1. What is the rationale for F.J. being NPO after midnight?

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Restriction of food and fluid is ordered to minimize the potential
risk of aspiration and to decrease the risk of postoperative nausea
and vomiting. Recent says not all pt. need to be NPO some can
have clear liquids up to 2 hr before surgery but because she has
hx. of diabetes she should be NPO for 8 hr.
2. What preoperative teaching should you provide to F.J.?
what to expect during the surgical experience, instruction on deep
breathing use of incentive spirometer coughing, leg extension
(ankle pumps and ankle circles) and moving post op pain
assessment and pain control

3. What conditions must be met for F.J. to provide consent

for surgery?
Doc must provide adequate disclosure of the dx. including the
nature and purpose of the proposed tx. the risks and
consequences of tx. the probability of success, benefits and risks
alternatives and prognosis if tx. is not done, assess pt.
understands and comprehends the info that was provided and
that consent is being given voluntarily.
4. What risks exist for F. J. as she undergoes surgery?
due to age, state of immobility and diabetes, she is at risk for
thrombophlebitis, pulmonary prob, delayed wound healing,
infection, surg complications. Probs with metformin, it should be
discontinued 48 hr before procedure require monitoring of renal
function and bleeding since last dose was prior evening.
5. What is the significance of F.J.’s glucose level and how
will it affect F.J.’s care?
Since her BS is elevated she is at higher risk for developing
acidosis during surgery and experiencing post op comp, include
prolonged wound healing and increased length of stay. Report FJ
glucose level to the physician. It is possible that short acting
regular insulin will be admin to resolve her hyperglycemia prior to
surg, FJ will require frequent monitoring of BS throughout periop
period with the goal of keeping them normal range.
6. What are your priority actions as F.J. awaits surgery?
pain control, teaching, assessment of baseline vitals, physical
assessment safety proper use of traction skin integrity circulation
checks. Ensure operative site is marked and jewelry makeup and
fingernail polish and toe polish is off and make sure consent is
signed and in the chart complete.

7. Name 3 nursing diagnosis, 3 interventions for each

diagnosis and patient education
•Nursing diagnosis,

1• Acute pain related to movement of bone fragment and immobilty

device as evidenced by report of pain.

•Nursing Intervention,

1.Assess pain by pain rating scale and record level of the pain .

2•Protect the immobilization of  affected part by cast ,splint and traction.

3• Provide the sentimental support to the patient.

4• Educate the patient regarding stress managament technique.

2. Risk for impaired blood sugar related to Diabetes mallitus as

evidenced by blood sugar monitoring.

Nursing Intervention;

1.Check the blood sugar level before administration of medicine .

2.Monitor  for sign and symptom increased blood sugar

like polyurea,polyphagia

3.Educate the patient regarding diabetic diet.

4.Assess the patient for Low blood sugar level

3.Risk for impaired skin integrity related to immobilty as evidenced by

immobile patient due to traction.

•Nursing Intervention;

1.Educate the patient regarding the use of emollient cream to decrease

dryness of the skin.

2. Educate the patient to take plenty of fluid to rehydrate the body .

3.Provide the nutritional diet to fulfill the nutritional need of body.

4. Change the position of patient frequently if possible

5. Give the back care to the patient to  increase the circulation.