Care Plan For Postoperative Male Client After Colectomy

Care Plan for Postoperative Male Client After Colectomy

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 patient is NPO with an NG tube to low intermittent suction. He has a history of smoking and no other major health issues. Vital signs include a temperature of 99.2°F, heart rate of 91 beats per minute, respirations of 20 breaths per minute, oxygen saturation at 93% on 2L nasal cannula, and blood pressure of 110/68 mm Hg. The patient reports pain at 6/10.

Assessment findings include the patient being alert and oriented, moving all four extremities but refusing to ambulate, with a regular apical pulse. Lung auscultation reveals clear but diminished breath sounds bilaterally. Bowel sounds are hypoactive. The abdomen is soft and tender in all four quadrants, with a well-approximated incision, no erythema, and intact staples. Drains include a Penrose drain with scant serous drainage and a Jackson-Pratt drain with sutures intact, producing 30 mL of serosanguineous drainage.

Paper For Above instruction

Introduction

Postoperative care for patients who have undergone a colectomy is critical for optimizing recovery, preventing complications, and promoting overall health. This nursing care plan focuses on a 64-year-old male patient four days post-emergency right colectomy due to cancer, highlighting assessment findings, potential complications, nursing interventions, and expected outcomes based on his current status.

Assessment and Clinical Findings

The patient's vital signs reveal a mild fever, slightly elevated heart rate, and oxygen saturation slightly below normal levels, indicating potential early signs of infection or respiratory compromise. The patient’s pain level at 6/10 suggests the need for adequate pain management to facilitate mobility and respiratory effort, as pain can lead to atelectasis and deep vein thrombosis (DVT). The physical assessment indicates that the patient is alert and oriented but refuses to ambulate, which could increase the risk for thrombosis or pulmonary complications. The hypoactive bowel sounds indicate ileus, common after abdominal surgery, which requires close monitoring and supportive care. The abdominal incision appears healthy, with no signs of infection, and drain outputs are within expected limits, though continual assessment is necessary.

Potential Complications and Nursing Priorities

• Infection prevention: Monitor for signs of wound infection or intra-abdominal abscess. Elevated temperature and pain may indicate early infection.
• Pulmonary complications: Prevent atelectasis and pneumonia by encouraging respiratory exercises, although the patient refuses ambulation, which warrants alternative strategies.
• Ileus recovery: Manage hypoactive bowel sounds, support nutrition advancement, and monitor for bowel function return.
• Pain management: Adequately control pain to facilitate activity and respiratory effort.
• Fluid and electrolyte balance: Monitor drain outputs and vital signs to prevent dehydration or imbalance.

Interventions

• Monitoring and assessment: Regularly assess vital signs, incision site, drain outputs, lung sounds, and bowel sounds. Document any changes promptly.
• Pain management: Administer prescribed analgesics and evaluate their effectiveness. Reassess pain levels regularly.
• Oxygen therapy: Ensure oxygen saturation remains above 92%. Adjust oxygen delivery as needed, and monitor for signs of respiratory distress.
• Respiratory exercises: Encourage deep breathing exercises, coughing, and use of incentive spirometry to prevent atelectasis, especially since the patient refuses to ambulate.
• Mobility encouragement: Collaborate with physiotherapy to assist with gradual ambulation to reduce DVT risk.
• Drain and incision care: Maintain sterile technique when handling drains, monitor output volume and characteristics, and ensure staples are intact.
• Nutrition support: Monitor bowel function and prepare for gradual diet advancement as tolerated.
• Patient education: Educate about the importance of mobility, respiratory exercises, and wound care to promote recovery.

Expected Outcomes

• The patient's vital signs stabilize, and signs of infection or respiratory distress are minimized.
• The patient reports adequate pain control, enabling participation in mobility and respiratory exercises.
• The bowel function begins to return, with bowel sounds becoming active.
• The surgical site remains clean, dry, and free from signs of infection.
• The patient gradually resumes ambulation, reducing risks of DVT and pneumonia.

Conclusion

This comprehensive nursing care plan addresses the immediate postoperative needs of a patient recovering from a right colectomy. Prioritizing infection control, respiratory support, pain management, and mobility are essential for promoting healing, preventing complications, and supporting overall recovery. Close monitoring and patient education are critical components to ensure a successful postoperative period and optimal long-term outcomes.

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