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Difficulty: HardReduction of Risk Potential

A practical nurse (PN) is participating in the care of a client who is 24 hours postoperative following an exploratory laparotomy and small bowel resection. Which of the following actions by the PN demonstrate appropriate application of risk reduction principles? Select all that apply.

  1. Assisting the client with early ambulation in the hallway to prevent postoperative complications such as atelectasis and venous stasis.Answer
  2. Notifying the registered nurse immediately when the client's nasogastric tube drainage abruptly changes from dark brown to bright frank red.Answer
  3. Instructing the client to firmly splint the abdominal incision with a pillow while performing deep breathing and coughing exercises.Answer
  4. D
    Reassuring the client that a sustained resting heart rate of 118 beats per minute and a blood pressure of 92/60 mm Hg are expected responses to surgical pain.
  5. E
    Deferring the report of a morning serum potassium level of 2.8 mEq/L (2.8 mmol/L) until the provider's afternoon rounds because the client denies muscle cramps.
  6. F
    Identifying the client by confirming the room number and bed assignment match the medication administration record prior to giving oral analgesics.

Answer

The correct actions demonstrating risk reduction are assisting with early ambulation, immediately reporting the change in nasogastric drainage to bright red, and teaching the client to splint the incision during coughing.
Appropriate risk reduction in the postoperative period includes proactive interventions that prevent complications and the prompt escalation of abnormal findings. Early ambulation promotes adequate circulation and pulmonary expansion, reducing the risk of deep vein thrombosis and atelectasis. Bright red nasogastric drainage 24 hours postoperatively is an abnormal finding suggesting active hemorrhage and requires immediate escalation to the RN. Furthermore, splinting the abdominal incision during coughing reduces mechanical strain on the suture line, preventing painful wound dehiscence and evisceration.

Step-by-Step Solution

1
Evaluate each option against established standards of care and risk reduction principles for a postoperative client.
Identify actions that prevent complications and recognize those that represent clinical errors or missed signs of deterioration.
Risk reduction involves proactive measures to prevent harm and timely recognition of adverse clinical events.
2
Analyze the vital signs and laboratory data presented in the scenarios.
Recognize that a heart rate of 118 bpm with a blood pressure of 92/60 mm Hg may indicate hypovolemic shock, and a potassium level of 2.8 mEq/L is critically low.
Both findings represent significant physiological instability requiring immediate escalation to the RN or provider, rather than reassurance or delayed reporting.
3
Review procedural standards for medication administration and post-procedure care.
Determine that using a room number for identification is an unsafe practice, while splinting incisions and assisting with early ambulation are evidence-based preventative measures.
Adhering to strict safety protocols (like utilizing two approved patient identifiers) and implementing preventative care interventions directly reduces client risk.

Key Concept

Application of Risk Reduction Principles in Postoperative Care
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Topics

Reduction of Risk Potential

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