Question

A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty.

History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their daily walk of 3 miles.History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.No known allergies.

Nurses' Notes
Day 3 0800: Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous passive motion (CPM) machine but attempting to take knee out of device. States, ""I've had enough of this mess. I'm going home."" Client is disoriented to time and place, oriented to self. Refuses to answer simple questions, rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports the client began displaying behavior changes the prior evening. States that client was awake most of the night and was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get out of bed without assistance.Placed call to provider to report findings. Awaiting call-back.

Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
Oxygen saturation 96% on room air
Weight 63.5 kg (140 lb)
Intake and Output (I&O)I = 750 mLO = 2,500 mL

Provider Prescriptions
Day 1:
Enoxaparin 30 mg subcutaneously twice daily
Levothyroxine 75 mcg PO once daily
Omeprazole 20 mg PO once daily
Pravastatin 40 mg PO once daily at bedtime
Morphine 2 to 4 mg intermittent IV bolus every 4 hr PRN pain
Hydrocodone 5 mg PO every 6 hr PRN pain
Acetaminophen 325 mg PO every 6 hr PRN pain or temperature greater than 38.3° C (101° F)

Diagnostic Results
Day 3 0800: Capillary blood glucose 92 mg/dL (82 to 115 mg/dL)

For each potential provider's prescription, select to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

1) Melatonin

2) Apply restraints

3) Urinalysis with culture and sensitivity

4) MRI of the head

5) Insert indwelling urinary catheter

6) IV fluids

A) Anticipated
B) Nonessential
C) Contraindicated

Answer 1

This question is about potential prescriptions for an older adult client following a knee arthroplasty surgery. Melatonin and apply restraints are nonessential or contraindicated, while urinalysis, IV fluids, and pain management are anticipated prescriptions depending on the client's condition.

Step-by-step explanation:

This question is related to the care of an older adult client who is postoperative following a right knee arthroplasty. The question asks about potential prescriptions for the client based on their current condition. Let's go through each option:

1. Melatonin: This prescription is nonessential for the client. Melatonin is a hormone that helps regulate sleep but it is not necessary in this case.
2. Apply restraints: This prescription is contraindicated for the client. Using restraints is not recommended unless absolutely necessary due to safety concerns and the potential for physical and psychological harm.
3. Urinalysis with culture and sensitivity: This prescription is anticipated for the client. A urinalysis with culture and sensitivity can help identify any urinary tract infections or other urinary issues.
4. MRI of the head: This prescription is nonessential for the client. As the client is experiencing behavioral changes and disorientation, an MRI of the head may not be directly related to their current condition.
5. Insert indwelling urinary catheter: This prescription is contraindicated for the client. Unless there is a specific medical reason, indwelling urinary catheters should be avoided as they can increase the risk of urinary tract infections and other complications.
6. IV fluids: This prescription is anticipated for the client. Given the client's disorientation, refusal to answer questions, and low blood pressure, IV fluids may be necessary to maintain hydration and support their overall condition.