A female patient who initially came to the clinic with incontinence was recently diagnosed with endometrial cancer
She is usually well organized and calm but the nurse who is giving her preoperative instructions observes that she is irritable, has difficulty concentrating, and yells at her husband. Which action should the nurse take?
a. Ask the health care provider for a psychiatric referral.
b. Focus teaching on preventing postoperative complications.
c. Try to calm patient and reinforce and repeat teaching about the surgery.
d. Encourage the patient to have bladder repair at the same time as the hysterectomy.
ANS: C
Since behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. It is also important to try to calm the patient by listening to her concerns and fears. Psychiatric referral will not necessarily be needed for her, but that can better be evaluated after surgery. Focusing on postoperative care does not address the need for preoperative instruction such as the procedure, NPO instructions before surgery, date and time of surgery, medications to be taken and/or discontinued before surgery, etc. The issue of incontinence is not immediately relevant in the discussion of preoperative teaching for her hysterectomy.
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