Question

PN 200 Fundamentals of Nursing II Case Study: Care of the Patient with Atelectasis Mildred North is admitted with acute cholecystitis, elevate white blood cell count and a fever of 102 degrees. She has undergone a cholecystectomy and has been transferred to your unit. It is her second day postoperatively. She has a nasogastric tube to continuous low wall suction, one peripheral IV in her left hand, and a large abdominal dressing. Her orders are as follows: Progress diet to low fat diet DS in normal saline with 40 mEq potassium to run at 125 ml per hour Turn, cough and deep breathe every 2 hours while awake Incentive spirometry every 2 hours while awake Dangle in AM; ambulate in PM Morphine sulfate 10 mg IM every 4 hours prn for pain Ampicillin (Omnipen) Gm 2 IVPB every 6 hours Tylenol 325mg rectal suppository every four hours for temperature above 100.4 Chest X-ray in AM 1. Explain the rationale for the use of incentive spirometry for this patient 2. Explain why you would need to turn off the suction when assessing bowel sounds 3. Identify the GI complication that may result from one of the medications the patient is receiving postoperatively 4. State the two (2) most common respiratory related complications for patients with abdominal or respiratory surgery 5. Explain the differences in suction between a Levine tube and a Salem sump. 6. Explain the rationale why this patient would have gastrointestinal suction 7. Identify the specific electrolytes complications and acid-base balance disturbances when the patient has gastric suctioning and defend your answer You know that Mrs. North is at risk for atelectasis and/or pneumonia 8. Discuss the pathophysiology of atelectasis is and why this patient is at risk. 9. Discuss the difference(s) between pneumonia and atelectasis

Answer 1

1) The rationale for the use of incentive spirometer in this patient is to prevent post operative pulmonary complications like atelectasis- partial collapse of the airway due to post operative hypoxemia (the most common complication) aspiration pneumonia , pulmonary collapse due to obstruction of the airways due to mucus secretions.

Incentive spirometry is the easy yet useful test that helps in preventing post operative pulmonary complications by teaching the patient to take long,slow, deep breaths, this helps in proper lung expansion and better gas exchange.

2) Turn off the suction while assessing the bowel sounds as it may mimic the sounds of peristalsis.

3) Morphine is an opioid analgesic that causes delay in gastric emptying, nausea and constipation. These are the common GI complications associated with opioid analgesics.