Can you answer this question correctly?

[RNin2007]

I have the answer in the back of the book....try to guess the correct answer and I'll get back to give the correct answer, and to see what you guys are coming up with. I am trying to understand the rationale for the book's answer, and would like to see how you guys interpret this:

From Postoperative Care chapter in Med-Surg Nursing book:

In preparation for discharge after surgery, the nurse should advise the patient regarding:

a. a time frame for when various physical activities can be resumed

b. the rationale for abstinence from sexual intercourse for 4 to 6 weeks

c. the need to call hospital clinical unit to report any abnormal signs or symptoms

d. the necessity of a referral to nutritional center for management of dietary restrictions.

a, b, c or d? ...... rationale _______?

~J

[KatieBell]

I could be wrong, but I'd pick A.

B. would be incorrect because I don't know what type of surgery the patient had, it may or may not be necessary to abstain from sex for 4-6 weeks..

C. Patient who have complications shoud call their Physician not the clinical unit with complications. The Physician can then direct care.D. again, not all patients have specific dietary restrictions.

So in the case of a patient whom I know nothing about, I would go with A... as all pts post operative need some sort of time frame for resuming activities, even if it just to tell them, go ahead and do everything you would normally do.

[llg, PhD, RN]

Ok. I'll take a stab at it.

First ... I eliminate answers b and d. Not all surgery requires abstinence from sexual intercourse -- e.g. minor surgery on your toe. So, unless there is more information than you have given us, b is not a necessary restriction. I can use a similar rationale for eliminating d. Not all minor surgery requires a nutrition center consult. If the patient's situations requires significant dietary restrictions, then by all means, refer them. But we don't know. If your book says that one of those 2 answers is correct and has not given you more information to indicate the need for the intervention in the question, then it is a bad book. Find a better source.

So ... that leaves us with answers a and c to consider. I like a because it is worded in a very general way, not assuming any specific restrictions or timetable, but rather stating the general principle that is adaptable to any specific circumstance. Even if there are no real restrictions after discharge, the nurse should tell the patient that.

I could also live with c as the correct answer because patients should be instructed on how to report significant complications. However, they should also be told what those complications might be as well as how to report them and how, when appropriate, to manage them. So ... while I like the idea behind answer c, it is not as well-stated and leaved out some key points. If the book says that c is the correct answer, then your book is poorly written, but it is trying to convey a valid point. Telling patients about possible complications and how to manage/report them is a very important part of discharge instructions. They should have phrased the answer better if that was the lesson they were trying to teach.

So ... that leaves "a" as the best choice in my mind. I'd be tempted to choose "c," but I would probably choose "a" and be prepared to defend my choice.

llg

[llg, PhD, RN]

Hi, Katie, ... You beat me to it ... You were posting as I was typing .. but we both came up with the same answer. I sure hope we're right!

llg

[suzy253, RN]

I'm going with C because even as a student, I have discharged lots of patients and teaching them the reportable signs and symptoms they should look out for and report, i.e. infection, has always been important. Not sure I like the way it is worded though.

Then again.....I've done A as well so now I can't decide.

[KatieBell]

LLG I'm curious to see if we are right.

The reason I eliminated C is that I have NEVER told a patient to call back to the unit, but to call their physician for complications. Of course we teach all patients about complications, but usually we do not have them call the unit of the hospital- what are we going to do on the unit? Tell them to call their MD....we can't admit or advise over the phone...a physician can do both.

[suzy253, RN]

LLG I'm curious to see if we are right.

The reason I eliminated C is that I have NEVER told a patient to call back to the unit, but to call their physician for complications. Of course we teach all patients about complications, but usually we do not have them call the unit of the hospital- what are we going to do on the unit? Tell them to call their MD....we can't admit or advise over the phone...a physician can do both.

that's what i mean....i don't like the wording of C too much.

[llg, PhD, RN]

Yes ... "c" is poorly worded. It's important to teach about complications, but that's not what you say to them about complications. In some cases, you might call the clinic, but that's not the norm. Plus, you should be teaching them about the complications themselves. That answer just doesn't include the right information. That's why I eliminated it. ... but I could understand that a poorly written test question might say something like that trying to teach the importance of discussing complications.

llg

[RNin2007]

So "a" is the correct answer, and it was interesting to see how you worked through these. I was wrong, and chose C, because I had not heard what KatieBell said:

"The reason I eliminated C is that I have NEVER told a patient to call back to the unit, but to call their physician for complications. Of course we teach all patients about complications, but usually we do not have them call the unit of the hospital- what are we going to do on the unit? Tell them to call their MD....we can't admit or advise over the phone...a physician can do both."

Makes sense! And thank you for helping me work on this reasoning, b/c I am sure the NCLEX will be full of these questions, where you just "can't quite figure out why..."

:)

~J

[suzy253, RN]

Hmmmm...interesting.

Learn something new everyday; as I posted my first response was C but I didn't like the wording---calling the unit instead of calling your health care provider. Thought it was just a problem with wording but I liked A as well as I just had a d/c recently of C-section postop patient and went over explicit time frames with her.

Thanks for posting it! :)

[RNin2007]

I think if was worded "call your healthcare provider" vs. hospital unit, that would have been the right answer...but I didn't look at it that way, because so far I haven't been able to experience discharging a patient. I just reasoned that unusual signs/symptoms should seem to have priority over returning to activities (after all, if your feeling crummy, you are likely not going to want to return to activities).

All in the wording! =)

~J

[RNin2007]

Oops, my last reply poofed on my screen...accidently replied 2x.

edit...

~J