Question

Carmen Costa is a 67-year-old female with Type I Diabetes admitted on Sunday for severe abdominal discomfort. On admission her vital signs were: BP 116/80, heart rate 86, respirations 20, temperature 98.4. Her blood sugar (BS) was 115 and her initial lab work was WNL. Carmen's x-rays revealed an abdominal mass and she was scheduled for an exploratory laparotomy on Monday. During surgery, Carmen was diagnosed with a cancerous tumor. The tumor was removed and Carmen was taken to a medical/surgical unit. Postoperatively Carmen had an IV of 1,000 mL D5W infusing at 50 mL/hr, an NG to intermittent suction, a Foley draining clear amber urine, and a midline abdominal dressing that was dry/intact (D/I). You are assigned to care for Carmen on her first Post-op (POD). Carmen is alert/oriented and her color is gray/pale. Her morning accucheck is 210 and she receives 8 units of regular insulin. Carmen's NG is draining brown/green mucous, her abdominal dressing is D/I, and she has an IV of D5W at 50 mL/hr. Carmen has very limited conversation this morning but states, "I'm very tired and sick to my stomach."

1. What collaborative management and postoperative teaching strategies are needed for Carmen and why? (Discuss postoperative management and types of medications she might need).

Answer 1

1. The collaborative management that she needs during post operetive period includes

a.counsellor to make her understand her condition and it is necessary for her to accept her condition.

b. surgical and medical oncologist to plan the care

c. physiotherapist to assist her in ambulation

d. Nursing team for her holistically approached care.

e. Pharmasist

The post operative teaching strategies include

The early ambulation to avoid the DVT

coughing and deep breathing excercise to avoid lung infections also as a pain management strategy.

Explain the need to be in NPO status

Explain her about the physical activities thet are allowed to her ,to prevent the compliocations

Teach her about the signs and symptoms of the infection such as fever,redness ariound the wound etc.

Explian her the importance of taking madicine

Explain her the signs and symptoms of hypoglycemia and hoe to be pro active.

Explain her about the importance of proper personal hygiene and the need of regular dressing.

Explain her the importance of follow up on correct time.

The post operative management mainy onclude the pain management.Administer the analgesics as per the doctors advice

Early ambulation to avoid DVT and the administration of DVT prophylaxis

It is important to meet the elimination pattern of the patient.

Assess the fall risk of the patient and do the needs accordingll

close monitoring of the patient.

Maintaining proper intake and out put chart to evaluate the fluid deficit

Check the blood sugar to check for the hypoglycemia as the patient is kept nill by mouth.

Certain types ofmedications she might need are

1. analgesics to relieve the pain

2.Proton pump inhibitor

3. antibiotics

4.Chemotherapy as per the schedule

5.Insulin as adviced