After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate?
A. Irrigate the wound & organs with Betadine.
B. Cover the wound with a saline-soaked sterile dressing.
C. Apply a dry sterile dressing & binder.
D. Push the organs back & cover with moist sterile dressings.
Correct Answer: B. Cover the wound with a saline-soaked sterile dressing.
Cover the organs with a sterile, non-adherent dressing moistened with normal saline. Do this to prevent infection and to keep the organs from drying out. Dehiscence of abdominal surgical wounds is a medical emergency and requires immediate action to reduce further complications.
Option A: To decrease intra-abdominal pressure and stress on the wound, place the patient supine in the low Fowler’s position with his knees slightly bent and cover the wound with a saline-moistened, sterile gauze dressing.
Option C: The physician may order an abdominal binder to help prevent evisceration. To prevent dehiscence, teach patients to splint the surgical site when coughing, vomiting, or sneezing. An abdominal binder for those at risk for dehiscence may be helpful, but evidence supporting its use is still needed.
Option D: Do not push back the organs because it may cause injuries. Although dehiscence occurs in less than 3% of abdominal surgeries, it’s associated with a mortality of 14% to 50%, with evisceration increasing the risk of death. Conditions that increase intra-abdominal pressure (obesity) or may disrupt skin health (poor nutrition, steroid use, diabetes) place patients at increased risk of dehiscence.
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