Cover the exposed incision with a sterile dressing, assist the patient back to bed, and promptly notify the healthcare provider. Option D
What the nurse out to do?
In order to stop infection, the nurse has to cover the patient's exposed and protruding wound as soon as possible with sterile dressing. In order to prevent additional strain on the incision site, the patient simultaneously requires assistance getting back into bed.
After that, the nurse has to alert the medical professional right away to enable fast assessment and action, which can involve restapling or using a different technique to close the wound. This all-inclusive strategy guarantees prompt attention, infection control, and cooperation with the medical staff for the proper handling of the patient's surgical incisional complication.
Missing parts;
A 75-year-old male patient had abdominal surgery a week ago. He has a 5-inch midline abdominal incision, which has staples open to air and a Jackson-Pratt device to suction on the left lower quadrant. The nurse charts he has eaten about one-fourth of his breakfast and lunch. He complains that his wife does not let him get out of bed without calling for assistance; however, his wife is not present today. The nurse tells the patient to ring his call bell so that staff can walk with him, but after lunch the nurse finds the patient alone near his door. “This incision doesn’t feel right,” he says. On examination, the staples have come loose, and part of his incision is exposed and bulging. What actions should the nurse take?
A. Instruct the patient to lie down and avoid any movement until assistance arrives.
B. Immediately call the healthcare provider to report the situation and await further instructions.
C. Reinforce the staples to secure the incision, then instruct the patient to avoid any unnecessary movements.
D. Cover the exposed incision with a sterile dressing, assist the patient back to bed, and promptly notify the healthcare provider.