On postoperative day 2, R.O. continues to improve and is tolerating ice chips. Breath sounds are clear, and she is performing her pulmonary hygiene. NGT has minimal drainage. The Foley catheter and Penrose drain have been removed, and her urine output is adequate. Her IV line is saline locked. The incision is well approximated with no drainage or redness. Her pain is 4 to 6 out of 10 with pain medication every 4 hours. Later that evening your assessment shows that R.O. is pale and listless; bowel sounds are absent; abdomen is distended and tender to the touch; the NGT is draining an increased amount of dark, green- ish black fluid. Her lung sounds are moist bilaterally, and her temperature has spiked to 40.2 ° C (104.4 °
F), O2 saturation is 97% on room air. she rates her pain at 10 out of 10 and is having difficulty taking deep breaths because of the pain, which she says “hurts over my whole stomach.”
8. What actions would you take?
9. Using SBAR, what would you communicate to the surgeon?
10. What will you consider as part of your nursing management of R.O.’s pain?
Case Study Progress
The surgeon assesses R.O. and orders an immediate return to the operating room. R.O. returns to surgery, where she has lysis of adhesions, removal of necrotic bowel, and drainage of an abscess. The surgeon has left her abdominal wound open and has ordered wound packing changes twice daily and abdominal irrigation with normal saline. R.O. cries and becomes agitated when you go to perform the procedure.
11. Which of the following pain and coping concepts would you question as you assist R.O to prepare for the procedure?
a. R. may fear loss of control during the dressing change.
b. R. may fear separation from family members during painful experiences.
c. R. is concerned about privacy during the dressing change.
d. Prior coping strategies can be used to prepare for the dressing change.
12. In anticipation of R.O.’s discharge, identify expected outcomes that must be achieved before discharge from the hospital.
Case Study Progress
After a week, R.O. continues to meet expected outcomes, with her wound healing well. Her discharge to home is planned for the next day. you provide discharge teaching to R.O. and her parents.
13. Which of these statements would indicate that more teaching is required?
a. “We need to return if R.O. begins vomiting again or develops a fever.”
b. “R.O. should wait 1 week before returning to her gymnastics program.”
c. “We will keep the incision clean and call if we see redness or drainage.”
d. “R.O. can advance her diet to the regular foods that she likes to eat.”
Case Study Outcome
R.O. is discharged to home with her parents and has an uneventful recovery. she is scheduled for a follow-up visit with the surgeon in 2 weeks.