Post-operative Case Study

s. M is a 80 year old female post-op uncomplicated bowel resection to repair damage and scarring of the bowel secondary to a traumatic automobile accident 5 years prior. Ms. M has smoked a pack of cigarettes a day for the last 60 years and has a history of chronic obstructive lung disease (COPD) and diabetes (controlled with oral medications). The patient arrived from the post anesthesia care unit (PACU) and according to report the surgery and PACU stay were without significant event. The patient is drowsy but easily aroused. The patient has a Patient Controled Analgesia (PCA) pump already set up for the patient. Morphine 1mg/1mL; dose-1 mg every 30 minutes; lockout of 10 mg in 4 hours. The patient received 2 mg of morphine intravenous push 20 minutes ago in the PACU. The PCA pump has not been used at all as of admission to the unit.  The patient currently reports pain of 3 on a scale of 0-10 with 0=no pain and 10=worst pain ever. The dressing is dry, clean, and securely in place. The patient is without any visual indications of distress at this time. The patient’s oxygen saturation is 95% on 2 liters oxygen per nasal cannula. Vital signs are: blood pressure 118/62 mm Hg, pulse 78 beats per minute, respiratory rate 22 breaths per minute with respiration of normal depth and chest expansion equal bilaterally. The patient’s 60 year old daughter is at bedside and verbalizes concern that her mother will experience pain and discomfort from the surgery. Questions: 1.       What are the patient’s risk factors for post-operative complications?   2.       Which post-operative complications are the patient at high risk for? Why?   3.       What is the nurse’s priority nursing diagnosis?     4.       What priority patient/family education should be completed at this time? Why?   Two hours later the nurse returns to check on the patient to find her resting comfortably. The PCA pump has delivered 2 mg of Morphine. Respiratory rate is 20 breaths per minute and SPO2 is 94%. The nurse teach’s the patient and her daughter appropriate use of the incentive spirometer device and observes its proper use by the patient. The patient reports pain at a 3 on the scale and has no requests at that time. One hour later the nurse is called to the patient’s room. The patient is found curled on her side holding her abdomen and reports pain at site is now at 9 on the scale. The patient’s vital signs are: blood pressure 120/65, pulse 99, respiratory rate 27 and shallow, and oxygen saturation of 92%. The patient reports having attempted to get out of bed without assistance and wound became very painful. The surgical dressing remains securely in place and now has moderate bloody secretions present. The nurse has placed an urgent call to the patient’s surgeon. Question: 1.      Provide the SBAR report the nurse should be prepared to provide regarding this patient. Fifteen minutes later the surgeon has not returned the nurses call. The patient’s condition is unchanged. Question: 1.      What should be the nurse’s action at this time?