Care Plan For Postoperative Day Four Male Colectomy Patient

Care Plan for Postoperative Day Four Male Colectomy Patient

Scenario you are the nurse caring for a 64-year-old male client who is postoperative day four after an emergency right colectomy due to cancer. The client is NPO with a nasogastric (NG) tube to low intermittent suction. He has a history of smoking, with vital signs within stable ranges but with some concerning clinical findings such as hypoactive bowel sounds, abdominal tenderness, and moderate pain. The assessment also indicates limited mobility and specific drain outputs. The following care plan addresses key nursing priorities including pain management, gastrointestinal recovery, prevention of complications, and mobility enhancement.

Assessment

The patient exhibits stable vital signs with a slight temperature elevation (99.2°F) and slightly decreased oxygen saturation (93% on 2L oxygen). Physical examination reveals hypoactive bowel sounds, abdominal tenderness in all four quadrants, and drains with serous and serosanguineous drainage, indicating ongoing postoperative wound and drain management needs. The patient remains NPO with NG tube suction, limiting oral intake and necessitating close monitoring of fluid and electrolyte status. The patient is alert but refuses to ambulate, posing a risk for immobility-associated complications. Pain is rated at 6/10, requiring assessment and management.

Diagnosis

• Pain related to surgical incision as evidenced by patient's report of 6/10 pain
• Impaired bowel motility related to recent abdominal surgery as evidenced by hypoactive bowel sounds and abdominal tenderness
• Risk for atelectasis related to limited mobility and diminished lung sounds
• Risk for infection related to surgical incision, drains, and limited mobility
• Risk for deep vein thrombosis (DVT) related to immobility and postoperative status
• Imbalanced nutrition: less than body requirements due to NPO status and recent surgery

Goals and Expected Outcomes

• The patient will report pain levels less than 3/10 within 24 hours through effective pain management strategies.
• The patient will demonstrate return of bowel sounds and tolerance of gradual reintroduction of oral intake within 48-72 hours.
• The patient will maintain adequate oxygenation with no signs of respiratory compromise.
• The patient will participate in mobility activities, including sitting up and ambulation, to reduce postoperative complications.
• The patient's surgical site and drains will remain free of infection, with minimal drainage and no erythema or swelling.
• The patient will demonstrate understanding of postoperative care plan, including signs of complications.

Interventions

Pain Management

Administer prescribed analgesics such as opioid or non-opioid medications to maintain comfort. Employ non-pharmacological methods including relaxation techniques and repositioning. Assess pain regularly using standardized tools and document responses, adjusting interventions as needed.

Monitoring Gastrointestinal Function

Monitor bowel sounds regularly to assess for return of bowel motility. Keep the NG tube patent and connected to low intermittent suction to decompress the stomach and prevent nausea or vomiting. Record drainage from Penrose and Jackson-Pratt drains and ensure they function correctly. Collaborate with the healthcare team regarding the timing of advancing the diet from NPO to clear liquids and gradually to solid foods.

Respiratory Care

Encourage deep breathing exercises, coughing techniques, and use of incentive spirometry to prevent atelectasis. Position the patient in semi-Fowler’s or Fowler’s position to facilitate lung expansion. Administer supplemental oxygen as prescribed and monitor oxygen saturation levels continuously.

Preventing Infection

Maintain sterile technique when handling drains and wound care. Observe for signs of infection such as increased redness, swelling, warmth, or purulent drainage. Provide wound care per protocol and keep drains patent, documenting output and color. Promote hand hygiene and educate the patient on proper personal hygiene.

Mobility Promotion

Encourage and assist the patient with gradual ambulation to prevent DVT, improve circulation, and enhance respiratory function. Implement sequential compression devices (SCDs) as prescribed and monitor for signs of DVT. Collaborate with physical therapy for appropriate mobilization plans.

Nutrition and Hydration

Monitor fluid and electrolyte status closely, especially with NPO status and drain outputs. When tolerated, advance diet slowly from clear liquids to regular diet per physician’s orders. Promote hydration using IV fluids as necessary, and assess for signs of dehydration or electrolyte imbalance.

Evaluation

• The patient reports pain relief to less than 3/10 after interventions.
• Resumption of bowel sounds and gradual advancement of diet, indicating recovering gastrointestinal function.
• Oxygen saturation remains within normal range with effective breathing exercises.
• The patient participates in mobilization efforts, including sitting in a chair and ambulation.
• No signs of surgical site infection or drain complications are observed.
• The patient verbalizes understanding of postoperative care and identifies signs of complications requiring medical attention.

References

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• Lima, C. (2020). Managing postoperative complications in colorectal surgery. Journal of Surgical Nursing, 39(4), 255-262.
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