PostoperativeCareofthePatientwith

Complications:IleusPNCILearner

AliceSmythe
Age:72Weight:55kgLocation:Patientshome/MedicalSurgical
Unit

Background
PatientHistory
PastMedicalHistory:Patienthadanuneventfullaparoscopic
cholecystectomytwodaysago.Shewasingoodhealthpriortoher
surgery
Allergies:NoknowndrugallergiesMedications:Aspirin325mgby
moutheveryday;multivitamin1tabletbymoutheveryday;
HYDROcodone5mg/acetaminophen325mg2tabletsbymouthevery
6hoursprnforpainCodeStatus:Fullcode
Social/FamilyHistory:Sheisrecentlywidowed;herhusbandof50
yearsdiedunexpectedly.Shehasonedaughterwholivesoutofstate.
Thedaughterwaspresentafterherfathersdeathandforthesurgery,
buthadtoreturnhomebecauseofhercareerandfamily.Thepatient
livesaloneinatwostoryhouse.

HandoffReport
Situation:
Thepatientisa72yearoldfemalewhohadalaparoscopic
cholecystectomy.Shewasdischargedtoreturnhomewithahome

healthnursecare.
Background:
Thepatienthadalaparoscopiccholecystectomytwodaysago.She
stayedovernightafterthesurgeryforobservationandthenwas
dischargedhome.Thepatientlivesalone.
Assessmentupondischargefromhospitalonedayago:
Vitalsigns:HR92,BP135/76,RR18,SpO298%onroomairand
temperature37.0CGeneralappearance:Appearsstatedage
Cardiovascular:Sinustachycardia.Peripheralpulsesstrong
Respiratory:Breathsoundsclearandequalbilaterally
GI:Bowelsoundsabsent.Abdomensoftwithmildtendernessupon
palpationGU:VoidsspontaneouslyExtremities:Equalmovement
bilaterally
ProgramforNursingCurriculumIntegration(PNCI)
2012CAEHealthcare,Sarasota,FLv.5

PostoperativeCareofthePatientwith
Complications:IleusPNCILearner

HandoffReportContinued
Skin:Pink,warmanddry.Abdominalincisionssitesintactwithsmall
amountofrednessandnodrainageNeurological:Alertandorientedto
person,placeandtime.Pupilsequalandreactivetolightand
accommodation
IV:NoneFallRisk:LowriskPain:Complainsofminimalpain,rated
2/10
Recommendations:Performphysicalassessment,includingassessing
incisions;Monitorforpostoperativecomplicationsandassesshome
environment

Orders
InitialHealthcareProvidersOrders:
AdmittohomehealthDietastoleratedActivityastoleratedand
encouragedCallhealthcareproviderofficeforincreasedpainorfever
Monitorincisionsforredness,drainage,warmthandodorSchedule2
weekpostoperativeappointmentwithhealthcareprovidersoffice
Dischargemedicationsinclude:HYDROcodone5mg/acetaminophen
325mg2tabletsPOevery6hoursprnforpain

ProgramforNursingCurriculumIntegration(PNCI)
2012CAEHealthcare,Sarasota,FLv.5

PostoperativeCareofthePatientwith

Complications:IleusPNCILearner

Preparation
LearningObjectives

Interpretsthefindingsfromthephysicalassessmentandlabdiagnostics
ofapatientwithanileus(ANALYZING)

Formulatesanursingplanofcarebasedonthepathophysiologyofileus
andassessmentofthepatient(CREATING)

Evaluatesthepatientsresponsetointerventionsandmodifiesthe
nursingcareasappropriateforthepatientwithileus(EVALUATING)

Determinesotherpotentialpostoperativecomplicationsthepatientisat
riskforandimplementsinterventionstopreventthemfromoccurring
(APPLYING)

Demonstratescommunicationtechniquesthathelptoalleviateanxiety,
fearandpanicandbuildatherapeuticrelationship(APPLYING)
RecommendedeDosemodulesforlearnerstocompletebeforethe
SCE:MedicationDosageCalculationSkillsXMedicationOrders&
S.I.UnitsXTablets&CapsulesLiquidMedicinesXInjectionsXI.V.
InfusionsInjectableMedicinesTherapy
XSlowI.V.InjectionsIntermittentInfusionsContinuousInfusions
Pediatrics
ThisSCEaddressesthefollowingQSENCompetencies:
XPatientCenteredCareXTeamworkandCollaborationXEvidence
BasedPracticeXQualityImprovementXSafety

Informatics
ProgramforNursingCurriculumIntegration(PNCI)
2012CAEHealthcare,Sarasota,FLv.5

PostoperativeCareofthePatientwith
Complications:IleusPNCILearner
PreparationQuestions

Discusspotentialpostoperativelaparoscopicabdominalsurgery
complications,includingassessmentfindings,diagnosticevaluation
andnursingmeasuresdesignedtopreventthesecomplicationsfrom
occurring.
Possiblecomplicationsoflaparoscopicabdominalsurgery
include:
Distendedabdomen
nauseaandvomiting
bowelandgastricmotility
pain
electrolyteimbalance
diarrheaandbloodystools
absentbowelsounds
Diagnosticevaluationsinclude:
electrolytesimbalancewouldshow
Nursingmanagementincludes:
assessingforbowelsoundsandflatulence
medicationadministration
NGtubefeedings

Describethemedicalandnursingmanagementforapatientwith
postoperativeileus.
Managementofapatientwithpostoperativeileuswouldinclude:
painmanagement
possibleNGtubeforparenteralfeedingsandsuctionofgastric
contents
IVfluidstopreventdehydration
antiemeticmedication
stoolsoftners
frequentlabsanddiagnostics

Discussthesymptomsthatwouldoccurwiththehypoorhyperstatus
ofthefollowingelectrolytes:sodium,potassiumandchloride.
Imbalanceofsodiumandpotassiumcouldcausepotentialheart
problems. This would have symptoms of heart palpitations,
tachycardia, bradycardia, and any dysrhythmias. It would also
causeretentionoffluids.Anincreasedordecreasedchloridelevel
would have symptoms of nausea, vomiting, and electrolyte
imbalance

Identifythelaboratoryandradiologyteststhatwouldbeexpectedina
patientwithanileus.Whatcanthenursedeterminefromtheresultsof
thesetests?
Labsofelectrolyteswouldbecriticalforthispatientinorderto
measurenutritionandhydration.TherewouldalsobeXraysof
thebowelsinordertoshowobstructionandconstipation.ACT
scancouldalsoshowtheobstructionandcouldindicate
progressionorregression.AWBCwouldalsobeimportantin
ordertoshowifthereisaninfection,whichcouldbethecause.

Discussthepathophysiologyofileus.

PathophysiologyofileustemporaryobstructedGItractand
paralysisofaportionoftheintestinesaftersurgery.Itcanbe
causedbyinflammationfromsurgery,electrolyteimbalances,
secondarysideeffectsofmedications.Therecanbeaphysical
blockageofthecolonoranonmechanicalobstruction.

Differentiatebetweenmechanicalandnonmechanicaltypesofbowel
obstruction.
Mechanicalbowelobstructionisacompleteorpartialobstruction
duetophysicalblockage.Nonmechanicalbowelobstructionisa
paralysisofbowelsduetoasecondaryeffectsuchas
medications,trauma,electrolyteimbalance,andinfections.

Discusstheprocedureforobtainingorthostaticvitalsigns.Whenisthis
procedureindicated,andhowarethefindingsinterpreted?
Inordertoobtainorthostaticvitalsignsyouwouldhavethepatientlie
inthebedandobtainbaselinevitals.Thenyouwouldtakevitalswhile
patientissittingonthesideofthebed,followedbytakingvitalswhen
patientisstanding.Theresultscouldshowthatthereisdehydrationand
electrolyteimbalanceifthepatientexperiencesvomiting,diarrhea,and
dizziness.

ReferencesAckley,B.J.,&Ladwig,G.B.(2010).Nursing
diagnosishandbook:Anevidencebasedguidetoplanningcare
(9thed.).St.Louis,MO:ElsevierMosby.Edelman,C.L.,&
Mandle,C.L.(2009).Healthpromotionthroughoutthelifespan
(7thed.).St.Louis,MO:Mosby.Forehand,M.(2010).Blooms
taxonomy.Emergingperspectivesonlearning,teaching,and
technology.DepartmentofEducationalPsychologyand
InstructionalTechnology,UniversityofGeorgia.Retrievedfrom

http://projects.coe.uga.edu/epltt/index.php?title=Bloom
%27s_TaxonomyGeiger,T.M.,MacKay,G.,&Ricciardi,R.
(2010).Outcomesoffasttrackpathwaysforopenand
laparoscopicsurgery.SeminarsinColon&RectalSurgery,
21(3),170175.Giger,J.N.,&Davidhizar,R.E.(2007).
Transculturalnursing:Assessmentandintervention(5thed.).St.
Louis,MO:Mosby.Harold,B.(2011).Urgenttreatmentof
patientswithintestinalobstruction.EmergencyNurse,19(1),28
31.InstituteforClinicalSystemsImprovement(ICSI).(2010).
Preoperativeevaluation.Bloomington,MN:Author.Retrieved
fromhttp://www.guideline.gov/content.aspx?
id=23858&search=preoperative+tests+and+elective+surgery
JohnsonRussell,J.(2010).Facilitateddebriefing.InW.M.
Nehring&F.R.Lashely(Eds.),Highfidelitypatientsimulation
innursingeducation,369385.Sudbury,MA:JonesandBartlett.
Lewis,S.L.,Dirkse,S.R.,Heitkemper,M.M.,&Bucher,L.
(2010).Medicalsurgicalnursing:Assessmentandmanagement
ofclinicalproblems(8thed.).St.Louis,MO:ElsevierMosby.
ProgramforNursingCurriculumIntegration(PNCI)2012CAEHealthcare,
Sarasota,FLv.5

PostoperativeCareofthePatientwith
Complications:IleusPNCILearner
ReferencesContinued
Lockwood,C.,ConroyHiller,T.,&Page,T.(2004).Vitalsigns.
InternationalJournalofEvidenceBasedHealthcare,2(6),207230.

doi:10.1111/j.14796988.2004.00012.x
Melnyk,B.M.,&FineoutOverholt,E.(2010).Evidencebased
practiceinnursing&healthcare:Aguidetobestpractice(2nded.).
Philadelphia,PA:LippincottWilliams&Wilkins.
NationalCouncilofStateBoardsofNursing.(2010).2010NCLEXRN
testplan.Retrievedfromhttps://
www.ncsbn.org/2010_NCLEX_RN_Testplan.pdf
QualityandSafetyEducationforNurses.(2011).Qualityandsafety
competencies.Retrievedfromhttp://www.qsen.org/competencies.php
Hellar,J.(2010).IntestinalObstruction.Retrievedfrom
http://www.nlm.nih.gov/medlineplus/ency/article/000260.htm
TheJointCommission.(2011).Nationalpatientsafetygoals.Retrieved
fromhttp://www.jointcommission.org/
standards_information/npsgs.aspx
U.S.DepartmentofHealthandHumanServices,NationalInstituteof
DigestiveandDiabetesandKidneyDiseases,NationalInstitutesof
Health.(2008)NationalDigestiveDiseasesInformation
Clearinghouse:IntestinalPseudoObstruction.Retrievedfrom
http://digestive.niddk.nih.gov/ddiseases/pubs/intestinalpo/index.htm

Authors
CarrieA.Thompson,FoxValleyTechnicalCollegeAppleton,WIand
KimLeighton,BryanLGHCollegeofHealthSciencesLincoln,NE.
ReviewedbyPatriciaR.Keene,UnionUniversityGermantown,TN,
andChristieSchrotberger,DianeMathe,LyndeRabine,GwenLeigh
andDonnaWalls,CAEHealthcareSarasota,FL2012

ProgramforNursingCurriculumIntegration(PNCI)

2012CAEHealthcare,Sarasota,FLv.5