Esther Jackson Is A 56-Year-Old Black Female Who Is 1 403280

Esther Jackson Is A 56 Year Old Black Female Who Is 1 Day Post Op Foll

Esther Jackson, a 56-year-old Black female, is currently one day post-operative following a left radical mastectomy. During morning rounds, the nurse reports that the patient has experienced increased back discomfort throughout the night and needed frequent assistance with repositioning. Although she was given pain medication about two hours ago, her discomfort persists with minimal relief. She expressed the need to inform the physician during rounds about her ongoing pain. The patient appears to be in no visible distress at that moment, prompting the nurse to proceed with report to the next patient. About an hour later, the nurse returns to Ms. Jackson's room with her morning medications and finds her slumped over the bedside stand, tears in her eyes. She reports feeling unwell, with ongoing back pain and fatigue, and declines her medications, citing nausea. The nursing assistant takes vital signs but reports difficulty in obtaining an accurate pulse due to the patient's 'all over the place' pulse. Her vital signs are recorded as temperature 37°C, respiratory rate 18 breaths per minute, and blood pressure 132/54 mmHg. In addition, the patient reports feeling sick to her stomach, which raises concern for possible underlying issues.

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The clinical presentation of Ms. Jackson suggests a potential complication related to her recent surgery and medication management. The persistent back pain, fatigue, perceived nausea, and irregular pulse are indicative of possible hypovolemia, medication side effects, or more critically, signs of bleeding or a hematoma formation, especially considering her recent mastectomy. Furthermore, the reported irregularities in her pulse could indicate hemodynamic instability, possibly because of hemorrhage, hypovolemia, or an adverse drug reaction, such as opioid-induced respiratory depression or hypotension.

To determine the cause of her symptoms, the initial course of action involves a comprehensive assessment, starting with a thorough physical examination. The nurse should evaluate the surgical site for signs of bleeding or hematoma, such as swelling, bruising, or abnormal drainage. An assessment of her vital signs, including blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature, should be performed immediately to monitor for signs of shock or infection. It is vital to check her mental status and level of consciousness, as altered mental status could suggest hypoperfusion or hypoxia. Given her report of nausea and feeling sick, it is essential to assess her hydration status, mucous membranes, and skin turgor to identify dehydration signs.

Laboratory testing is essential for confirming suspicions of bleeding or infection. A Complete Blood Count (CBC) will evaluate her hemoglobin and hematocrit levels to detect anemia secondary to blood loss. Coagulation studies (PT, PTT, INR) are necessary to assess clotting function, especially if bleeding is suspected. Serum electrolyte levels, blood glucose, and renal function tests can help evaluate metabolic disturbances. Additionally, a blood type and crossmatch might be ordered if a transfusion appears necessary.

Imaging studies, such as an ultrasound or a chest and abdominal CT scan, may be ordered to identify intra-abdominal bleed or fluid collection if there is suspicion of internal bleeding or hematoma formation. Continuous cardiac monitoring with telemetry can help detect arrhythmias related to electrolyte imbalance or hypoperfusion. Repeat vital signs, typically every 15 to 30 minutes initially, are necessary to monitor for deterioration or improvement. Repeat CBCs may be ordered every 4 to 6 hours if significant blood loss is suspected, to monitor trend changes in hemoglobin and hematocrit levels.

Monitoring and tests should be repeated based on the patient’s clinical status. For example, if initial labs show a declining hematocrit or hemoglobin, subsequent blood work every few hours would help monitor ongoing bleeding and guide transfusion decisions. If vital signs indicate worsening hypotension or tachycardia, more frequent assessments are required, and immediate intervention such as fluid resuscitation and blood transfusion may be necessary.

In caring for Ms. Jackson while managing these concerns, maintaining a high level of vigilance is crucial. Regular assessments should be conducted, prioritizing her stability and comfort. Clear communication with the healthcare team about her changing condition, laboratory results, and response to interventions is vital for timely decision-making. Ensuring infection control measures, managing pain effectively with consideration of her nausea, and providing emotional support are all part of holistic patient care.

Balancing the needs of other patients involves efficient delegation and thorough reassessment, ensuring that all patients receive timely care. Utilizing appropriate resources such as nursing assistants and prioritizing tasks based on urgency can help in managing multiple patients simultaneously. Regular and structured rounds help identify changes in each patient's condition early, facilitating prompt intervention without neglecting others.

References

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