Your patient, post-op drainage of a pelvic abscess secondary to diverticulitis, begins to cough violently after drinking water. His wound has ruptured and a small segment of the bowel is protruding. What’s your priority?
A. Ask the patient what happened, call the doctor, and cover the area with a water-soaked bed sheet.
B. Obtain vital signs, call the doctor, and obtain emergency orders.
C. Have a CAN hold the wound together while you obtain vital signs, call the doctor and flex the patient’s knees.
D. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.
Correct Answer: D. Have the doctor called while you remain with the patient, flex the patient’s knees, and cover the wound with sterile towels soaked in sterile saline solution.
Call for help but stay with the patient. Tell the person who responds to notify the surgeon immediately. Lower the bed until it is flat or no steeper than 20 degrees. Have the patient bend his knees to reduce abdominal muscle tension. Soak sterile towels with sterile saline or use pre moistened sterile dressings.
Option A: Using a water-soaked bed sheet to cover the area may lead to severe infection. Preventive measures to avoid wound dehiscence and wound evisceration include client coaching and teaching the client how to splint their incisional area when coughing, sneezing, vomiting and when doing planned, routine coughing and deep breathing exercises postoperatively.
Option B: In some situations, a surgical incision may open during the recovery process, allowing organs to be visible or even spill out of the body. This is obviously a serious medical condition that should be treated as soon as possible. Vital signs may be taken after the surgeon has arrived or the patient’s wound has been securely covered.
Option C: It is not advisable to touch an evisceration. Covering the area with sterile, saline-soaked dressings could prevent an infection. Dehiscence and evisceration can be a life-threatening emergency; do not leave the client immediately call for help and, using a clean, sterile towel or sterile saline dampened dressing, cover the wound. Under no circumstance should reinserting the organs be attempted. Maintain light pressure on the wound and monitor the client for shock until help arrives.
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