The nurse assesses four clients before knee surgery. Which client is most likely to have the surgery delayed?

Question

1. A 10-pack-year history of smoking
2. Left calf pain, redness, and swelling
3. Upper respiratory infection last month
4. A low-normal serum hemoglobin level

Answer 1

2
2. Calf pain, tenderness, and swelling are consistent with clinical indicators of a deep vein thrombosis or infection, so this client is most likely to have the surgery resche-duled after resolution of these findings. Knee surgery usually includes using a tour-niquet on the affected leg; if the client's surgery is planned for the left leg, the client is likely have a thromboembolic event (such as a pulmonary embolism) when the tourniquet occludes blood flow. Even if the pain and redness are in the right leg, the surgery is likely to be delayed until the problem is resolved because decreased post-operative mobility greatly increases the risk of a thromboembolic event and because infection usually contraindicates surgery (from an increased risk of sepsis).
1. Many surgeons refuse to operate on clients with a significant smoking history un-less they quit smoking for a long period because smoking impairs tissue healing.
3. The client should be fully recovered from an uncomplicated upper respiratory in-fection last month.
4. A low-normal hemoglobin is sufficient to clear the client for surgery.