Question

care of a patient with Atelecasis

Case Study: Care of the Patient with Atelectasis Mildred North is admitted with acute cholecystitis, elevate white blood cell count anda 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 State the two (2) most common respiratory related complications for patients with abdominal or respiratory surgery Explain the differences in suction between a Levine tube and a Salem sump. Explain the rationale why this patient would have gastrointestinal suction Identify the specific electrolytes complications and acid-base balance disturbances when the patient has gastric suctioning and defend your answer 4. 5. 6. 7. You know that Mrs. North is at risk for atelectasis and /or pneumonia 8. 9. Discuss the pathophysiology of atelectasis is and why this patient is at risk. Discuss the difference(s) between pneumonia and atelectasis After morning report, you do an assessment and auscultate decreased breath sounds and crackles in the posterior right lower lung base, her right middle lobe and right lower lobe percuss dull. She splints her right side when taking a deep breath. You suspect she is developing atelectasis.

Answer 1

1. the purpose of using incentive spirometry in this patient is :

• to prevent atelectasis

can be developed in a patient after thoracic or abdominal surgeries and prolonged bed rest. (after abdominal surgery, the function of respiratory muscle will be affected)

incentive spirometry helps to take a slow deep breath, from the functional residual capacity to the total lung capacity followed by a 5-second holding of breath.

2.suction should turn off before auscultation because it helps to find out any bowel obstruction or presence of bowel sounds.

on auscultation, proximal high pitched sounds can be heard when air and fluid propelled by peristalsis hitting bowel obstruction and bowel sounds is absent on the distal region.

3. Ampicillin Gm (omnipen) is no longer recommended for gastrointestinal or genitourinary procedures due to the risk of superinfection caused by Enterobacter, Pseudomonas or candida.

4. respiratory muscle dysfunction after abdominal or respiratory surgery, leads to complications such as atelectasis and pneumonia.

5. Levin tube is a single lumen plastic or rubber tube with holes on the tip and along the side

Salem samp tube is a double lumen tube, one for suction and drainage and a smaller one for ventilation. a blue sump port allows atmospheric air to enter patients stomach. so, the tube can float in the stomach without adhering to gastric mucosa

6. nausea is the most common problem after cholecystectomy, so nasogastric tube suction helps to alleviate abdominal distention and nausea. should maintain nothing per oral until nausea gets rid and after returning bowel movement.