Question

When assessing the patient in seclusion, the nurse finds the patient sleeping. The staff member reports that he has been sleeping for 15 minutes. What is the nurse's appropriate action?

Answer 1

The nurse should perform a safety check on the patient by evaluating vital signs and adherence to recovery instructions. Communication with the care team is essential to address any patient status changes or concerns.

Step-by-step explanation:

When a nurse finds a patient sleeping in seclusion, the appropriate action would depend on the policies of the healthcare facility and the individual care plan of the patient. However, generally, the nurse should ensure the patient's safety by checking vital signs and ensuring the patient is breathing normally and has a stable heartbeat. The nurse should also review any specific recovery and post-seclusion care instructions from the medical team, which may include considerations from the surgeon, anesthesia professional, and other healthcare staff involved in the patient's care.

These instructions can pertain to potential complications such as blood clots, as is indicated by initiating aspirin therapy in case of embolus risks mentioned in the provided information. It is vital for the nurse to communicate with the team about the patient's condition, noting any observable changes or concerns that need to be addressed. This can be part of the 'time out' process where the care team collectively reviews the patient's status before proceeding with any further treatment or actions.