Question

69-year-old male who presented to the Emergency Department 4 days ago with complaints of nausea, vomiting, and severe abdominal pain and was admitted for emergent surgery for bowel perforation.He underwent a hemicolectomy. He has a midline abdominal incision without redness, swelling, or drainage. He is tolerating a soft diet without nausea or vomiting. Bowel sounds are present in all four abdominal quadrants. He had a bowel movement yesterday.Last urinary outputwas400 ml at 6 a.m. He is reluctant to use the incentive spirometer,but his wife encourages him to do his deep breathing. Abdominal pain has been controlled with morphine. He has refused to ambulate this morning because of fatigue and a sore leg. Rates pain 3/10.He is ringing the call light requesting to see his nurse.Most recent VS: Temp 99, Pulse 90, Respirations 20, BP 130/70, O2 sat 94%Weight 176 pounds (80 kg). Height 72 inches (1.82 meters)Allergies: Penicillin (hives) Past medical history(PMH): History of cataracts and controlled hypertension.He smokes 1/2pack filtered cigarettes a day for 50 years, walks 3 miles/day.Social history: Married and lives in own home. Two grown children who live out of state. Recently retired.

Orders:

Diet: regular

Continuous ECG, SpO2monitoring, and vital signs every 4 hours

Oxygen to maintain SpO2greater than 92%

Meds: Morphine sulfate 4–6 mg IV push every 4 hours PRN pain

1. What are you on alert for with this patient? Why?

2. What assessments are important to gather? Why?

Answer 1

1.The patient has to be in alert for the following

• Elevated body temperature is a sign of infection
• Lack of incentive spirometry post operatively can risk the patient for getting easy lung infection (post operative pneumonia )
• Immobilisation can lead to DVT (the patient is complaining of sore leg)
• Risk of thromboembolism due to immobilisation

The assessment important to gather are

• Assess the leg for tenderness , warmth , inflammation to rule out DVT
• Basic blood investigation to rule out infection
• Pain assessment, to plan for pain management with analgesics as per the order