Question

 Case Study, Chapter 19, Postoperative Nursing Management

 1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the: staples are dry and intact. There is a Jackson--Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of browni liquid. The patient has no bowel sounds.

 The Foley catheter has a small amount of dark amber-colored sediments. The urine without patient has sequential compression device (SCD) in place.

 The nurse performs an assessment and notes that the patient's breath sounds are decreased bilaterally in the bases and the patient has: inspiratory crackles. The patient's cardiac assessment is within normal limits. The patient is receiving Oz at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate, 110 bpm; respiratory rate, 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

 a. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

 make?

 b. What gerontologic postoperative considerations should the nurse

 2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm

 machinery accident. The right calf has an area 3 cm x 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

 Smith's wound?

 a. Explain the wound healing process according to the phase of Mr.

 b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry

 dressing. Explain how to perform this dressing change.

Answer 1

1.A. The assessment parameters and the interventions needed are as follows:

1. Signs of shock to be assessed

* IV fluids administration

* changing positions

* Tranfusions

2. Assessment of surgical site

* dressing must be intact and dry

* any skin integrity must be assessed

3. Assess the airway and maintain breathing

* provide supplemental oxygen as required

* assess breathing by feeling the movement of air

* keep the head elevated

* do the suctioning

4. Assess cardiovascular stability

* assessing all iv sites

* potential of hemorrhage, hypotension and shock.

5. Assess for nausea and vomiting

* assessing it post anestheia

* anti emetics

6. Assess for pain and anxiety

* assess patient environment

* control the environment

* diversional therapies and family visits

* analgesics as per order

7. Vital signs monitoring

* every 15min for the 1st hour

* every 30 min for next 2hours

* check temperature every 4 hours for 2hours

8. Prevent Dvt

* early ambulation

* leg exercise

B. The gerontological consideration the nurse has to make are many such as :

* they have slower recovery time

* they have greater risk of acquiring the complications

* longer hospital stay due to renal and hepatic function

* must be more prominent about the pressure ulcers

* other would be post operative delirium

2. A. Based on the data provided Mr. Smith is admitted for an abscess. Therefore he is experiencing second intention healing. Once incision and drainage done the cavity will have dead cells going into it. In order to make drainage flow either the tube is connected or the tube will be placed.

B. The procedure follows:

* assess the HCP order if old dressing is in place and dry

* hand hygiene Don gloves

* gently pull old dressings to assess the necrotic tissues

* states not to moisture dressing will remove

* remove gloves, hand hygiene, done the sterila candles

* pour prescribed solution on the guage

* covering the a the areas