QLexNursing

💎 Oxygen saturation — ✅ REPORT

💎 The client’s oxygen saturation dropped from 97% to 92% on room air over three days, which is a significant change, even though 92% is still borderline acceptable.

💎 A new decrease in oxygen saturation could indicate developing respiratory compromise, underlying pulmonary issues, or reduced reserve, which is important information before anesthesia.

💎 Combined with anxiety and tachycardia, this drop might signal a stress response, impaired gas exchange, or early cardiopulmonary concerns.

💎 Preoperative providers and anesthesia must know about any change in oxygenation to decide if further evaluation (e.g., ABG, chest imaging, or delay in surgery) is needed.

⭐ Blood pressure — ✅ REPORT

⭐ The client’s blood pressure has increased from 126/74 mm Hg to 158/96 mm Hg, which is now in the hypertensive range.

⭐ Elevated blood pressure increases the risk of intraoperative and postoperative complications, such as bleeding, cardiac events, or stroke during anesthesia.

⭐ Even though anxiety may contribute, this level of hypertension still needs provider notification so they can decide whether to proceed, medicate, or delay surgery.

⭐ Preoperative stability is essential for safe anesthesia induction, so significant changes in blood pressure must be reported.

🟢 Client’s request for information — ✅ REPORT / ACT ON

🟢 The client is requesting information about risks and benefits of surgery, which signals that they may not fully understand the procedure.

🟢 For informed consent to be valid, the client must understand the nature, risks, benefits, and alternatives of the procedure, and this explanation must come from the provider/surgeon, not the nurse.

🟢 While this doesn’t mean surgery must be canceled outright, it must be reported so the provider can return to the bedside and clarify, reinforcing true informed consent.

🟢 If the client still has questions, proceeding with surgery would be ethically and legally problematic, making this a critical finding to communicate.

🔷 Client’s PO intake — ✅ REPORT

🔷 The client reports eating toast, coffee, and scrambled eggs at 0730 on the morning of surgery, which violates usual NPO (nothing by mouth) guidelines before general anesthesia.

🔷 Solid food is typically restricted for at least 6–8 hours prior to surgery to reduce the risk of aspiration when the airway is unprotected under anesthesia.

🔷 This is a critical safety issue and must be reported so the provider and anesthesia team can decide whether to delay or reschedule the procedure.

🔷 Proceeding with surgery after a recent solid meal puts the client at risk of regurgitation and aspiration pneumonia during intubation.

🔹 WBC count — ❌ Do NOT report (assuming normal)

❌ The scenario does not highlight any abnormal WBC value or signs of systemic infection such as high fever, chills, or purulent drainage.

❌ If the WBC were elevated or very low, it would absolutely be important before surgery, but here it is mentioned only as a routine lab.

❌ In exam items, labs not flagged as abnormal are usually considered to be within expected range.

❌ Therefore, the WBC count is not one of the key findings that must be reported based on the information provided.

🔹 Abdominal findings — ❌ Do NOT report as a concern

❌ The abdominal assessment shows a soft, rounded, nondistended abdomen with no tenderness and active bowel sounds in all four quadrants, which are normal findings for a preoperative client.

❌ The client reports a formed bowel movement yesterday, suggesting normal gastrointestinal functioning without constipation or obstruction.

❌ There is no guarding, rigidity, rebound tenderness, or signs of acute abdomen, so nothing here suggests a reason to delay surgery.

❌ Because all abdominal findings are within expected limits, there is no need to specifically report them as a problem to the provider.

🔹 Blood type — ❌ Do NOT report as a concern

❌ Having a documented blood type is an expected part of preoperative workup, especially for surgeries where there is some bleeding risk.

❌ The presence of a blood type in the chart is not an abnormal finding and does not in itself signal a problem.

❌ It is information used for transfusion planning, not something that indicates deterioration or a reason to cancel surgery.

❌ Therefore, it is not a “report this as a concern” finding—it's simply routine pre-op data.

🔹 Capillary refill — ❌ Do NOT report

❌ Capillary refill less than 2 seconds is normal and indicates adequate peripheral perfusion.

❌ There are no signs of shock, dehydration, or vascular compromise in the extremities based on this finding.

❌ It supports the conclusion that circulation is stable, even with an elevated BP.

❌ Because this is a reassuring assessment, it is not a concern to report to the provider.

🔹 Platelet count — ❌ Do NOT report (assuming normal)

❌ Nothing in the scenario suggests that the platelet count is abnormal; it is simply listed as part of routine lab data.

❌ If the platelet count were low (thrombocytopenia), that would certainly be reportable due to bleeding risk—but this is not indicated.

❌ In exam-style questions, lab values that are not highlighted as abnormal are typically assumed to be within normal range.

❌ A normal platelet count is expected pre-op and not something that requires urgent reporting.