Chapter 12
Nursing
Chapter 12 MEDICAL-SURGICAL
Nursing Care of Patients Having Surgery
183 Traditionally, after GI surgery, bowel sounds were moni- tored by the nurse. The patient was kept NPO until flatus and bowel sounds returned. It is now known that bowel sounds are not correlated with bowel motility and the patient’s abil- ity to safely drink and eat postoperatively. In fact, patients can be hydrated and fed early, which promotes healing and faster recovery. Follow your institutions’ policy if monitor- ing bowel sounds is required. CUE RECOGNITION 12.3 The surgeon’s orders for a patient who had a colectomy are NPO with IV fluids and an NG tube to low intermittent suction to be irrigated prn. The patient reports stomach pressure and nausea with a need to vomit. What action do you take? Suggested answers are at the end of the chapter.
move in bed, to els that may in tolerance for ac
and the type of surgery performed can predict postoperative urinary retention (Abdul-Muhsin et al, 2020). After outpatient surgery, patients may be required to void before discharge. CLINICAL JUDGMENT Mrs. Wood, age 42, returns to the surgical unit after a hysterectomy. Her postoperative vital signs and data collection findings are normal. Mrs. Wood rates her pain level at 9 out of 10, and the nurse notes that she moans occasionally, repeatedly moves her legs, and pulls at her covers near her abdominal incision. She is drowsy but repeatedly says it hurts. In the PACU, a PCA pump was started. The last dose of medication was delivered 45 minutes ago. Her family is at her bedside trying to talk to her about her experience. 1. What nonverbal pain cues do you find Mrs. Wood is displaying? 2. How do you document Mrs. Wood’s pain? 3. What action do you take to relieve Mrs. Wood’s pain? 4. When will you next monitor Mrs. Wood’s pain level? 5. If Mrs. Wood indicates that her pain remains unrelieved with the PCA pump, what action will you take? 6. Which team members do you collaborate with? 7. What action do you take to support the needs of the patient and family? Suggested answers are at the end of the chapter. CLINICAL JUDGMENT Mrs. Owens returned from a bowel resection 2 days ago. She is receiving 1,000 mL of 0.9% normal saline solution over 10 hours on an IV controller pump. 1. You verify that the IV controller pump is set at what rate? 2. How many milliliters do you record as Mrs. Owens’s total intake for the last 12 hours? • Intake for 12 hours: • 8 oz coffee
urological surgery, older patients, or those with an IV or urinary catheter to detect urinary elimination problems such as output of less than 30 mL per hour. • Recognize that the patient who is voiding small amounts frequently (30 to 50 mL every 20 to 30 minutes) or who dribbles may have retention overflow and may not be fully emptying the bladder. This pattern may require a postvoid NEW! “Cue Recognition” exercises provide practice in identifying actions to take when presented with patient cues or data.
Nutrition N Nourishing t After surgery, nously is com catabolism (m a patient is fas long. One liter nourished adu but malnouris impacting the your patients Patients us diet as soon a to see patient the patient sh Offering a full may “turn off” After GI sur scribed, those serve the sutu liquids are giv
bladder scan to determine residual urine volume and need for catheterization to empty the bladder and prevent complications. • Assist patient to the bathroom or bedside commode and provide privacy after safety is ensured, and allow male patients to stand or sit to urinate to promote voiding. • Use techniques to stimulate voiding for patient who is unable to void to prevent need for catheterizing (e.g., running water, pouring warm water over a female patient’s perineum, or drinking a hot beverage) because catheterization increases the risk of infection. • Have patient place feet solidly on the floor to relax the pelvic muscles to aid voiding.
NEW! “Clinical Judgment” case studies and questions added to the chapters to help students practice and think about what they are learning, and then apply the learning to clinical decision-making. • Notify the surgeon if a patient is uncomfortable, has a distended bladder, or has not voided within the specified timeframe to obtain treatment orders. NURSING DIAGNOSES, PLANNING, AND IMPLEMENTATION EVALUATION. The goal for urinary retention is met if the patient is able to void within specified timeframe without pain or complications. Imbalanced Nutrition: Less Than Body Requirements related to NPO, pain, and nausea EXPECTED OUTCOME: The patient will resume normal dietary intake and maintain weight within normal limits. • Maintain IV fluids, enteral feedings or parenteral nutrition until the patient resumes oral intake (“Nutrition Notes: Nourishing the Postoperative Patient”). • Give antiemetics promptly as ordered to control nausea and vomiting. CLINICAL JUDGMENT Mr. McDonald is a 48-year-old Black male who had a laparoscopic appendectomy at 1300. The hand-off report you received at 1900 included vital signs within normal parameters, pain of 3 out of 10, declined need for analgesic, due to void by 2200, voided 30 mL at 1830 and 20 mL at 1900, has not been out of bed, and tolerated light dinner well. You make your 1930 rounds and find Mr. McDonald alert but drowsy with vital signs unchanged, three bandaged laparoscopic incisions on his right lower abdomen dry with wound edges approximated, abdomen soft, bowel sounds present in all four quadrants, and slight bladder distention. He reports his pain level at 2 out of 10. He is repositioning his feet frequently and rubbing his hands during your data collection and states, “Nothing really hurts, I’m just restless. It must be the unfamiliar bed.” 1. What additional data do you collect? 2. What actions do you take to alleviate Mr. McDonald’s symptoms? 3. If Mr. McDonald does not empty his bladder on his own, what other data do you collect? 4. You find that Mr. McDonald’s bladder contains 800 mL of urine after techniques to promote voiding are not effective, and you notify the surgeon. Develop your ISBARR (communication tool). Suggested answers are at the end of the chapter. 27/12/21 7:53 PM Mobility DATA COLLECTION. It is important for the patient to move as much as possible to prevent complications, promote healing and regain their preoperative level of function. Pain, inci- sions, tubes, drains, dressings, and other equipment may make movement difficult. Determine the patient’s ability to Davis Advantage LPN/LVN A consistent approach across the curriculum to help students become practice-ready nurses § Provide day 1 readiness by introducing the platform in Fundamentals EVALUATION. The goal for imbalanced nutrition is met if the patient is able to maintain the baseline weight and resume a normal dietary intake. The goal for constipation is met if the patient is free from discomfort and establishes a regular bowel elimination pattern. to teach students to “think like a nurse” from the very beginning. § Create a consistent learning experience in every course area to build students’ confidence as they move through the curriculum. § Prepare students for the Next Gen NCLEX® with case scenarios and questions that develop clinical judgment skills.
Study Guide , 7th Edition Paula D. Hopper, MSN, RN, CNE | Linda S. Williams, MSN, RN
NURSING DIAG
Impaired Bed M insufficient mu EXPECTED OUT physical activ • Assist or turn for support, a contraindicat circulation an • If ambulation
with Jennifer Otmanowski, RN, MSN, CNE and Lazette Nowicki, DNP, MSN, BSN, RN The Study Guide corresponds to the text chapter by chapter, while reinforcing the text’s emphasis on ‘connections’ each step of the way. It also includes questions that correspond to the Audio Case Studies. Perforated pages make it easy for students to submit their assignments to their instructors for evaluation. 336 pages | 63 illustrations | Soft cover, perforated pages | 2023 $44.95 (US) ISBN-13: 978-1-7196-4459-4 Risk for Constipation related to decreased peristalsis, immobility, altered diet, and opioid side effect EXPECTED OUTCOME: The patient will return to normal bowel elimination patterns within 3 to 4 days postoperatively. • Monitor elimination and document to detect problems. • Encourage early ambulation and exercise to promote restoration of GI function. • Provide stool softeners or laxatives as ordered to prevent constipation.
• 4 oz orange juice • 6 oz tomato soup
• 3/4 cup gelatin • 2 cups of water • 1,200 mL of 0.9% normal saline solution IV • Output for 12 hours: • 1,700 mL of urine Suggested answers are at the end of the chapter.
NURSING DIAGNOSES, PLANNING, AND IMPLEMENTATION
Risk for Urinary Retention related to surgery, pain, anesthesia, and altered positioning EXPECTED OUTCOME: The patient will regularly and com- pletely empty bladder.
(e.g., deep bre or passive isom leg muscles) w
• To prepare th of the bed slo is reported, lo orthostatic vi circulatory sy • Allow patient and pedal the the arteries to • Ensure patien • If a patient to to promote he the patient sh
• Measure and record output and urine characteristics of postoperative patient, especially for those having
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