A post-operative patient reports mild abdominal discomfort and rates her pain at 3 on a scale of 1 to 10. What is the most appropriate initial nursing intervention?

B) Encourage the patient to use relaxation techniques.

A) Administer a prescribed opioid analgesic.

B) Encourage the patient to use relaxation techniques.

C) Apply a warm compress to the abdomen.

D) Document the pain level and reassess in one hour.

What is the most appropriate initial action for the nurse when a patient reports mild abdominal discomfort with a pain rating of 3 on a scale of 1 to 10 following abdominal surgery?

D) Document the pain level and continue monitoring.

A) Administer an additional dose of pain medication.

B) Reassess the patient's pain in 30 minutes.

C) Educate the patient on non-pharmacological pain relief methods.

D) Document the pain level and continue monitoring.

What is the primary reason the nurse notified the healthcare provider regarding the patient's changed status?

B) The patient showed a mild elevation in temperature.

A) The patient reported increased abdominal discomfort.

B) The patient showed a mild elevation in temperature.

C) The surgical site showed a slight increase in warmth.

D) The patient's heart rate was slightly elevated.

A post-operative patient reports increased abdominal discomfort and has a slight increase in temperature. Which of the following interventions should the nurse prioritize to address the patient's symptoms?

A) Administer scheduled acetaminophen

C) Apply an ice pack to the incision site

D) Discontinue pain management regimen

What is the primary reason for encouraging the patient to walk periodically after surgery?

B) To prevent deep vein thrombosis

A) To improve respiratory function

B) To prevent deep vein thrombosis

Which of the following actions by the nurse is most appropriate for monitoring the patient's post-operative recovery given her current condition?

B) Educate the patient on the importance of deep breathing exercises.

A) Increase the frequency of temperature checks to every hour.

B) Educate the patient on the importance of deep breathing exercises.

C) Request an immediate wound culture to rule out infection.

D) Discontinue acetaminophen as the patient's fever has reduced.

What is the primary reason for encouraging a postoperative patient to ambulate periodically?

B) To promote respiratory function

What is the primary reason for encouraging the patient to ambulate periodically following surgery?

A) To decrease the risk of blood clots

B) To alleviate surgical site pain

C) To improve respiratory function

What is the primary reason for encouraging postoperative patients to ambulate early in their recovery?

B) To promote circulation and prevent blood clots

C) To improve mood and decrease anxiety

D) To reduce fever and lower body temperature

What is the most likely reason for encouraging the patient to maintain adequate hydration during the post-operative period?

A) To decrease the risk of dehydration and support overall recovery

B) To increase urine output and promote kidney function

C) To improve skin elasticity and prevent pressure ulcers

D) To prevent gastrointestinal upset and reduce nausea

Post-operative hysterectomy - Nursing Case Study

Pathophysiology

• Primary mechanism: Tissue Healing - After a hysterectomy, the body initiates a healing process involving inflammation, tissue regeneration, and scar formation. Inflammation attracts immune cells to the site, promoting debris clearance and tissue repair.

• Secondary mechanism: Hormonal Changes - Removal of the uterus can alter hormone levels, impacting mood and physical recovery. The body's adjustment to these changes can influence the healing process and overall well-being.

• Key complication: Infection Risk - Surgical sites are vulnerable to infections. Signs include redness, swelling, and fever. Prompt identification and treatment are crucial to prevent the spread of infection and ensure proper healing.

Patient Profile

Demographics:

45-year-old female, teacher

History:

• Key past medical history: Early-stage uterine fibroids

• Current medications: Ibuprofen 400 mg as needed for pain, Multivitamin daily

• Allergies: None known

Current Presentation:

• Chief complaint: Post-operative monitoring following hysterectomy

• Key symptoms: Mild abdominal discomfort, fatigue

• Vital signs: Temperature 98.6°F, Heart rate 76 bpm, Blood pressure 118/76 mmHg, Respiratory rate 16 breaths per minute, Oxygen saturation 98% on room air

Section 1

As the nurse conducts an initial post-operative assessment, the patient presents comfortably in bed, with only mild abdominal discomfort reported. She rates her pain at 3 on a scale of 1 to 10, indicating manageable discomfort. The surgical site is clean, with minimal redness and no visible signs of infection such as swelling or drainage. The nurse notes that the patient's abdomen is soft and non-tender upon palpation, which is a positive indication of normal post-operative recovery. Bowel sounds are present and active in all quadrants, suggesting that gastrointestinal function is resuming appropriately following surgery.

Laboratory results from the morning blood draw show a slightly elevated white blood cell count of 11,000/mm³, which is typically expected in the early post-operative phase due to the body's inflammatory response to surgery. Hemoglobin and hematocrit levels are within normal limits, indicating that there has been no significant blood loss. Electrolyte levels are stable, and renal function tests are normal, reflecting adequate hydration and kidney function.

The patient expresses some concern about her fatigue, which the nurse explains can be attributed to both the body's natural healing process and the hormonal adjustments following the hysterectomy. The nurse provides reassurance, emphasizing the importance of rest and gradual return to activity. Education on monitoring for signs of infection and proper wound care is reinforced, ensuring that the patient and her family are aware of when to seek further medical attention. These findings and interventions support continued recovery, with plans to reassess the patient’s status in the next 24 hours.

Section 2

As the nurse continues to monitor the patient throughout the day, a shift in the patient's status becomes apparent. By early afternoon, the patient reports an increase in her abdominal discomfort, rating her pain at a 5 out of 10. The nurse performs a focused assessment, noting that the patient is now slightly more restless and appears fatigued. Upon inspection, the surgical site remains clean with no additional redness or drainage. However, the nurse observes a slight increase in warmth around the incision. Palpation of the abdomen reveals that it remains soft and non-tender, but the patient indicates increased sensitivity near the incision site.

Vital signs are reassessed, showing a mild elevation in temperature to 100.4°F (38°C), consistent with the body's inflammatory response but warranting close observation for potential infection. Blood pressure remains stable at 120/78 mmHg, and heart rate is slightly elevated at 92 beats per minute, possibly due to increased discomfort. Respiratory rate is unchanged at 18 breaths per minute, and oxygen saturation remains at 98% on room air. The nurse decides to notify the healthcare provider of these changes and anticipates orders for additional interventions, such as a repeat complete blood count (CBC) to monitor white blood cell trends and possibly a wound culture if infection is suspected.

In response to the increased discomfort and potential early signs of infection, the nurse collaborates with the healthcare team to implement additional interventions. Pain management is adjusted, with the patient receiving a scheduled dose of acetaminophen to address both pain and fever. The nurse reinforces the importance of hydration and encourages the patient to increase oral fluid intake, supporting overall recovery and helping to manage temperature. Education continues to play a vital role, as the nurse discusses signs of infection with the patient and family, emphasizing the need for prompt reporting of any further changes. With these measures in place, the patient is reassured, and plans are made for ongoing monitoring and reassessment in the next 12 to 24 hours.

Section 3

Over the next 12 hours, the patient shows a mild but noticeable response to the interventions put in place. The administration of acetaminophen has successfully reduced her fever, with her temperature now reading 99.2°F (37.3°C). The patient reports that her abdominal discomfort has decreased to a pain score of 3 out of 10, which indicates a positive response to the pain management strategy. She appears more comfortable and less restless, allowing her to rest more effectively. The increased fluid intake has been maintained, and the patient is compliant with the encouragement to stay hydrated. Despite these improvements, the nurse remains vigilant and continues to monitor for any signs of worsening or new complications.

The repeat complete blood count (CBC) ordered by the healthcare provider reveals a mild elevation in white blood cells (WBC) at 11,000 cells/mcL, suggesting a potential early stage of an inflammatory process but not yet indicative of a full-blown infection. Other lab values remain within normal limits. With this information in hand, the healthcare team decides to continue observing the patient closely, opting to hold off on more invasive diagnostics such as a wound culture unless further signs of infection develop. The nurse continues to monitor the surgical site for changes, noting that the warmth around the incision has not increased and there remains no evidence of pus or unusual drainage.

In discussions with the patient and her family, the nurse reinforces the importance of adhering to post-operative care instructions, including walking periodically to promote circulation and prevent complications such as deep vein thrombosis. The patient is encouraged to report any changes in symptoms immediately. With a stable vital sign profile and her overall condition showing signs of improvement, the focus remains on supportive care and education as she progresses through the critical early stage of her post-operative recovery. The plan is to reassess her condition thoroughly at the next nursing shift change, ensuring a seamless transition in care and continued vigilance for any new developments.

Section 4

As the nursing team transitions to the next shift, the patient's vital signs are reassessed. Her temperature remains stable at 99.2°F (37.3°C), and her heart rate is slightly elevated at 98 beats per minute, which is consistent with her current state of mild discomfort. Blood pressure is recorded at 122/78 mmHg, and her respiratory rate is 18 breaths per minute, both within normal limits. The patient reports feeling fatigued but notes that her pain remains manageable, maintaining a score of 3 out of 10. Upon physical assessment, the surgical site shows no signs of increased redness or swelling, and the incision remains clean and dry with minimal serosanguinous drainage.

Despite the stable findings, the nurse is attentive to a new concern: the patient is experiencing some mild nausea, which she rates as a 2 out of 10 on the discomfort scale. This new symptom prompts the healthcare team to review her medication regimen and dietary intake. The patient has been advancing her diet to include soft foods, which may contribute to her nausea. The nurse collaborates with the dietary team to adjust her meal plan, focusing on bland, easily digestible foods to alleviate her symptoms. Additionally, the nurse educates the patient about the importance of slow, small meals to aid digestion.

The care team decides to continue monitoring the patient closely, emphasizing the importance of mobility and adequate hydration. The nurse reinforces the need for periodic ambulation to prevent complications, such as blood clots, and encourages the patient to maintain fluid intake, aiming for at least 2 liters per day. With these interventions in place, the patient is reassured that her mild symptoms are being addressed proactively. The plan includes a follow-up on her nausea and overall condition during the next shift, allowing for timely adjustments in care as needed.

Section 5

As the next shift begins, the nurse conducts a follow-up assessment to evaluate the patient's response to the recent interventions. The patient's vital signs are stable, with her temperature remaining at 99.1°F (37.3°C) and her heart rate slightly decreased to 92 beats per minute, indicating some improvement in her comfort level. Blood pressure is consistent at 120/76 mmHg, and her respiratory rate remains steady at 18 breaths per minute. The patient reports that her fatigue has lessened, and her pain score remains at a 3 out of 10, suggesting that she is continuing to manage her discomfort effectively.

The nurse notes a positive response to the dietary adjustments, as the patient's nausea has decreased to a 1 out of 10. She expresses relief and gratitude for the dietary changes, indicating they have helped her feel more comfortable. The nurse observes that the surgical site remains clean and dry, with no signs of infection or increased drainage, supporting the stability of her post-operative recovery.

Encouraged by these improvements, the healthcare team decides to maintain the current plan of care, focusing on gradual mobility and hydration. The patient is reminded of the importance of continued ambulation to promote circulation and prevent complications, such as blood clots. The nurse also reiterates the goal of maintaining fluid intake to support recovery, ensuring the patient understands the critical role of hydration in her healing process. With these ongoing supportive measures, the team remains vigilant, anticipating a smooth progression in the patient's post-operative journey while preparing for any necessary adjustments in care.