5.4.3: FRAME 3- Prioritize Hypothesis

CORRECT Answer

Question Type: Drop-Down Cloze

Scoring: 0/1

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

The nurse is concerned about the client’s inability to ambulate, 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 underlying cause of the client’s delayed progress is most likely 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

RATIONALE

It is important for students to recognize the multifaceted components and processes of the post-operative recovery of clients. Sometimes, identifying a key cause of a client’s problems can be quite difficult. In the case of Jacklyn, her delay in progress is caused by her low hemoglobin levels. In turn, causing her decreased SpO2, SOB with ambulation, and low energy. Each of these also can contribute to her mental state of depression; however, her depressive state is not the physiological reason for those issues.

While the client appears to be frustrated and withdrawn, it is important for the nurse to hypothesize logical underlying causes.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 lack of energy and motivation. Post-operative anemia or low hemoglobin after a major surgery is associated with poor outcomes including infections, increased length of stay, and mortality. Anemia is a very common complication in the post-operative 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 the treatment of pre-operative anemia, reduction of 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 post-operative recovery.

FOCUSED GUIDE

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, safe-affordable housing, childcare, food insecurity, insurance, sick pay, and access to reliable transportation. Lower household income has been associated with economic instability resulting in 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 and the work may be too strenuous for her to continue working, therefore leading to economic concerns. Objectives associated with Economic Stability are 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 which generally has fewer employment opportunities. Jacklyn does not drive, which adds an additional barrier for employment and adherence to postoperative therapies.