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 /4 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 1 Chest X-ray in AM

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 /4 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 1 Chest X-ray in AM

Answer 1

1. Use of incentive spirometry

Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications like atelectasis, acute respiratory inadequacy etc.

Incentive spirometry is done to assess the postoperative pulmonary complications (atelectasis, acute respiratory inadequacy) and mortality in adult patients admitted for upper abdominal surgery

2. Turn of gastric suction while assessing the bowel sound.

because during suctioning of the stomach there is no content in the bowel so the bowel sound may be slow or absent so, to assess the bowel sound the GI suctioning should be stop to increase the bowel sound.

3. Effect of drugs on GI Tract

Morphine- It is opioid analgesic, Most opiates that have a selective or predominant mu agonist activity inhibit gastric motility and delay gastric emptying by acting centrally; delta and kappa agonist are inactive when injected systemically.

Ampicilline may cause diarrhoea and nausea vomiting

Tylemol does not cause any gastric irritation

4. Respiratory complications related to surgery of Abdomen and lungs are-

Atelactasis(Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It may affect part or all of a lung)

lung volumes reduced

Pneumonia

5.Differences

Prospective analysis of the relative postoperative efficacy of Levin and sump nasogastric tubes

Output per hour from the tubes was close: 25.29 cc from Levin, and 26.56 cc from sump tubes

There was a difference (P = .05 level) in hourly drainage from women patients, 20.49 cc from Levin, and 25.14 cc from sump tubes.

There is no difference in the clinical efficacy of Levin and sump tubes. There is no scientific basis for the prevalent use of sump tubes.

6. The rational of GI suctioning is only the Rest of the GI Tract or decompression and prevent inflamation in liver by Bile buildup.

7.electrolyte diturbances and acid base imbalance

Hypernatremia(Low Fluid Content) may be seen due to excess loss of fluid through GI Suctioning.

8. pathophysiology

Reduced alveolar ventilation or any type of blockage.
impedes the passage of air
the trapped alveolar air becomes absorbed into the bloodstream, but outside air cannot replace the absorbed air because of the blockage
isolated portion of the lung becomes airless and the alveoli collapse.
result atelactasis.

9.Differece between pneumonia and atelactasis

Atelectasis is a collapse or closure of the lung resulting in imbalance in gas exchange. It is caused due to deflated air sacs that make up the lung called ‘ alveoli’ . Pneumonia is an inflammation of the lung tissue as a result of bacterial, viral or other infection.