Question

Mr.Bubba had open abdominal surgery 5 days ago and is at rehab facility.He has type 2 diabetes and is obese.As you are assisting him to get out of bed, he anxiously states, "I just felt something give ".You lay him back in bed and assess his abdomen and find wound has dehisced and eviscerated.The patient is pale and diaphoretic and asking for drink of water. What are your priority actions?

Answer 1

Answer: As mentioned in the case, the patient is Diabetic and had abdominal surgery 5 days ago. But wound has dehisced and eviscerated, so the nurse need to take priority actions as:

• Assess the blood pressure of the patient.
• Make the patient in the supine position.
• Remove the debris from the wound.
• Air dry wound could able the wound to heal quickly.
• Check for the discharge from the wounds, clean the wound and perform the dressing.
• It is important to increase the blood flow to the particular wounded area.
• Nurse need to apply warm, moist dressing which is sterilized.