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post op for colectomy surgery/ case study

a 74 year old male married and retired under went a right hemisphere colectomy his right side of his colon was removed due to cancer. he has a history of smoking & no ther health problems. He is in PACU. He has a midline incission with a penrose drain, a stab wound w/ a jackson pratt drain to incession. he also has a NG tube,attached to intermittent suction. he is alert orient can move all 4 extremities. BP is normal R are 16 o2 stats is at 86% W/ additional oxygen given via mask.

1. what are his risk factors.

2. what iss his aldrete score

3. what nursing measures can u intiate to promote oxygenation

4. what type of drainage is expected from incision and drains during 1-2 days.

5. what observations can be made and reported to indicate removal of NG tubs

6. write and prioritize nursing diagnosis and goals at least 6

7.what discharge instructions would you give.

can some one please help? what is a jackson pratt and a penrose drian dose he not have a colostomy? and what is a aldrete score.

2. what iss his aldrete score

well, in order to get an accurate aldrete score, u would need to know his pre-op pressure, his pacu pressure and also what is the policy for the pacu in your hospital as to if the pressure score is based on points or percentage (like score 2 for BP 0-20 points within of preop pressure, score 1 for BP 20-50 points within preop pressure, score 0 for more than 50 points within preop pressure) i have worked at one hosp where we did % but other hosp and ASC where it was points (easier math maybe? i though percent was easy enough and more realistic)

3. what nursing measures can u intiate to promote oxygenation

in pacu we would check and make sure its a good signal, and have pt start to C&DB....also start incentive spirometer,and if pt has lung hx, may need a neb, u have to assess pt...how are his lungs...what was preop sats?? is mask on right? perhaps hes in pain, major bowel surgery and not wanting to take deep breaths due to pain, or fear of creating pain. boy, could go on and on with this one

and what is a aldrete score

sorry didnt see that...aldrete score is used to assess pt when he gets to pacu, during pacu, and on DC . assessed are moving extremeties...BP...awakeness....skin color....breathing status.

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt.

jackson-pratt is the name of a type of drainage tube that is left in an operative wound to help remove drainage fluids. it works by applying negative pressure, or mild suction, and continuously pulling out any drainage fluid that might be present from the wound area. the tubing is laid into the open surgical area just prior to final closure of the wound. the outer end of the tubing is connected to a bulb very similar in size to the bulb you use to inflate a blood pressure cuff. this bulb, however, has an exit port. the nurse is responsible for emptying, measuring, re-applying the suction pressure and documenting the drainage from this bulb on a regular basis. if the patient is sent home with this jackson pratt drain still in place then discharge teaching will include showing the patient how to empty the bulb periodically and re-apply the pressure. here is a link to a very nice picture of a jackson-pratt drain:

http://www.ghorayeb.com/jpdrain.html - the site states " the jackson-pratt drain consists of a plastic tubing with multiple perforations that is left inside the wound. it is introduced through a separate stab wound and sutured to the skin. it is connected to a plastic bulb that is squeezed and emptied of its air content. when the bulb is allowed to recoil, it creates a vacuum and sucks blood or fluid from the wound, thus preventing hematoma or seroma formation. it is usually removed a day or two after the operation." in clinical areas you will often see a jackson-pratt drain referred to as a "jp drain". that is just shorthand.

a penrose drain is merely a length of sterile flexible rubber tubing that is also placed in the incisional wound just prior to final closure with it's outer end sticking out of the incision or a separate stab wound. they come in various sizes and the size the surgeon uses will depend on the amount of drainage anticipated or the size of the wound. unlike the jackson-pratt drain which uses negative suction and nicely contains all the liquid fluid drainage neatly in it's bulb, a penrose drain merely continues to empty its liquid contents to the outside of the body as it occurs. therefore, the patient needs to have a dry, sterile dressing in place over the penrose drain to catch these fluids. at this site you can see a penrose drain in the bottom right photo in the right side of the patient's nose. it's that beige round tan thing coming out of the nose. http://www.ghorayeb.com/septalabscess.html this next picture isn't the greatest, but it is of a rat (yes, a rat) that had an eye removed. a penrose drain was placed in the eye cavity and there is a picture of it about halfway down this webpage http://www.xs4all.nl/~tirion/medical.html

the patient did not have a colostomy. the case scenario is telling you that. he has had a right hemisphere colectomy. another name for this is a right hemicolectomy. a colectomy is an excision (removal) of part or all of the colon. in this case, the right hemisphere, or part of the transverse and the entire ascending colon. it is done through an incision into the abdomen. when a colectomy is performed a section of the colon is removed and the two ends of intestine that remain are anastomosed (connected) together. a right hemicolectomy specifically is surgical removal of the right colon (including 10 cm of transverse colon and 10 cm of ileum) followed by ileocolonic anastomosis. (surgical operations) what do you suppose some of the post op changes to the patient's bowel movements might be with a surgery like this? think about the function of the colon and it's role in reabsorbing water.

the adrete anesthesia recovery score is a simple scoring system, usually based on a 1 to 10 number system, by which each patient is evaluated prior to their release from the post anesthesia recovery unit. it was developed about 30 years ago by an anesthesiologist by the name of dr. antonio aldrete. usually, a score of at least a 9 is desireable. here is a link to a site that includes the aldrete post anesthesia recovery score and the scores. it is about 1/6th down the page of the article. from this, and the information you were given in your case scenario you will be able to determine an aldrete score for your case study patient. http://www.nursingceu.com/courses/152/index_nceu.html

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