4.4.3: FRAME 3- Prioritize Hypothesis
- Page ID
- 90030
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It is post-op day 3, and Jacklyn has had trouble walking down the hallway without needing to take a break and becoming short of breath. Jacklyn refused her walk this morning as she told the nurse, “I feel like I am not making any progress, I’m worse off now than I was before my surgery. I wish my son never brought me to the hospital.” Jacklyn then requests the lights be turned down and left alone.
QUESTION: Drop Down Cloze
Scoring Rule: 0/1
The nurse is concerned about the client’s inability to ambulate very far, increasing oxygen needs, and lack of motivation. Choose the most likely options for the information missing from the statement(s) by selecting from the list of options provided.
The client’s delayed post-operative recovery is multifaceted. The nurse recognizes the most likely underlying cause of the client’s delayed progress is caused by 
as evidenced by 
, 
, and 
.
| Dropdown 1 Options | Dropdown 2 Options | Dropdown 3 Options | Dropdown 4 Options |
|---|---|---|---|
| Depression | Turning lights down | Client anger | Low energy |
| Decrease in blood pressure | Decreased SpO2 | Wanting to be alone | Client frustration |
| Low hemoglobin level | +1 pedal pulses | Weak grips | Increased heart rate |
| Decreased motivation | Refusing walks | SOB with ambulation | Refusing breakfast |
Putting It All Together
DEBRIEF
While the client appears to be frustrated and withdrawn, it is important for the nurse to hypothesize logical underlying causes. This client is experiencing shortness of breath with ambulation, increasing oxygenation needs, and a lack of energy and motivation. Postoperative anemia or low hemoglobin after major surgery is associated with poor outcomes, including infections, increased length of stay, and mortality. Anemia is a very common complication in the postoperative period, with a prevalence of 80-90% after major surgery. Since 2005, the concept of patient blood management has been introduced and utilized in healthcare to focus on treating preoperative anemia, reducing peri-operative blood loss, and optimizing patient-specific physiological reserves post-operatively (Kalra et al., 2021).
It is important for the nurse to also address the client’s mental status since the client has a recent history of depression where she sought treatment. Fixing the underlying cause and helping the client to understand and educate them on processes occurring in their body will be essential in supporting the client’s mental state and continuing to progress through postoperative recovery.
RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)
Economic stability is a person’s ability to possess, maintain, or acquire the necessary resources for a healthy life. Income and financial health are the strongest and most well-studied factors. Other factors include employment and work environment. Lower household income has been associated with purchasing fewer healthy foods, engaging in less physical activity, and higher prevalence of cardiovascular disease (CVD) (Brandt et al., 2022).
Individuals with disabilities, injuries, or conditions like CVD may be limited in their ability to work. Jacklyn works on a cattle lot with her son, which may be too strenuous for her to continue working, leading to economic concerns. Objectives associated with Economic Stability is to increase suitable employment in working-aged people (SDOH-02) and to decrease injuries resulting in missed days of work (OSH-02). Economic Stability is also influenced by insurance coverage or lack of insurance to cover required procedures and/or post-operative therapies. Healthcare expenses not covered by insurance and high deductible costs can create a financial burden for individuals and families. Another contributing SDOH for Jacklyn is that she lives in a rural community that generally has fewer employment opportunities. Jacklyn does not drive, adding an additional barrier to employment and adherence to post-operative therapies.
What Do You Think About?
- What is the significance of hemoglobin and how does it apply to other disease processes?
- Identify the significance of the client’s medications and how they relate to her postoperative anemia.
- Provide at least three examples that contribute to economic stability?