Question

Susan Lee is a 60 year old female admitted to the medical surgical floor complaining of abdominal pain on and off for 4 months. Her complaints were constipation, bloating, abdominal pain and indigestion. Her CT scan diagnosed an abdominal mass. Susan’s past medical history includes COPD, Diabetes type 1, and vascular issues. Her medications include the following:

Location: Medical Surgical Floor

Susan is stable to leave the PACU. SBAR to the medical surgical floor is as follows, and you are now the nurse on the floor taking care of Susan.

Post op orders:

• Vital signs q1h x 4, then q2h x 2, then q4
• NGT low intermittent suction, irrigate as needed with 30 ml nss
• NPO I and O q4h
• Foley Catheter
• Incentive spirometry q1h while awake
• OOB to chair evening of surgery
• SCD’s
• Reinforce dressing as needed

Medications:

• IV D5 ½ NS at 125 ml/hr
• Sliding scale insulin ( Novolog)
• Bedside blood glucose ac and HSS:
  • 0-150 =0 units
  • 151-200=2 units
  • 201-250= 4 units
  • 251- 300 = 6 units
  • >300 8 units and call MD
• Morphine 2 mg IV q2h prn moderate pain < 7
• Morphine 4 mg IV q2h for severe pain, 7 or >
• Zofran 4 mg IV q6h prn nausea
• Lovenox 40 mg SQ daily

Questions to answer:

12. Based on knowledge of Susan’s surgical condition, what are the top 3 priorities during her post-op period?
13. Susan asks why she must wear the SCDs and refuses them. What can you do to educate Susan about the rationale of wearing them?
14. You are making your hourly rounds after your initial assessment and note a nickel size bloody area on the surgical dressing. What are your next actions?
15. When listening to bowel sounds, what must you do prior to the assessment?
16. Susan has been in your care for 5 hours post-op. Each hour the NGT has drained 50-75 ml. You notice on this hourly rounds that the NGT has not drained. What is your next action?
17. Susan tells you it is difficult and it hurts to use the incentive spirometry. What education can you provide to her about how and why she needs to use it?

Answer 1

1.The top three priorities during her post operative period are :-

- prevention of infection at surgical site

- prevention of the formation of pressure ulcer , punemonia and DVT due to immobilisation

- restoration of the bowel and bladder movements

2. Sequential Compression Device (SCD) is a method of DVT prevention that improves blood flow in the legs. SCD's are shaped like “sleeves” that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots.

3. Being a nurse it's my duty to educate the patient about the benefits of the SCD and why it's used .I would explain that Sequential Compression Device (SCD) is a method of DVT prevention that improves blood flow in the legs. SCD's are shaped like “sleeves” that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots.

4. It is normal to have some clear or bloody discharge on the wound covering or bandage (dressing) for the first few days after surgery.

5. The examination begins with the patient in supine position, with the abdomen completely exposed. The skin and contour of the abdomen are inspected, followed by auscultation, percussion, and palpation of all quadrants.

6. Action is to check for any blockage in the NGT and flush it with normal saline .

7. Incentive spirometry - is a device that measures how deeply you can inhale (breathe in). It helps you take slow, deep breaths to expand and fill your lungs with air. This helps prevent lung problems, such as pneumonia.