Surgical Scenario 3: Doris Bowman-
pre/post quiz
Case Scenario/Description
Location: Post Anesthesia Care UnitTime: 09:30Situation:The patient is Doris Bowman. She is a
39-year-old female who underwent a total abdominal hysterectomy with bilateral
salpingo-oophorectomy under general anesthesia this morning. Mrs. Bowman tolerated the
procedure without complications. Estimated blood loss is 400 mL, and she received 1 unit of
packed red blood cells during the procedure. She was difficult to arouse from anesthesia and
has experienced extreme pain postoperatively.Background:Mrs. Bowman was experiencing
increasingly painful and heavy periods along with fatigue and was diagnosed with uterine
fibroids, dysmenorrhea, and menorrhagia. She recently started iron tablets for iron deficiency
anemia.Assessment:She awakens easily, responding to voice. Current vital signs are:
temperature: 98.4 °F (36.9 °C); heart rate: 90; respiratory rate: 16; blood pressure: 130/86; and
SpO2: 95% on oxygen 2 L per nasal cannula. Pain level ranges from 2-3 out of 10. Lung sounds
are clear. She has a midline abdominal incision covered with a 4x4 dressing with no drainage
noted; bowel sounds are hypoactive. An IV of D5 ½ normal saline is infusing at 125 mL/hr. She
has a urinary catheter in place with 200 mL urine output. She received ondansetron IV for
nausea and the scheduled IV NSAID at 0900.Recommendation:Vital signs are now every 15
minutes. You can review her post-op orders and labs in the chart. Pain assessment and
monitoring should include Glasgow Coma Scale, respiration assessment prior to administering
analgesics.
.....
The nurse is aware the initial hours after surgery require close monitoring of client status. Which
of the following areas of assessment are of primary concern? (Select all that apply.)
Correct Response: Hemodynamic stability, Spontaneous voiding, Return of bowel sounds,
Incisional pain, Adequate ventilation, Neurologic status
Rationale:In the initial hours after surgery it is important for the nurse to assess the following:
adequate ventilation; neurologic status and hemodynamic stability (to confirm adequate
circulation and mentation); return of bowel sounds, incisional pain, surgical site integrity, and
nausea and vomiting (to confirm gastric motility and bowel function); and spontaneous voiding
(to demonstrate return of bladder function as well as to ensure no injury occurred during the
surgical procedure). Overall skin integrity and ability to ambulate are not primary concerns
immediately after surgery; however, as the client continues to improve, these will be concerns
as well.
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