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Author Question: A client had a surgical procedure with spinal anesthesia. The nurse raises the head of the client's ... (Read 94 times)

PhilipSeeMore

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on: Jun 25, 2018
A client had a surgical procedure with spinal anesthesia. The nurse raises the head of the client's bed. The client's blood pressure changes from 122/78 mm Hg to 102/50 mm Hg. What action by the nurse is best?
 
  a. Call the Rapid Response Team.
  b. Increase the IV fluid rate.
  c. Lower the head of the bed.
  d. Nothing; this is expected.

Question 2

Ten hours after surgery, a postoperative client reports that the antiembolism stockings and sequential compression devices itch and are too hot. The client asks the nurse to remove them. What response by the nurse is best?
 
  a. Let me call the surgeon to see if you really need them.
  b. No, you have to use those for 24 hours after surgery.
  c. OK, we can remove them since you are stable now.
  d. To prevent blood clots you need them a few more hours.


momtoalll

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Reply #1 on: Jun 25, 2018
Answer to Question 1

ANS: C
A client who had epidural or spinal anesthesia may become hypotensive when the head of the bed is raised. If this occurs, the nurse should lower the head of the bed to its original position. The Rapid Response Team is not needed, nor is an increase in IV rate.

Answer to Question 2

ANS: D
According to the Surgical Care Improvement Project (SCIP), any prophylactic measures to prevent thromboembolic events during surgery are continued for 24 hours afterward. The nurse should explain this to the client. Calling the surgeon is not warranted. Simply telling the client he or she has to wear the hose and compression devices does not educate the client. The nurse should not remove the devices.


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PhilipSeeMore

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Reply #2 on: Jun 25, 2018
Thank you :)


momtoalll

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Reply #3 on: Jun 25, 2018
Happy to help you


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