Robert Espinoza, age 44, has just had

Robert Espinoza, age 44, has just had exploratory abdominal surgery. The post-anesthesia recovery room (PACU) nurse calls at 1410 to provide report for Mr. Espinoza and tells you he has a peripheral IV inserted in his right arm, infusing NSS at 50 mL/hr. He has a midline abdominal dressing that is dry and intact with two Jackson-Pratt (JP) drains in place. He also has a nasogastric (NG) tube and an indwelling urinary catheter to gravity drainage. The nurse reports that his NG tube has been checked for placement and has been draining moderate amounts of yellow-green contents. His vital signs in the PACU are as follows: temperature, 98.0°F; pulse, 86 beats/min; respirations, 16 breaths/min; blood pressure, 134/80 mm Hg. At 1400, he received 4 mg morphine sulfate IV for sharp incisional pain reported as 8 on a scale of 1 to 10 (10 = worst). At 1500, you receive Mr. Espinoza on your medical-surgical unit via stretcher by a hospital transporter. The NG tube tape that secured the NG to his nose is no longer in place. You also notice that the urinary drainage bag lying on top of his legs has a small amount of amber urine in the reservoir. While you are in his room, Mr. Espinoza says, “Hey, it feels like there’s something wet under my back.” His vital signs on arrival are as follows: temperature, 98.0°F; pulse, 130 beats/min; respirations, 18 breaths/min; and blood pressure, 100/68 mm Hg. His respirations are regular and un-labored, and his skin color is pink. He now rates his pain as dull and 2 on a scale of 1 to 10 (10 = worst). Mr. Espinoza’s family is anxiously waiting in the waiting room on your unit. Prescribed Interventions Indwelling urinary catheter to gravity × 24 hours; discontinue at 0800 on 8/24 Routine JP drain care Strict I&O Routine postoperative vital signs NG tube to intermittent suction; 30 mL NSS flush q4h Intravenous fluids: NSS at 50 mL/hr Morphine sulfate 3 mg IV q4h prn for pain Considering Mr. Espinoza’s immediate postoperative status, describe how you would transfer him from the stretcher to his bed. Ans: There are numerous factors to take into account before relocating Mr. Espinoza. The first thing I would do is to make sure his NG tube is positioned correctly and tape it down until I can fix it permanently. In order to allow the patient’s wound to be splinted, I believe it would be more appropriate to transfer them using a transfer board or a sheet placed beneath them. Leveling both beds is required. On top of the patient, I would position the drains and the foley catheter, and I would probably relocate the iv pump (if connected) closer to the bed. The patient would be lifted onto the bed by myself and those assisting with the move. Prioritize, with rationales, your assessments and nursing care for Mr. Espinoza in the following areas: a) Immediate assessments and interventions b) Assessment and management of tubes c) Pain management and comfort level d) Care of his family have a medication card for Morphine made

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