1. 1) Vitals signs per routine is appropriate to detect any fluctuations in vital organ functioning.
2) Neurologic status checks every 4 hours , to see any deterioration in neurological functioning
3) Turn ,cough ,deep breaths and incentive spirometry every 2hour is appropriate and is taught pre surgery to expand lungs to prevent atelectasis and for doing it post surgery to avoid accumulation of secretion and pulmonary infections and hence prevent atelectasis.
4) Heat pack and elevate right lower extremity and right upper extremity is appropriate ,it is done to avoid inflammation and swelling
5) Neurovascular checks every 1 hour is appropriate to assess the neurovascular functioning
6) NPO to prevent aspiration patient is kept NPO before surgery
7) IV fluids D51⁄2NS at 100 mL/hr for hydration and fluid and electrolyte balance
8) Morphine sulfate 5 mg IV every 4-6 hours prn is appropriate and within normal range to relieve pain .
2. Weight of the patient is 65kg
Appropriate dose of morphine is 0.05mg to 0.1mg /kg every 4 to 6 hours .
No, the dose of morphine is not appropriate . For chronic pain we give 2.5 to 5mg /kg every 4hours in a child of 16 years .
3. The prescribed dose of morphine is 0.05- 0.1 mg /kg = 0.05×65 to 0.1×65 = 3.25 mg to 6.5mg
Available dose of morphine is 2mg/ml
Means 1ml has 2mg of morphine
We need 3.25mg to 6.5 mg
2mg of morphine is present in 1ml
1mg of morphine will be present in 1/2
Then 3.25mg of morphine will be present in 1/2 ×3.25 ml = 1.6ml
And 6.5mg of morphine will be present in 1/2× 6.5 ml = 3.2ml
1.6ml to 3.2ml of morphine will be drawn according to the upper and lower range and will be double checked by second RN .
4. Patient has sign and symptoms of hypotensive shock
2 Immediate interventions are :-
- Provide Trendelenburg position
- IV fluid administration (isotonic fluids like RL ,NS 0.9% etc )
5. The possible reasons for her changes in her neurologic status are :-
- shock ( hypotensive)
- Increased ICP
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