Trinity Valley Community College Associate Degree Nursing
Level II Clinical Activity Ethical Legal
Ethical Legal – Post Operative Complication
Case Study –Failure to adequately assess and monitor the patient post-operatively.
A 74 your-old female was admitted to the hospital for a left total knee replacement. She went through the surgical procedure without any adverse events. She was in the post-anesthesia care unit (PACU) where the anesthesiologist ordered a Patient-Controlled Analgesia (PCA) pumpfor post-operative pain management. Following one episode of hypotension, which was treated by a 500 ml bolus of normal saline, the patient was discharged to an inpatient orthopedic- medical-surgical nursing unit. The hand-off report was given to the charge nurse who assigned the patient to a licensed practical nurse (LPN). The charge nurse assessed the patient on admission and found the following vitals: BP 108/69, P 94, R18, and T 98.9 ° F. The PCA pump was in place with Morphine.
Post-operative orders included:
Admit to orthopedic- medical-surgical nursing unit
Vitals every 2 hours unit stable, then every 4 hours.
Albuterol nebulizer treatment for wheezing every 4 hours prn.
NPO for 12 hours, then offer ice chips and clear liquids,
CPM to be initiated by physical therapy when vitals are stable.
Morphine PCA with concentration of 5 mg / ml, (150 mg in 30 ml): 2 mg every 15 minutes with lock out 32 mg in 4 hours.
Approximately four hours after arriving on the unit, the patient vomited immediately after the first respiratory therapy treatment. The Respiratory Therapist reported the vomiting to the charge nurse who informed the LPN to “check on” the patient. Approximately 10 minutes later the LPN found the patient unresponsive and immediately called a code.
The charge nurse responded, as did the code team and the patient was intubated and transferred to ICU.
In the ICU the patient was diagnosed with anoxic encephalopathy due to the time that lapsed before CPR was initiated. Prognosis was poor and the family decided to withdraw life support after 3 days. The patient died 6 hours later under the care of hospice.
Questions for discussion:
- What Texas BON standards of practice were violated? Provide specific examples. Discuss the care that should have been provided to meet the standard of practice.
- Describe how this situation should have been handled.
- What is the role of the RN charge nurse related to scope of practice and delegation to the LVN?
- What Unprofessional Conduct standards would be applied to the care provided by the RN?
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