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Discussion

What does this pt have given these VS

Mrs. Jill is 78 years old and she had a surgical repair of an abdominal aortic aneurysm 24 hours ago, which includes a large mid-abdominal incision. The nurse's assessment reveals that the incision is clean, dry, and intact; abdomen is soft, non-tender, not distended, with bowel sounds present in 4 quadrants; peripheral pulses are all 2+; heart sounds with S1 and S2 distinct with no extra heart sounds or murmurs; however, breath sounds are diminished. The nurse reviews the vital signs:

Assessment 1: T 97.2 P 72 R 16 B/P 130/82

Assessment 2: T 100.4 P 92 R 28 B/P 136/82

From the list, circle the two most likely complications that would explain the changes in Mrs. Jill's vital signs.

Atelectasis Wound infection

Pneumonia Paralytic ileus

Hemorrhage Dehiscence/evisceration

Unmanaged pain Deep vein thrombosis

Featured Replies

Atelectasis Wound infection

Pneumonia Paralytic ileus

Hemorrhage Dehiscence/evisceration

Unmanaged pain Deep vein thrombosis

I'm assuming these are 8 separate choices...

Pneumonia is a good choice, with the diminished lung sounds and temp.

Unmanaged pain would be my other choice, d/t the rise in pulse and b/p.

Atelectasis wouldn't be because she still HAS lung sounds.

Wound infection, no, no mention of anything "infected" sounded in the assessment.

Paralytic ileus, no, BS is all 4 quad.

Hemorrhage, probly not, abd nontender, non distended.

Dehiscence/evisceration no, not mentioned in assessment.

DVT, unknown, no mention of assessment of legs. No mention of SOB.

Those would be my answers.

Pat

If the temp is oral, infection.

Pneumonia is a definite possibiity c inc resps, dim lung sounds.

Pain, certainly, c inc resps, pulse, b/p.

Dehis and bleeding lead to a DROP in BP.

  • Admin

Atelectasis is quite common in this scenario post-op.

Anesthesia(general) and the surgical procedure as described above, leads to atelectasis by causing diaphragmatic dysfunction and diminished surfactant. Low grad temp is a s/s as are chest pain, tachycardia, and diminshed breath sounds. Hypotension can occur.

I'm assuming these are 8 separate choices...

Pneumonia is a good choice, with the diminished lung sounds and temp.

Unmanaged pain would be my other choice, d/t the rise in pulse and b/p.

Atelectasis wouldn't be because she still HAS lung sounds.

Wound infection, no, no mention of anything "infected" sounded in the assessment.

Paralytic ileus, no, BS is all 4 quad.

Hemorrhage, probly not, abd nontender, non distended.

Dehiscence/evisceration no, not mentioned in assessment.

DVT, unknown, no mention of assessment of legs. No mention of SOB.

Those would be my answers.

Pat

I would agree with the pneumonia which may have been brewing preop given her age, and the pain control issue as she is elderly with a large abdominal incision. An increase resp rate and bp and hr would point to that. A temp 24 hours post op is not uncommon and is often from the lungs.

The pedal pulses were mentioned as 2+ and a little early to see a post op DVT (24hours). Likewise with a wound infection, one day post op not likely to be seen.

I would not say hemmorhage either with the soft, non tender abdomen and Bp unless significantly lower than preop is good for someone actively bleeding .

As for the wound evisceration//paralytic illeus, the assessment does not support these with what was stated.

Would want to see a pre-op vs post-op chest xray to determine the pneumonia vs atelectasis issue

  • Experts
mrs. jill is 78 years old and she had a surgical repair of an abdominal aortic aneurysm 24 hours ago, which includes a large mid-abdominal incision. the nurse's assessment reveals that the incision is clean, dry, and intact; abdomen is soft, non-tender, not distended, with bowel sounds present in 4 quadrants; peripheral pulses are all 2+; heart sounds with s1 and s2 distinct with no extra heart sounds or murmurs; however, breath sounds are diminished. the nurse reviews the vital signs:

assessment 1: t 97.2 p 72 r 16 b/p 130/82

assessment 2: t 100.4 p 92 r 28 b/p 136/82

from the list, circle the two most likely complications that would explain the changes in mrs. jill's vital signs.

atelectasis wound infection

pneumonia paralytic ileus

hemorrhage dehiscence/evisceration

unmanaged pain deep vein thrombosis

the two most likely complications would be atelectasis/wound infection. i also wouldn't rule out the pneumonia but to have a paralytic ileus you would need to have absent bowel sounds. the signs and symptoms of atelectasis (and some are the same for pneumonia as well) are:

  • decreased chest wall movement
  • cyanosis
  • diaphoresis
  • substernal or intercostal retractions
  • anxiety
  • decreased fremitus
  • mediastinal shift ot the affected side
  • dullness or flatness over lung fields
  • end-inspiration crackles
  • decreased or absent breath sounds
  • tachycardia
  • from page 94 of nurse's 5-minute clinical consult: diseases from lippincott williams & wilkins

the complications of abdominal aortic aneurysm repair are:

  • hemorrhage that can proceed to shock
  • left side heart failure
  • arrhythmias
  • mi
  • renal failure
  • acute tubular necrosis
  • ileus or bowel rupture
  • pancreatitis
  • ischemia of the left colon
  • paralysis due to spinal cord ischemia
  • lower extremity ischemia or embolus
  • peritonitis
  • aortic dissection or perforation
  • endovascular graft migration
  • from page 2 of nurse's 5-minute clinical consult: treatments from lippincott williams & wilkins

I'm assuming these are 8 separate choices...

Pneumonia is a good choice, with the diminished lung sounds and temp.

Unmanaged pain would be my other choice, d/t the rise in pulse and b/p.

Atelectasis wouldn't be because she still HAS lung sounds.

Wound infection, no, no mention of anything "infected" sounded in the assessment.

Paralytic ileus, no, BS is all 4 quad.

Hemorrhage, probly not, abd nontender, non distended.

Dehiscence/evisceration no, not mentioned in assessment.

DVT, unknown, no mention of assessment of legs. No mention of SOB.

Those would be my answers.

Pat

You still have lung sounds with atelectasis, i think you are thinking of something else

I would say atelectasis/wound infection,

slight raise in temp decrease breath sounds. both of those indicate atelectasis.

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