The nurse is changing the surgical dressing on an older patient's ...

[wrbasek0]

The nurse is changing the surgical dressing on an older patient's abdomen and sees the item pictured in the diagram below. How should the nurse care for this device?
 
  : Select all that apply.
  1. Plan to replace the precut gauze as part of the dressing change.
  2. Cleanse around the tube with the cleanser ordered or according to protocol.
  3. Use the safety pin to secure the outermost bandage to the dressing.
  4. Remove the tube, culture the wound, and cleanse it with saline gauze
  5. Remove the safety pin

Question 2

The patient who had an emergency abdominal surgery looks at his incision on the first postoperative day and says, I sure hope this doesn't leave much of a scar. Is there some type of medicine or ointment I can put on it?
 
  What should the nurse consider prior to responding to that comment?
 
  1. This incision will heal by primary intention and will probably leave only a hairline scar.
  2. This incision will fill in with granulation tissue and leave a moderately big scar despite any medication applied.
  3. This incision was done in an emergent fashion but continuous application of steroid creams will prevent scarring.
  4. This incision will have to be reclosed later and will leave a large scar unless a topical antibiotic is used continuously.

[ladyjames123]

Answer to Question 1

Correct Answer: 1, 2

This is a Penrose drain. The nurse cares for this device by cleansing around it per hospital protocol and replacing the precut gauze dressing as necessary. The pin should not be used to secure the dressing as that would make it very easy to inadvertently pull the drain out when the dressings are removed to be changed. The drain is there to passively remove drainage from the wound bed and it should not be removed until there is a physician order to do so. A culture is necessary only if there are assessment findings that indicate possible infection. The safety pin is in place to keep the drain from slipping back into the patient, so it should not be removed.

Answer to Question 2

Correct Answer: 1

This picture shows a clean, straight incision that was closed early, so it will probably leave a hairline scar. This is called healing by primary intention. Healing by secondary intention is when the incision is left open and granulation begins. This leaves a large scar. The fact that this was an emergency surgery should have nothing to do with the scarring potential if the incision is clean and closed immediately. Healing by secondary intention is when the incision is left open and granulation begins.