Perioperative Nursing:An unfolding Case study The Case:John Egan, 53, has a history of Type I diaetes !ellitus, "igarette s!o#ing $% pa"# years, CA&, and P'&()i* +ee#s ago, he developed a +ound of his left heel +hi"h !easured $"! y ,"! +hen he dis"overed it(&espite I' antiioti"s and "he!i"al deride!ent, the +ound developed a gangrene infe"tion(-e is s"heduled for a ./A of the left lo+er e*tre!ity to!orro+ at 0%:%%a!(-is !eds in"lude daily insulin, aspirin 3,5!g1day, Pletal 0%%!g .I&(-e has an advan"ed dire"tive and N/&A( Identify the priority nursing "are for 2r( Egan:3hat do +e need to do pre4op5 Identify the priority nursing "are for 2r( Egan:Co!plete pre4operative testing1Preparation 2aintain nor!al glu"ose levelsEnsure infor!ed "onsentEnsure "orre"t surgi"al sitePrevent post4op infe"tionCo!plete pre4operative tea"hing to prevent "o!pli"ationsAddress psy"hologi"al "o!fort 3hat preoperative testing is appropriate for 2r( Egan5 Pre4surgi"al )"reening Tests Chest *4rayEle"tro"ardiography for 6 $% yrsCo!plete lood "ountEle"trolyte levels7rinalysis84ray left lo+er e*tre!ity 3hen "o!pleting a !edi"ation re"on"iliation for 2r( Egan the evening efore surgery, +hi"h orders in"rease the nurse9s "on"ern5Insulin : units ;egular +ith 05 unit NP- su4"utaneous < a!(Aspirin 3,5!g P= < d(Pletal 0%%!g P= .I&Ativan %(5!g I'P on "all to =; in A2(>http:11+++(?oint"o!!ission(org Insulin : units ;egular +ith 05 unit NP- su4"utaneous < a!(@-igh Alert 2edA @NP= after 2idnightA

Aspirin 3,5!g P= < d( @&o not use arevA@leeding potentialAPletal 0%%!g P= .I&@leeding potentialA &r( &a!on is 2r( Egan9s surgeon and &r( ;iley is 2r( Egan9s anethesiologist(.oth "o!e to see hi! and dis"uss the surgery the evening efore( -o+ does the nurse ensure infor!ed "onsent53hat !ust the patient "onsent to for the pro"edure to e done5 Informed Consent for Surgery & Blood Transfusion3 requirements:Adequate disclosure of diagnosis-purpose, risks, and consequences of treatment, probability of success, prognosis if not institutedUnderstanding & compreension -patient must be drug free prior to signing consentConsent gi!en !oluntarily -patient must not be persuaded or coerced to undergo te procedure Infor!ed Consent Infor!ation&es"ription of pro"edure and alternative therapies7nderlying disease pro"ess and its natural "ourseNa!e and Allo+s fa!ily to #no+ patient +ishes in the event of serious intraoperative "o!pli"ation&urale po+er of attorney for health"are &uring the ad!ission assess!ent, the nurse -* of !ultiple surgeries>-ealth "are professionals Gate* Allergy1)ensitivity) D )>7rti"aria >;hinorrhea>.ron"hospas!>Co!pro!ised respiratory status>Cir"ulatory "ollapse D &eath2anage!ent>Identify those at ris#>Gate* free environ!ent>Gate* free eJe+elry re!oved>Gast void>&entures re!oved>Infor!ed "onsent veriBed>Patient Allergies Co!!uni"ation D )afetyIn the =; -olding ;oo!, 2r( Egan is delivered into the "are of the holding roo! nurse(7sing ).A; te"hni