Question

Mary, a 25-year-old female, arrives in the postoperative phase. Mary’s mother died of colon cancer, and Mary had a colonoscopy that revealed three precancerous polyps and one malignant polyp. Mary had a partial colectomy to remove the malignant section of her colon. The physician placed a closed drain system in Mary’s abdominal incision. The abdominal drain has 20 mL of blood-tinged drainage. The drain was injected with epinephrine, a local anesthetic. Mary has a urinary catheter in place that is collecting 30 mL of clear urine every hour. Mary was very anxious on intubation and extubation, which caused a small abrasion to her upper lip. Mary’s ECG rhythm is 48 bpm, indicating bradycardia. Mary remains drowsy from the anesthesia, but she appears to be comfortable with a limited amount of pain. The postanesthesia nurse raises Mary’s head and places her in the sitting position. The nurse supports Mary with pillows and provides a pillow for her to place on her stomach when she takes deep breaths.

Mary sits up for 1 hour. Her vitals have improved to to 98.6°F, P 65 bpm, R 14/min, and BP 117/72 mmHg and have returned to her preoperative baseline vitals. Mary is transferred to the medical-surgical unit for further observation for 24 hours prior to being discharged home.

What are three priority assessments? Why?

Name at least three topics for discharge instructions that you, the postoperative nurse, should anticipate.

Answer 1

The priority assessment are

• Assessing surgical site for any bleeding,infection,tenderness to rike out for infection and post of complications
• Regular monitoring of her vital signs as the patient has borderline range to normal respiratory rate if 14 and blood pressure of 117/72mmHg
• To monitor urine output because an output less than 30ml can be dangerous leading to renal shutdown and delay the prognosis and infection control practices
• Assessing the mental status examination for ruling out coping strategies
• Assess patient for bowel sounds to ensure the return of bowel movements post surgery and to initiate oral diet

The discharge instructions should have the following topics

• Medication:to take medication as directed to prevent infection, pain
• Follow up as directed to assess the prognosis
• Diet:a bland or a soft diet as tolerated by the patient to ensure bowel movements
• Bowel pattern: to follow a healthy and regular bowel pattern daily,if constipation, abdominal pain or any complaints sjoukd ne reported immediately
• No OTC as it can interact with current drug and cause adverse reactions