The nurse assesses a patient on the second postoperative day ...

[armygirl]

The nurse assesses a patient on the second postoperative day after abdominal surgery to repair a perforated duodenal ulcer. Which finding is most important for the nurse to report to the surgeon?
 
  a. Tympanic temperature 99.2 F (37.3 C)
  b. Fine crackles audible at both lung bases
  c. Redness and swelling along the suture line
  d. 200 mL sanguineous fluid in the wound drain

Question 2

After receiving change-of-shift report about these postoperative patients, which patient should the nurse assess first?
 
  a. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating
  b. Patient who has 30 mL of sanguineous drainage in the wound drain 10 hours after hip replacement surgery
  c. Patient who has bibasilar crackles and a temperature of 100F (37.8C) on the first postoperative day after chest surgery
  d. Patient who continues to have incisional pain 15 minutes after hydrocodone and acetaminophen (Vicodin) administration

[jliusyl]

Answer to Question 1

ANS: D
Wound drainage should decrease and change in color from sanguineous to serosanguineous by the second postoperative day. The color and amount of drainage for this patient are abnormal and should be reported. Redness and swelling along the suture line and a slightly elevated temperature are normal signs of postoperative inflammation. Atelectasis is common after surgery. The nurse should have the patient cough and deep breathe, but there is no urgent need to notify the surgeon.

Answer to Question 2

ANS: A
The patient's history and assessment suggests possible wound dehiscence, which should be reported immediately to the surgeon. Although the information about the other patients indicates a need for ongoing assessment and/or possible intervention, the data do not suggest any acute complications. Small amounts of red drainage are common in the first postoperative hours. Bibasilar crackles and a slightly elevated temperature are common after surgery, although the nurse will need to have the patient cough and deep breathe. Oral medications typically take more than 15 minutes for effective pain relief.