Question

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 ½ 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 prm for pain Ampicillin (Omnipen) Gm 2 IVPB every 6 hours Tylenol 325mg rectal suppository every four hours for temperature above 1 Chest X-ray in AM 00.4 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 4. 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 Discuss the pathophysiology of atelectasis is and why this patient is at risk. Discuss the difference(s) between pneumonia and atelectasis 8. 9. 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 aull. She splints her right side when taking a deep breath. You suspect she is developing atelectasis.

Answer 1

1. After surgery, it may be difficult to breathe as you normally do. Taking deep breaths allows air to inflate your lungs, opening your airways to prevent fluid and mucus buildup. Using an incentive spirometer may speed your recovery and lower your risk of lung problems such as pneumonia.

2. We should turn off the suction before assessing bowel sounds to avoid influencing bowel sounds.

3. The GI Complicationia caused by ampicillin - PSEUDOMEMBRANOUS COLITIS and causes diarrhea, nausea, vomiting

4. Respiratory related complication after surgery are :-

- pulmonary embolism

- atelectasis

- lung infection like pneumonia

- aspiration