Care Plan For Postoperative 64-Year-Old Male Client

Care Plan for Postoperative 64-Year-Old Male Client After Emergency Colectomy

Scenario: You are the nurse caring for a 64-year-old male client who is postoperative day four after emergency right colectomy due to cancer. The client is NPO with NG tube to low intermittent suction. Vital signs are stable with minor variations; the client reports pain at 6/10. Physical assessment reveals alertness, intact surgical site, hypoactive bowel sounds, and partial oxygen saturation with supplemental oxygen. The goal is to promote recovery, prevent complications, and ensure adequate postoperative care tailored to the client's current status.

Priority Nursing Diagnoses

• Impaired Gas Exchange related to diminished bilateral lung sounds and supplemental oxygen requirement.
• Pain related to surgical incision and abdominal trauma.
• Risk for Infection related to surgical incision and drain sites.
• Deficient Knowledge regarding postoperative care and activity restrictions.
• Risk for Decreased Gastrointestinal Motility related to postoperative ileus.

Goals and Expected Outcomes

• The client will maintain adequate gas exchange as evidenced by oxygen saturation above 92% on supplemental oxygen and clear lung sounds.
• The client will report manageable pain levels below 4/10 during rest and activity.
• The client will demonstrate understanding of wound and drain care to prevent infection.
• The client's bowel movements will resume normal pattern within 48-72 hours.
• The client will ambulate with assistance to enhance postoperative recovery and prevent complications such as deep vein thrombosis (DVT).

Interventions and Rationales

Impaired Gas Exchange

Maintain oxygen therapy at 2L via nasal cannula and monitor oxygen saturation regularly to ensure adequate oxygenation. Auscultate lung fields to detect changes in breath sounds. Encourage deep-breathing exercises and use of incentive spirometry to prevent atelectasis (Brady & Murphy, 2016). Position the client semi-Fowler's to promote lung expansion. Monitor for signs of hypoxia and report invasive airway issues if oxygen saturation drops below acceptable levels.

Pain Management

Administer prescribed analgesics, such as opioids, around the clock as needed, and evaluate effectiveness frequently. Use non-pharmacologic measures like relaxation techniques and distraction. Assess pain level regularly using a standardized scale and adjust interventions accordingly to promote comfort and facilitate activity.

Preventing Infection

Maintain aseptic technique during wound and drain site care. Inspect incision, Penrose drain, and Jackson-Pratt drain sites for signs of erythema, swelling, or increased drainage. Encourage hand hygiene and promote patient education regarding drain management and signs of infection. Keep drains patent and record drainage amount and character to monitor individual recovery.

Promoting Gastrointestinal Function

Monitor bowel sounds and abdominal assessment findings for signs of return of bowel function. Gradually advance diet from NPO to clear liquids as tolerated, based on bowel sounds and absence of nausea or vomiting. Encourage early ambulation to stimulate gastrointestinal motility and reduce risk of ileus (Joy & Mather, 2017). Administer prokinetic agents if prescribed, and offer comfort measures for abdominal discomfort.

Patient Education

Educate the client about activity restrictions, drain management, signs of infection, and when to seek medical attention. Reinforce the importance of monitoring respiratory and gastrointestinal status and adhering to prescribed therapies. Provide written instructions and ensure understanding to promote confidence in self-care post-discharge.

Facilitating Early Ambulation

Assist the client to sit at the edge of the bed, then gradually progress to ambulation with assistance. Encourage mobility within safety limits to enhance circulation, prevent DVT, and promote GI motility (Nurses' Health, 2019). Monitor for orthostatic hypotension or pain during movement and provide supportive devices if needed.

Evaluation

The client demonstrates effective gas exchange with oxygen saturation ≥92%. Pain is managed effectively with a score less than 4/10. Wound and drain sites are clean, dry, and free of infection signs. Bowel sounds return within expected timeframe, and the client begins gradual ambulation. Education is understood and applied, contributing to overall recovery.

References

• Brady, K., & Murphy, S. (2016). Pulmonary care and oxygen therapy. Journal of Nursing Practice, 22(4), 45-52.
• Joy, A., & Mather, J. (2017). Postoperative gastrointestinal management. Surgical Nursing Journal, 19(2), 100-107.
• Nurses' Health. (2019). Promoting early ambulation after abdominal surgery. Nursing Times, 115(34), 24-26.
• Smith, R., & Jones, L. (2018). Infection prevention in surgical patients. Infection Control & Hospital Epidemiology, 39(8), 924-929.
• Johnson, M., et al. (2020). Wound care management in postoperative patients. Journal of Advanced Nursing, 76(5), 1054-1062.
• Green, J., & Carter, P. (2019). Managing postoperative pain in abdominal surgery. Pain Management Nursing, 20(1), 32-39.
• Lee, D., & Garcia, A. (2021). Strategies to promote gastrointestinal recovery post-surgery. Frontiers in Surgery, 8, 635827.
• Wilson, T., & Clark, S. (2022). Strategies to prevent postoperative pulmonary complications. Critical Care Nursing Quarterly, 45(3), 246-253.
• Martins, E., & Silva, R. (2023). Nutritional considerations in postoperative colorectal cancer patients. Nutrition and Cancer, 75(2), 123-130.
• Thompson, H., et al. (2020). Signs and symptoms of infection to monitor in postoperative care. Clinical Nursing Studies, 8(4), 45-52.