Question

Catherine Colonic, 74 years of age, is a male patient who was admitted to the surgical unit after undergoing a laparascopic right hemicolectomy.

The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact.

There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present.

The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place.

The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O₂ at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time.

1. Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed
2. What gerontological postoperative considerations should the nurse make?

Exercise 2: Postop Nursing Management

Anthony Abscess is admitted to the hospital for surgical incision and drainage (I&D) and packing of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous.

1. Explain the wound healing process according to the phase of Mr. Smith’s wound? Why is the wound packed?
2. The surgeon orders for wet-to-dry sterile saline dressing twice a day with gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change.

Answer 1

Laproscopy: Examination of loins or abdomen/ specifically examination or surgery on the peritoneal cavity using a laproscope

Hemicolectomy : The surgical procedure to remove a half of the large intestine or colon.

1. Assessment parameters :

Assessment parameters to detect the post operative complications of Laparoscopic Hemicolectomy includes:

* Assess for the lower gasrointesinal bleeding and bleeding from surgical site. Note the presence of any blood clots or bright bleeding in the surgical drainage

* Monitor blood pressure for detecting any risk of hypotension

* Assess for any risk of infection on the incision sites

* Monitor the patient breathing pattern and oxygen saturation to detect any difficulty in respiration

* Assess for anaesthesia effects/complications like confusion, disorientation

* Assess colour, amount, odour of drainage from the surgical site to detect the presence of any bleeding or infection. Initially it will be bright red then it become dark. Within 2 days the drainage becomes greenish yellow or clear in colour.  

The main postoperative complications of Laproscopic Hemicolectomy are bleeding, infection, Deep vein Thrombosis or Pulmonary embolism , injury to the neighbouring organs etc.

Interventions:

* Assessment and monitoring for detecting any complications as mentioned above.

*Change the dressings frequently, apply skin care around the incision sites,in an aseptic condition.

* Place the patient in low Fowler's position to ease the breathing and drainage.

* Check the tubings for any kinks or twists

* Administer intravenous fluids to prevent dehydration and electrolyte imbalances.

* Administer medications, antibiotics to prevent infections, as per Doctor's order.

2. Gerontological considerations

Gerontology: The study of the elderly.

Gerontological considerations for a patient after laproscopic Hemicolectomy:

* Check for skin integrity , as the elderly are more prone to bed sores and surgical site infections.

* Deep vein Thrombosis: Monitor the use of Sequential Compression Device, that helps in Preventing Deep vein Thrombosis.

* Encourage for Early ambulation to prevent blood clots and embolism, if it is not contraindicated.

* Assess for urine output. Maintain intake and output chart . Kidney functioning in elderly must be monitored.

* Ensure fluid and electrolytes balance as elderly are more prone to dehydration and electrolyte imbalances.

* Reorientation to time , place and person to prevent disorientation

* Protect from delirium attacks as the postoperative delirium is common in elderly.

* Check for any contraindications for prescribed drugs..such as anticoagulants.