4 Exercise Content
• Frank Smith is a 42-year-old patient diagnosed with pituitary prolactinoma,
a benign tumor that arises from the pituitary gland, resulting in a decrease
in libido and impotence and increased milk production of the breast. The
patient also has complaints of headache and drowsiness and the
presence of visual field changes and papilledema preoperatively.
A. What postoperative care should the nurse provide the patient?
(Maintain airway (monitor oxygen levels, administer oxygen as needed
Relieve pain
Administer meds
.Monitor vital signs and neurological status every 30 to 60 minutes
.(Monitor for increased intracranial pressure (ICP
Look for s/s of cerebral edema
Monitor for decreased level of consciousness, motor weakness or
.paralysis, aphasia, visual changes, and personality changes
.Provide a quiet environment
.Monitor the head dressing frequently for signs of drainage
Mark any area of drainage at least once each nursing shift for baseline
.comparison ,record the amount and color
.Monitor electrolyte levels
Monitor for dysrhythmias, which may occur as a result of fluid or electrolyte
.imbalance
B. The patient’s family asks the nurse how will they know that the
problems the patient had before surgery have stopped; what is the
nurse’s best response?
.Sing and symptoms will stop •
Prolactin levels will be within normal range •
C. What discharge instructions should the nurse provide the patient
and family?
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• Increase your activity slowly. Talk with your healthcare provider about
which activities you can start with.
• Don’t drive until your healthcare provider says it’s OK.
• Don’t lift anything until your healthcare provider says it’s OK. Your provider
may tell you not to lift more than 10 pounds for a period of time.
• Take your medicine exactly as directed.
• Don't drink alcohol or use recreational drugs.
• Get plenty of rest and sleep.
• Don't take aspirin, ibuprofen, or similar medicines unless your healthcare
provider says it's OK.
• Make a follow-up appointment.
John Moore, a 22-year-old patient who weighs 150 pounds, presents to the
emergency department (ED) after being thrown from his horse and passing
out for a few minutes; he regained consciousness. The friend who was also
riding a horse called the squad. The patient presented with a Glasgow
Coma Scale (GCS) of 15, and the neurologic exam was within normal
limits (WNL). The ED physician wrote the orders for a CT scan without
contrast of the head, CBC, renal and metabolic profile, PT, PTT, and INR.
The nurse sent the labs and had the IV of NS at keep-open rate per ED
protocol hanging. The nurse was awaiting radiology to call for the patient to
go for the CT when the patient had an epileptic cry, became unconscious,
stiffened his entire body, and then had violent muscle contractions. The
respirations are very shallow, and the lips and nail bed became blue. The
patient lost control of bladder and bowel. The patient bit his tongue and
blood is coming from the mouth. The radiology department calls and is
ready for the patient.
1. List in the correct order the actions that should be taken by the
nurse.
· DURING THE SEIZURE:
.Turn the patient to his side o
Notify the ED physician about the seizure and get an order for a o
.short-acting benzodiazepam. Provide the medication
.Observe and time the seizure o
.Institute seizure precautions o
.Tell radiology that you will come as soon as the patient is stabilized o
:Document ·
· Circumstances before the sz
· Occurrence of an aura
· Areas of the body involved
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· Size of both pupils
· Duration of each phase
· Unconsciousness, if present, and its duration
· Paralysis / weakness
· Inability to speak
· Cognitive status
2. Explain what type of seizure the patient is having, and describe the
three phases of the patient’s seizure and the specific nursing care
for each stage.
Grand mal (tonic-clonic)/generalized seizure
Pre-ictal: no aura is noted in the case study; 50% of all patients have an ·
.aura
Ictal: epipleptic cry (simultaneous contractions of the diaphragm and chest ·
.muscles causes cry); loss of consciousness
Observe movement of head and eyes, muscle rigidity, progression o
of seizure, and the duration and LOC, incontinence of stool and
.urine
.Protect from injury; turn to side and loosen clothes o
Post-ictal: does not remember seizure, confused, hard to arouse from ·
.sleep
Assess airway, breathing, VS, neuro checks; keep on side and o
.clean up the patient; reorient the patient as the patient awakens
3. The ED physician prescribes the following: Valium (diazepam) 10
mg every 10 to 15 minutes PRN for seizures (maximum dose of 30
mg). Once seizures stop, administer Dilantin (phenytoin) 10 mg/kg
IVPB. ECG monitoring continuously, vital signs, GCS, and
neurologic checks every 30 minutes. Explain what medications the
nurse should provide, in what order, and how they should be
administered.
Keep the patient in a side-lying position to maintain an adequate airway ·
.and prevent aspiration
Give 10 mg Valium IVP over 2 minutes and repeat every 10 to 15 minutes ·
.until the seizing stops or the 30 mg maximum dose is reached
.Monitor vital signs/neuro checks, GCS after the seizure is stopped ·
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Give Dilantin IVPB; 150 pounds /2.2 #/kg = 68 kg ·
mg/kg x 68 kg = 680 mg mixed in 100 mL NS and given at a rate of 50 10
mg/min., so give over 13.6 min. 60 minutes/13.6 min. = 4.1 x 100 = 441
.mL/hr. The nurse will run the piggyback at 441 mL/hour
.Monitor ECG when administering Dilantin ·
Have the patient on a portable monitor and oxygen with emergency ·
medical supplies on hand and ready to go to CT scan as soon as the
patient is stable enough to go and the CT department is ready for the
patient. Follow the hospital policy and procedure for transporting a
.critically ill patient
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