Question

2. Mr. Owens is a 62-year-old man who underwent a neck dissection yesterday due to cancer of the mouth. You are the nurse assigned to care for Mr. Owens during his first postoperative day. Initial assessment finds Mr. Owens sitting up in bed; he is drowsy, but oriented x3 when aroused. He has significant edema in his neck and mouth area, but does not appear to be in respiratory distress. His respiratory rate is 16 to 18, and his oxygen saturation is 96% on 40% oxygen via face tent. He has two peripheral IV lines both infusing Lactated Ringer's solution at 75 mL/hr. Two Jackson Pratt drainage tubes are partially filled with serosanguinous drainage. Learning Objective 5) What is the rationale for the patient being placed in Fowler's position after surgery? a. The nurse notes that there has been 240 mL output in the drainage tubes during the first 24 hours afr thergical procedure. What should the nurse do? Postoperatively, the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements related to anorexia and dysphagia. The b. c.

Answer 1

Ans) a. The rationale behind placing patient in fowlers position:

• Fowler'position is a standard patient position.
• It is used to relax tension of the abdominal muscles, allowing for improved breathing in immobile patients as it alleviates compression of the chest due to gravity, and to increase comfort during eating and other activities.
• It is also used in postpartum women to improve uterine drainage. The patient is placed in a semi-upright sitting position (45-60 degrees) and may have knees either bent or straight. Such a position is maintained during procedures that involve either the nasal or oral passageways as it prevents aspiration during the introduction of feeding tubes and also promotes a slight gravitational pull in peristalsis when swallowing.

b.The principle reasons for having a drain to remove this
fluid are:
1. To allow the wound to heal.
2. To reduce pain, as the collection of fluid in a
closed cavity can cause discomfort.
3. To prevent a collection of fluid which is a
potential site for infection.
4. To minimise any bruising to the area.

So if the nurse notes 240 ml output in the drainage tubes for first 24 hours after the surgical procedure, The nurse should inform the concerned doctor about it, carry out all due orders.

Notify the colour, amount, consistency, etc & document it in the nurses notes.

c. Post-operative: Nursing Diagnosis: Imbalanced nutrition, less than body requirements related to anorexia and dysphagia.

Objective: Improved nutritional status of patient.

Nursing intervention:

- Assess the nutritional status of the patient, fluid volume status, patient's anorexia & dysphagia complaints.

- Assess the patient's likes & dislike & inform to the dietician.

- Develop a diet plan to meet the nutritional & hydration needs of the patient.

- Recognize & consult doctor & dietician the need for enteral feedings.

- Monitor strict intake output chart.