Author Question: What is the priority nursing assessment for a patient who his receiving postoperative epidural ... (Read 77 times)

EY67 · **on:** Jul 23, 2018

What is the priority nursing assessment for a patient who his receiving postoperative epidural analgesia with hydromorphone (Dilaudid)?

a. Respiratory rate, depth, and pattern
b. Skin underneath the epidural dressing
c. Bladder scanning to check for urinary retention
d. Itching on the trunk and/or extremities

Question 2

The nurse is caring for a patient with rheumatoid arthritis who is in constant severe pain. Which nursing diagnosis is the highest priority for this patient?

a. Impaired walking r/t patient's need to use a cane or walker with ambulation
b. Readiness for enhanced comfort r/t sedentary lifestyle and poor physical condition
c. Effective therapeutic regimen management r/t mistrust of health care personnel
d. Chronic pain r/t ongoing inflammatory tissue damage and joint destruction

milbourne11 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
The respiratory system is the priority nursing assessment for patients receiving narcotic pain medication via any route. This is because narcotics can cause respiratory suppression. The other assessments are a lower priority and may be done after a respiratory assessment is completed.

Answer to Question 2

ANS: D
Chronic pain is the highest priority diagnosis for this patient because it is severe. The other diagnoses may be addressed once the patient's pain is controlled.