Question

A client returns to the hospital unit following an appendectomy. Which finding on the postoperative admission assessment should be reported to the physician immediately? A. Oral temperature 99F B. Pulse 98 and thready C. Complaints of nausea D. Absent bowel sounds

Short answer

Absent bowel sounds (Option D) should be reported to the physician immediately as they can indicate a serious complication post-surgery.

Step-by-step solution

Review Normal Postoperative Signs

After an appendectomy, it's expected for the patient to have some mild to moderate pain, potential nausea, and possibly a low-grade fever as the body recovers from the surgery and anesthesia.

Identify Abnormal Findings

Assess each finding to determine if it is within the expected range of symptoms following an appendectomy or if it is an abnormal finding that warrants immediate medical attention.

Analyze Choices

Determine if the findings are common and benign postoperative signs or if they are indicative of potential complications. Reporting vital changes that may indicate serious issues is a priority.

Determine Which Finding to Report

Among the provided options, absent bowel sounds may suggest a complication such as an ileus or bowel obstruction, which can be serious and should be reported to the physician immediately.

Key concepts

Appendectomy Recovery

The recovery process following an appendectomy, the surgical removal of the appendix, necessitates thorough observation and care to ensure a smooth transition back to health. The period right after surgery is critical, as the body needs time to heal from the stress of the operation. Typical experiences include mild to moderate pain at the site of surgery, a low-grade fever as the body's immune response is activated, and some nausea which might be related to anesthesia or the surgery itself.

During this phase, it's essential for patients to follow their healthcare provider's advice on wound care, physical activity, and diet. Staying hydrated, gradually reintroducing foods, and taking prescribed medications can all aid in reducing discomfort and preventing complications. Consulting with the healthcare team about pain management is vital, as well as reporting any unexpected or severe symptoms that may arise.

Postoperative Complications

After surgery, attentive monitoring for potential postoperative complications is imperative. Complications can arise that may impact the patient's recovery, and in some cases, immediate medical intervention is required.

Common complications include infection, bleeding, and blood clots. In the context of an appendectomy, specific concerns would involve the risk of an ileus or bowel obstruction, suggested by absent bowel sounds, as this could indicate a halt in the normal movement of the intestines. Other red flags include severe abdominal pain, fever higher than what is considered a low-grade fever, signs of infection at the surgical site, persistent vomiting, and difficulty breathing. Early detection and reporting of such symptoms are crucial to prevent further complications and to secure a safe recovery.

Nursing Assessment

In the postoperative phase, nursing assessment is a systematic process aimed at identifying immediate needs and potential complications. Nurses are trained to take a comprehensive approach that includes evaluating vital signs, pain levels, wound condition, and overall patient well-being. They look for signs that are outside of the norm for postoperative recovery, such as tachycardia, which might signal bleeding or infection, or hypotension, which could suggest fluid imbalance or shock.

Vital Signs and Symptoms Monitoring

As part of the nursing assessment, vital signs such as temperature, pulse, respiratory rate, and blood pressure are routinely monitored. Additionally, nurses assess the patient's level of consciousness, the presence of any gastrointestinal symptoms like nausea or bowel sounds, and the condition of the incision site for possible signs of infection.

NCLEX-RN Exam Preparation

Preparing for the NCLEX-RN exam, which is a requirement for becoming a licensed nurse in the United States, involves a deep understanding of postoperative care, among other topics. Candidates should be well-versed in recognizing postoperative complications and understanding timely interventions.

Study Strategies for Success

Effective preparation strategies include studying from current nursing textbooks, taking NCLEX review courses, and practicing with sample test questions. It's advised to study content areas such as medical-surgical nursing, pharmacology, and patient care management in-depth to be equipped to answer questions on the exam that relate to postoperative nursing assessment and care. Prioritizing practice on questions that simulate the breadth and style of the NCLEX-RN can also build the test-taking skills and confidence necessary for a successful outcome on exam day.