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Difficulty: HardReduction of Risk Potential

A client is 2424 hours postoperative following a total abdominal hysterectomy. Which actions should the practical nurse take to minimize the risk of potential complications for this client? Select all that apply.

  1. Instruct the client to firmly hold a pillow against the abdomen when performing prescribed coughing exercises.Answer
  2. Ensure that prescribed sequential compression devices are securely applied and functioning whenever the client is resting in bed.Answer
  3. Examine the surgical incision site and vaginal pad for an increasing amount of bright red drainage.Answer
  4. D
    Administer a prescribed dose of intravenous (IV) push fentanyl for a sudden spike in abdominal pain.
  5. E
    Provide oral acetaminophen and dim the lights for a client exhibiting a new-onset heart rate of 118 beats/min118\text{ beats/min} and blood pressure of 88/54 mmHg88/54\text{ mmHg}.
  6. F
    Acknowledge a laboratory alert for a serum potassium level of 2.7 mEq/L2.7\text{ mEq/L} (2.7 mmol/L2.7\text{ mmol/L}) and wait for the registered nurse's scheduled rounds to discuss it.

Answer

The correct actions are to instruct the client to splint the abdomen when coughing, ensure sequential compression devices are applied while in bed, and examine the surgical site and vaginal pad for bright red drainage.
To reduce the risk of postoperative complications following a total abdominal hysterectomy, the practical nurse should implement evidence-based prophylactic measures and closely monitor for adverse events. Splinting the abdomen with a pillow during coughing reduces tension on the surgical incision, preventing dehiscence and minimizing pain. Applying sequential compression devices promotes venous return and reduces the risk of deep vein thrombosis. Additionally, examining the incision site and vaginal pad for bright red drainage is essential to identify early signs of postoperative hemorrhage.

Step-by-Step Solution

1
Identify the client's postoperative risks and the practical nurse's scope of practice.
The client is at risk for hemorrhage, deep vein thrombosis, and respiratory complications. The nurse must implement prophylactic measures and escalate critical findings.
Understanding the clinical context is essential for selecting safe and effective risk reduction strategies.
2
Evaluate the options for appropriate prophylactic and monitoring interventions.
Splinting the abdomen, using sequential compression devices, and checking for bright red drainage are correct actions.
These interventions directly prevent respiratory complications and DVT, and allow for early detection of hemorrhage.
3
Evaluate the remaining options for inappropriate or unsafe actions.
Administering IV push fentanyl, treating shock symptoms with acetaminophen, and delaying the report of a critical potassium level are incorrect actions.
IV push medications exceed the practical nurse's scope. Shock indicators and critical hypokalemia require immediate escalation to prevent severe morbidity or mortality.

Key Concept

Postoperative Risk Reduction and Scope of Practice
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Topics

Reduction of Risk Potential

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