I am a student preparing to be able to care for a hypothetical 2 day post op total laryngectomy patient. I have gathered a ton of information so far but I am having some difficulties finding some things, and hope you can help. Mainly, what labs should I be monitoring, and why (or where to find this information.. I've been searching for days.. and it doesn't help that my knowledge of labs is pretty poor)? Electrolytes?
I know I need to monitor LOC, suture line, sputum, lung sounds, saO2, pain levels, vital signs, wound drainage, urinary output, adequate fluid intake, infection/necrosis. Is there anything else I should be monitoring, and/or what should cause alarm/need to call the doctor at 2 days post op? What problems am I most concerned with 2 days post op... Respiratory distress, hemorrhage, infection, wound breakdown... anything else?
I know I need to maintain airway (most important), encourage deep breathing and coughing, elevate HOB, suction (w/o trauma to the suture line), suctioning larynectomy tube and nose, trach care, mouth care, provide communication tools, get him up and OOB, ... + teaching. Am I on the right track?
:heartbeat Thanks in advance for any help you may have for me and my hypothetical patient.
Feb 28, '10
This looks very thorough. When you are monitoring for hemorrhage, you may see changes in the H&H, Hgb. Check the posterior neck area as the blood may pool there (looks like bruising).
Infection you would see at the site (redness, edema, discharge). Look for changes in the pts temp and WBCs in their labs.
There may be changes due to imbalanced nutrition (decrease in weight, albumin, protein). If there is a decrease in fluid intake, there may be an increase in Na due to dehydration/hemoconcentration but if there is adequate fluid intake & urinary output then probably not.
Have a swallow assessment done (collaborative with speech therapist). Risk for aspiration.
There is a great care plan book called Nursing Care Plans Nsg Dx and Intervention
by Meg Gulanick. They also mention using humidified O2, checking the site & surrounding skin for s/sx of decreased circulation (pale, blue or dark).
Feb 28, '10
You are on the right track, you just need to ask yourself "now how do I monitor these potential problems?"
urinary output>>>> kidney function>>> Creatinine and BUN
adequate fluid intake, Electrolyte imbalance >>> CMP, signs of dehydration and overhydration, and Intake and output
infection/necrosis, pneumonia>>>>WBC's>>>> CBC
post op pts are at risk for DVTs too, so what lab will you monitor?
Lab Values Explaination
>> look at post number 6 by papawjohn, its really helpful
Feb 28, '10
Thanks so much! Very, very helpful.
It's funny, cuz I read your responses and think 'darn, I should have known that..' I can't wait til the day this is all second nature to me (:
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