ario:T.C. is a 49-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingooophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intraabdominal haemorrhage, requiring transfusion with 3 units of packed red blood cells (RBCs). After discharge, she continued to have abdominal pain, chills, and fever. She was readmitted twice: first for treatment of postoperative infection and second for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to hav abdominal pain, hills, fever, and nausea and vomiting.T.C. has now been admitted to your unit from the postanesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are 130/70, 94, 16, 99.7 F. Respirations are shallow and her Spo2 is 93% with oxygen at 2 L by nasal cannula. She is easily aroused and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact and a Jackson-Pratt drain that is fully compressed and contains a scant amount of bright red blood. Her Foley to down drain has clear yellow urine. She is receiving an IV of 1000 mL D5.45NS at 100 mL/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose 2 mg, lock-out interval 20 minutes, 4-hour maximum dose of 30 mg. When aroused she states that her pain is an 8 on a scale of 1 to 10. 1.What concerns you most right now about T.C. and why?2.Identify factors that are affecting T.Cs respiratory status.3.What interventions do you need to implement to promote T.C.s respiratory status?Case Study Progress:The unit is busy, and you are concerned about monitoring T.C. carefully enough. Your present patient load is six; of these, two patients are newly postoperative and one is getting ready for discharge. You have on experienced unlicensed assistive personnel (UAP) to help you. You are concerned that T.C.s respiratory status may further decline.4.Formulate a plan for the UAP and you to care for T.C. during your shift.5.Which of T.C.s vital signs values would be most important for the UAP to report to you immediately?a.Heart rate of 100 beats/minb.Temperature of 100 Fc.Respiratory rate of 9 breaths/mind.Blood pressure of 160/80 mm Hg6.Identify three outcomes that you expect for T.C. as a result of your interventions.Case Study Progress:Throughout the first postoperative day, it is difficult to balance T.C.s need for pain medication and depression of her respiratory status. 7.Discuss how PCA devices are used for controlling pain.8.During the past 24 hours, T.C. had 122 PCA demands and 31 doses delivered. How many total miligrams of morphine sulfate did she receive?9.What adjustments could be made to her plan of care to better control her pain?10.What other measures can you use to manage T.C.s pain more effectively?11.How do you best evaluate the effectiveness of the PCA therapy?a.Asses the time interval between doses receivedb.Have T.C. state her pain level on a scale of 1 o 10c.Determine how many doses of medication T.C. receivedd.Appraise whether T.C. understands the purpose of PCA therapyCase Study Progress:The physician adjusts T.C.s pain management regimen. By the end of the second postoperative day, her pain is better controlled, although she is still complaining of moderate abdominal and incisional pain. She is able to ambulate in her room with assistance, void after the Foley catheter removal, and tolerate oral fluids without nausea. As you perform your shift assessment, you note that her abdominal dressing is saturated with blood. You identify the need to assess T.C.s wound.12.Why do you need to assess the wound?13.How should her wound appear at this time?14.When you change T.C.s dressing, you note a large amount of bloody drainage coming from the distal end of the wound. What other assessment do you need to obtain?15.Her assessment findings are unremarkable and you place a new sterile dressing on the wound. What will you do next?Case Study Progress:The physician comes and, after examining T.C., believes she is experiencing some internal bleeding. He takes her back to surgery where he isolates an area where the sutures have broken and cauterizes the affected vessels. T.C. returns to the unit, and her condition is quickly stabilized. The next evening you over hear T.C. and her husband saying that they are very dissatisfied with the care provided by the physician. They believe that he has mismanaged T.C.s care. They are discussing getting an attorney. They ask you what you think.16.What do you do and why?17.You state, Tell me whats going on with you right now. Maybe I can help you be more comfortable. What would be the benefit of taking this approach?18.Mr. C. says, No on is telling us anything. My wife came in here for a simple hysterectomy. She ends up with four surgeries. She still has pain, and she is worse off than when she started. Somebody has screwed up big time. Then they have the nerve to send me a bill. This morning they demanded $185,000. Im not paying a dime until she gets better. How are you going to respond?