SUMBAD, MARK BHEN E.

NCLMSN3
BSN-NCB3 SIR ELTON JOHN DELOS SANTOS

Case Study: Postoperative Nursing Management

1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical
unit after undergoing removal of a section of the colon for colorectal cancer. The
patient does not have a colostomy. 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.

a. Explain the assessment parameters used to provide clues to detect postoperative

problems early and the interventions needed. (11 to 15 sentences only)
 The assessment parameters and the interventions needed are as follows,
first would be the signs of shock to be assessed and the interventions needed
are IV fluids administration, changing positions and transfusions. Second
assessment parameters would be assessment of surgical site and its
interventions are dressing must be intact and dry and any skin integrity must
be assessed. On the third would be to assess the airway and maintain
breathing and its intervention would be to provide supplemental oxygen as
required, assess breathing by feeling the movement of air. Keeping the head
elevated and do the suctioning. Next assessment parameters is to assess
cardiovascular stability and its needed intervention would be assessing all iv
sites and potential of hemorrhage, hypotension and shock. Next parameter is
to assess for nausea and vomiting and its intervention would be assessing it
post anesthesia and anti emetics. Next parameter is to assess pain and
anxiety and its intervention would be to assess patient environment, control
the environment, diversional therapies and family visits and analgesics as per
order. Next parameter would be Vital signs monitoring and its intervention
would be every 15min for for the 1st hour, every 3omin for next 2hours and
SUMBAD, MARK BHEN E. NCLMSN3
BSN-NCB3 SIR ELTON JOHN DELOS SANTOS

check temperature every 4 hours for 2 hours for vital monitoring. Next
parameter is to Prevent DVT and its intervention would be early ambulation
and leg exercise.
b. What gerontologic postoperative considerations should the nurse make? (15 to 20
sentences only)
 The gerontological consideration the nurse has to make first understand is
that they have slower recovery time because the patient has several small
abdominal incisions and undergone removal of a section on her colon which
makes it hard for the patient to recover easily because of her underlying
condition. Second nursing consideration is that they have greater risk of
acquiring the complications because patients who undergone such surgery
like Patient Rita can easily acquire infections because of its underlying
conditions on surgery which it is easier for her to acquire such complications.
Nursing consideration also is that they have longer hospital stay due to renal
and hepatic function and that’s why as a nurse we should give much effort to
take care of them as they have need more attention for them to be
motivated and feel more loved. Another nursing consideration Is that we
must be more prominent about the their pressure ulcers and other would be
post operative delirium.

2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) 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.

a. Explain the wound healing process according to the phase of Mr. Smith’s wound?
(5 to 10 sentences only)
 The cascade of healing is divided into these four overlapping phases:
Hemostasis, Inflammatory, Proliferative, and Maturation. Mr. Smit is in stage
two of the healing process, which has four stages for tissue recovery, the first
phase, coagulation has been overcome, he is currently in the inflammation
phase in which pathogens are being eliminated,for the immune system, then
comes the proliferation stage that is responsible for regenerating new tissue
and then the maturation stage in which the built tissue acquires strength and
elasticity.
b. The surgeon orders for wet-to-dry sterile saline dressing twice a day with
iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how
to perform this dressing change. (in bullet form; total of 8 steps)
1) assess the HCP order if old dressing is in place and dry
SUMBAD, MARK BHEN E. NCLMSN3
BSN-NCB3 SIR ELTON JOHN DELOS SANTOS

2) hand hygiene Don gloves

3) gently pull old dressings to assess the necrotic tissues
4) states not to moisture dressing will remove
5) remove gloves, hand hygiene, done the sterila candles
6) pour prescribed solution on the guage
7) covering the a the areas
8) used supplies are stored in a plastic bag and closed for safe storage