How to answer a nursing case study (Solved)

How to answer a nursing case study (Solved)

Case Study 2: 63-year-old K.S. has just arrived to the PACU, where the nurse makes the initial assessment. K.S. is
turned, the OR sheets are removed, his skin is observed for redness and pooling of blood, and his head is
elevated 45 degrees. He is on 40% humidified oxygen via a Ventimask mask. K.S’s initial set of vital
signs are 140/80, HR 92, RR 14, T 99° and pulse ox 98%. Fifteen minutes later, the nurse charts his vital
signs as 144/76, HR 100; RR 10, T 99.1° and pulse ox 88%.
1. What action would be appropriate by the nurse based on the vital signs assessment 15 minutes
after arrival to PACU?
2. What age-related factors would the nurse want to consider regarding K.S.’s nursing care?



Systolic blood pressure is elevated; he has redness and pooling of blood, indicating that the operation site is bleeding. Also, the temperature is elevated, which is a sign of high fever, bradypnea, and low oxygen saturation levels. The nurse should give Rapid-acting antihypertensive such as nifedipine to reduce systolic BP. The nurse should examine if the venti mask that the patient has been placed on is appropriately placed, stimulate the patient and increase the percentage of oxygen being delivered. Redness and fever are some of the first signs of infections post-op; therefore, the nurse should examine the wound and antibiotics administered to the patient. Vital signs should be regularly monitored after every 15 minutes for the past hour. The patient should also be placed in a lateral or recovery position and continuous intravenous fluids maintained.


  Elderly patients are among the vulnerable groups of the population. There is a decrease in physiological functions because some systems begin to shut down. The onset of functional impairments predisposes older patients to postoperative complications (Olotu et al., 2019). The functional status of the patients should be determined by the adequate perioperative assessment, including chronic disorders, comorbidities, polypharmacy, malnutrition, and risk for falls. Dietary intake and fluids should be monitored because they are crucial in the recovery phase of the patients. The risk for infections and hospital lengths is reduced when oral or enteral diet intake is initiated early. A multidisciplinary approach should be applied to ensure improved health outcomes for the patients (Olotu et al., 2019). The goal of postoperative care is to ensure that the functional status of the client pre-op is maintained by the application of evidence-based practices throughout the phases of surgery.


Olotu, C., Weimann, A., Bahrs, C., Schwenk, W., Scherer, M., & Kiefmann, R. (2019). The Perioperative Care of Older Patients: Time for a New, Interdisciplinary Approach. Deutsches Ärzteblatt International, 116(5), 63.

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