Question

Mr, Owen is a 62-year-old man underwent a neck dissection yesterday due to cancer of the mouth. You are the nurse assigned to care for Mr. Owens during his first postoperative day. Initial assessment finds Mr. Owens sitting up in bed: he is drowsy, but not appear to be in respiratory distress. His respiratory rate is 16 to 18, and his oxygen saturation is 96% on 40% oxygen via face tent. He has two peripheral IV lines both infusing Lactated Ringer's solution at 75 ml/hr. Two Jackson Pratt drainage tubes are partially filled with serosanguinous drainage, (Learning Objective 5)

a. What is the rational for the patient being placed in Fowler's position after surgery?

b. The nurse notes that there has been 240 ml output in the drainage tubes during the first 24 hours after the surgical procedure. What should the nurse do?

c. Postoperatively, the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements related to anorexia and dysphagia. The nurse instructs Mr. Owen to eat soft food and suggests that he tilt his head to the unaffected side to facilitate swallowing. What is the rationale for these instructions?

d.In reviewing Mr Owens medical record, what findings in his health history are associated with development of oral cancer?

Answer 1

A. ANS: after surgery the patient’s Fowler's position rationale:

i. Breathing purposes: placing the patient at Fowlers's position will ease breathing for the patient

ii. Aspiration prevention: if the patient is left in a flat position after the surgery there is a high possibility for him to aspirate. Therefore the Fowler's position will prevent Mr. Owen from aspirating.

B. ANS: Having noted the 240ml output in the drainage tubes during the first 24 hours, the nurse should do the following;

First, record that in the input-output chart, then empty the drainage tube.

Secondly, since Mr. Owen has recorded quite a large volume of fluid in the output, the nurse should inform the respective doctor about the same so that the doctor can check to rule out whether the patient is bleeding

C. ANS: Imbalanced nutrition less/more than body requirements related to significant weight loss/gain and lack of appetite or interest in food. In this situation the nurse identifies that the patient is at risk for imbalanced nutrition, less than body requirements to anorexia and dysphagia.
Nursing Interventions: Stimulating Appetite and Provide a comfortable environment , free of odors; offer smaller more frequent meals. Help patients understand factors that can affect appetite and provide these four levels of liquids.
Thin liquids (low viscosity)
Nectar like liquids ( medium viscosity)
Honey like liquids (viscosity of honey)
Spoon thick liquids ( viscosity of pudding)