After surgery for an ileal conduit, the nurse should closely evaluate the client for the occurrence of which of the following complications related to pelvic surgery?
A. Peritonitis
B. Thrombophlebitis
C. Ascites
D. Inguinal hernia
Correct Answer: B. Thrombophlebitis
After pelvic surgery, there is an increased chance of thrombophlebitis owing to the pelvic manipulation that can interfere with circulation and promote venous stasis. The pathogenesis is thought to include injury to the intima of the pelvic vein caused by a spreading uterine infection, bacteremia, and endotoxins, which can also occur secondary to the trauma of delivery or surgery.
Option A: Peritonitis is a potential complication of any abdominal surgery, not just pelvic surgery. Typically, patients who experience spontaneous bacterial peritonitis have chronic liver disease with a Child-Pugh classification, which assesses the prognosis of liver disease, of C. This ranking involves a high to a maximum score of 10 to 15 points (on the Child-Pugh scale), and measures 1-year patient survival at 45% and 2-year survival at 35%.
Option C: Ascites is most frequently an indication of liver disease. In the United States, the most common disease that causes patients to get ascites is cirrhosis, which accounts for approximately 80% of cases. Other causes of ascites include cancer, 10%; heart failure, 3%; tuberculosis, 2%; dialysis, 1%; pancreatic disease, 1%; and others, 2%.
Option D: Inguinal hernia may be caused by an increase in abdominal pressure or congenital weakness of the abdominal wall; a ventral hernia occurs at the site of previous abdominal surgery. Inguinal hernias are considered to have both a congenital and acquired component. Most adult hernias are considered acquired. However, there is evidence to suggest genetics also play a role. Patients with a known family history of a hernia are at least 4 times more likely to have an inguinal hernia than patients with no known family history.
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