Question

Location: Surgical Unit 0800

Report from night shift charge nurse:

Situation: Sara Lin is an 18-year-old female patient who had an emergency appendectomy. It is day 2 postoperative, and Sara is expected to be discharged late this afternoon. We have discontinued her IV antibiotics after her morning dose. She will be getting oral meds today.

Background: Sara presented in the ED 2 days ago with a 2-day history of nausea, vomiting, and increasing pain. She was taken to surgery that day and had an open appendectomy for a ruptured appendix. She has been stable since arriving to the unit. Her parents have been here with her most of the time and are very helpful and supportive.

Assessment: Sara is alert and oriented, appropriate for age. She needs to be reminded to use her incentive spirometer. Abdomen is soft, tender to touch. Bowel sounds active. She has progressed to regular diet, and she's eating small amounts. No nausea reported since postoperative day 1. The abdominal dressing was changed by the surgery team early this a.m. The incision is closed with staples; the edges are well-approximate and only slightly reddened with minimal serosanguinous drainage. Her sequential compression devices were discontinued, and her Jackson-Pratt drain was pulled this morning. A small amount of bleeding was present; no further bleeding is noted. This morning, she had her first small soft brown stool since surgery.

Recommendation: You will have to transition Sara to oral antibiotics and pain medication. She last had pain medication 4 hours ago. You will need to provide discharge patient education on incision care, pain medication and antibiotics, signs of postoperative infection, activity restrictions, and surgical follow-up.

1. What is the importance of using the incentive spirometer in Sara Lin's case? How would you tell her to use it?

2. What was the purpose for the sequential compression devices she wore? How often should they be worn?

Answer 1

1. The importance of using the incentive spirometer after surgery, it may be difficult to breathe the patient as normally do. Taking deep breaths allows air to inflate lungs, opening patient airways to prevent fluid and mucus build up. Using and incentive spirometer may speed recovery and lower the risk of lung problems. Such as pneumonia.

Educate the patient about use of incentive spirometer ; sit up as straight as possible. Do not bend your head forward and backward. Hold the incentive spirometer in an upright position. Place the target points to the level that you need to reach. Exhale (breath out) normally and then do following:

• Put the mouthpiece in your mouth and close your lips tightly around it. Do not block the mouthpiece with your tongue.
• Inhale slowly and deeply through the mouthpiece to raise the indicator. Try to make the Iindicator rise up to the level of the goal marker.
• When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 3 seconds.
• Exhale normally.
• Repeat these steps 10 to 12 times every hour when you are awake, or as often as directed.
• Clean the mouthpiece with soap and water after each use. Do not use a disposable mouthpiece for longer than 24hours.
• Keep a long of the highest level you are able to reach each time. This will help healthcare providers see if your lung function improves.

2.   The purpose for the sequential compression devices (SCDs) is DVT (Deep vein thrombosis) prevention that improves blood flow in the legs. The SCDs are inflatable sleeves are attached to a pump that inflates and deflates the sleeves. The plumbing action acts like your muscles to help blood flow and prevent clots. SCDs are often used after surgery until patient can get up and walk.

The SCDs must be worn for atleast 18 to 21 hours of each 24 hour day.