The nurse in a gynecology clinic is completing preoperative teaching for a patie

Question

The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 326mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels, currently, she is taking an oral hypoglycemic agent. The nurse advices her to ask the anesthesiologist Wether she should take this medication the morning of surgery. ( Learning objective 2 and 4)
a. The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?
b. Why is it important to assess the patient for use of herbal products prior to surgery?
c. The patient asks how surgery could affect her blood glucose; how should the nurse respond?

Explanation / Answer

Answer a. The nurse will instruct a patient to stop aspirin prior to surgery because Poise2 trial of aspirin shows that patients that are taking aspirin since long and undergo surgery they suffer more blood loss in the comparison to the patients that skip aspirin prior to surgery. Patient can stop aspirin prior to surgery and can start it again as risk of major bleeding after surgery passes to not bear much blood loss during surgery and in the healing process.

Answer b. Accessing history of the herbal products is also quite important because certain herbal products like gingko biloba, kava, garlic, grapefruit juice, ginger etc also tend to increase the tendency of blood loss during surgery. Thus, the patient who is about to get hysterectomy should also skip these formulations till she gets surgery and recovers from it.

Answer C. Hysterectomy will not affect her blood glucose because she will continue to have her menstrual cycle because only her uterus has been removed. However, studies show that oophorectomy of ovaries tend to raise the blood glucose level because in this there will be no menstrual cycle. That affects the blood glucose adversely.

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