patient to be in during the post-operative phase?
- List some education content you would review with your patient prior to discharge or admission to the floor.
