Question

You are caring for J.B., a 56-year-old woman with colon cancer. PHM includes colon resection followed by combined chemotherapy approximately 18 months ago; recently diagnosed with recurrence of colon cancer, chemotherapy was administered for five of the eight schedules cycles; previous significant weight loss(current height , 67”; weight, 105 pounds); 5-packed-year ( 2 PPD x 25 yrs) smoking his. J.B., is admitted acute N/V and dehydration. She is nutritionally depilated. Her physician determines that diagnostic evaluation requires exploratory laparotomy. VS 150/90, 124, 26, 100 degree F.

1. List at least five major risks and potential complication for J.B
2. The physician performed an exploratory laparotomy for lysis of adhesions, small bowel resection, and colectomy with Hartmann’s pouch. After surgery J.B is admitted to SICU (surgical intensive care unit) with a large abdominal dressing. You role J.B side-to-side to remove the soiled surgical linen, and dressing become saturated with a large amount of serosanguinous drainage. Would the drainage be expected after abdominal surgery? Why?
3. Traditionally the physician performs the first dressing change. Why is this done
4. The physician removes the surgical dressing. The wound edge are well approximated, the suture line are edematous, the staples are intact, the transverse colostomy rosebud looks pink in the middle and dark around the edges, and there are two JP drains in the right abdomen. Do any of this finding concerns you, why

Answer 1

1) Dehydration refers to loss of excess fluids from the body. The common causes of dehydration includes vomiting, sweating, polyuria incase of diabetes mellitus,excess exposure to sun,burns,secondary to chemotherapy. In this given scenario the patient suffered nausea and vomiting secondary to chemotherapeutic drugs. Potential complications of chemo drugs includes hypovolemia resulting in drop in blood pressure. Seizures secondary to disturbance in electrolytes, Renal problem like kidney stones,UTI and end up with renal failure.

2) Serosanguinous drainage is water like secretions from the surgical wound.It indicates damage to the capillaries and blood vessels. The color ranges from light red or pink tinge and it also looks clear. It commonly occurs after a major abdominal surgery. This kind of drainage is common after first two or three days postoperative;y.Excess of drainage need to be notify physician as it reveals deep layer injury.

3) The first surgical dressing postoperatively is traditionally done by physicians,the reason behind this is to identify the incision site, assess the wound drain,to detect surgical site infection, to identify redness,erythema,localized pain,excess exudates.