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 D5 in normal saline with 40 mEq potassium to run at 125 mL per hour Tum, 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 pm 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 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

Cholecystectomy: The surgical procedure to remove gallbladder is called Cholecystectomy.

Atelectasis: The collapse of a part or whole lung is called atelectasis. It is one of the common postoperative complications affecting the respiratory system.

1. Incentive Spirometry can be used for a postoperative patient to prevent or reverse the condition of atelectasis. Incentive Spirometry helps the patient to take deep breaths, in turn helps to open the airways and it protect the lungs from fluid or mucous build up. when the procedure of deep breathing with help of incentive spirometer repeats on every 2 hours , the condition atelectasis can be reversed and makes the breathing easier.

2. Turn off the suction while assessing the bowel sounds:

Bowel sounds are indicating that the intestines are active. After an abdominal surgery small intestine( bowel) normally returns back to the activity within hours, and the stomach need 1- 2 days. Before checking the bowel sound of a patient with an NG tube, turn off the suction as the suction noises can mimic the bowel sound. Assessment of Bowel sound will not be proper in the presence of suction noises.

3. GI complication resulting from the use of Ampicillin

Ampicillin may cause the side effects such as nausea, vomiting and diarrhoea . But rarely it causes a serious intestinal infection with Clostridium difficile. The symptoms of this infection may range from abdominal cramping to foul smell , bloody stools and continous diarrhoea. Clostridium difficile is a type of resistant bacteria.

4. Respiratory complications of patient with abdominal or respiratory surgery:

* Atelectasis: common respiratory complication after abdominal surgery, characterised by the collapse of airways resulting in decreased gas exchange in lungs.

* Pneumonia and respiratory failure: difficulty in coughing after surgery may result in accumulation of secretion in the lungs and pneumonia . Gradually atelectasis and resulting pneumonia may contribute to respiratory failure.