Question

1030:

A 33-year-old client is 1 hr postoperative following a laparoscopic cholecystectomy. Alert and oriented to x 3. Skin warm and dry. Lungs clear auscultated throughout all lung fields. Normal sinus rhythm. Denies nausea and vomiting, bowel sounds hypoactive in all four quadrants. Peripheral pulses +2 bilaterally. Incision dressing clean and dry, incision upon inspection intact, no redness, swelling, or drainage noted.

Client Education
1230:
Discharge instructions given to the client. Instructions on incision/wound care and proper hand washing. The client is expected to experience carbon dioxide retention in the abdomen. Instructed the client to rest for 24 hr following surgery. The client can bathe or shower the day after surgery. Instructed the client to avoid lifting 2.3 kg (5 lb) or more for 1 week. Diet as tolerated.

Provider Prescriptions
1030:

Acetaminophen 500 mg PO every 4 hr as needed for pain.
Cefaclor 250 mg PO every 8 hr.
For each potential provider's prescription, click to specify if the potential prescription is "Anticipated" or "Contraindicated" for the client.

Option 1: Ondansetron 4 mg PO for nausea
[ ] Anticipated
[ ] Contraindicated

Option 2: Change dressing when soiled
[ ] Anticipated
[ ] Contraindicated

Option 3: Encourage deep breathing exercises every hour
[ ] Anticipated
[ ] Contraindicated

Option 4: Apply heat for abdominal pain as needed
[ ] Anticipated
[ ] Contraindicated

Answer 1

Option 1: Ondansetron 4 mg PO for nausea

[X] Anticipated

[ ] Contraindicated

Option 2: Change dressing when soiled

[X] Anticipated

[ ] Contraindicated

Option 3: Encourage deep breathing exercises every hour

[X] Anticipated

[ ] Contraindicated

Option 4: Apply heat for abdominal pain as needed

[ ] Anticipated

[X] Contraindicated

Step-by-step explanation:

The anticipated prescriptions are based on the client's postoperative status and the standard care after a laparoscopic cholecystectomy. Ondansetron (Option 1) is anticipated as it helps in preventing nausea, which is a common postoperative symptom. Changing the dressing when soiled (Option 2) is anticipated for maintaining proper wound care and preventing infection. Encouraging deep breathing exercises every hour (Option 3) is also anticipated to prevent complications such as atelectasis and improve respiratory function.

However, applying heat for abdominal pain (Option 4) is contraindicated. Heat can increase blood flow and potentially exacerbate inflammation, which is not suitable for the postoperative period. The incision site needs to be kept dry and clean to minimize the risk of infection. Therefore, applying heat to the abdominal area is not recommended in this scenario.

Overall, the anticipated prescriptions align with the client's current condition and promote optimal recovery, while the contraindicated prescription considers potential risks and complications associated with heat application in the postoperative setting.

Answer 2

Option 1: Ondansetron 4 mg PO for nausea

- Answer: [Anticipated]

Option 2: Change dressing when soiled

- Answer: [Anticipated]

Option 3: Encourage deep breathing exercises every hour

- Answer: [Anticipated]

Option 4: Apply heat for abdominal pain as needed

- Answer: [Contraindicated]

Step-by-step explanation:

The client is advised to rest for 24 hours following surgery, bathe or shower the day after surgery, avoid lifting more than 2.3 kg (5 lb) for 1 week, and have a diet as tolerated.

Now let's assess the potential provider's prescriptions and determine if they are "Anticipated" or "Contraindicated" for the client:

Option 1: Ondansetron 4 mg PO for nausea

- Answer: [Anticipated]

- Explanation:

Ondansetron is an antiemetic medication commonly used to treat nausea and vomiting. Although the client denies nausea and vomiting at the moment, it is anticipated that they may experience these symptoms postoperatively. Therefore, prescribing ondansetron to manage potential nausea is anticipated.

Option 2: Change dressing when soiled

- Answer: [Anticipated]

- Explanation:

It is important to maintain proper hygiene and prevent infection in postoperative wounds. Changing the dressing when it becomes soiled helps to keep the incision clean and dry, reducing the risk of infection. Therefore, the prescription to change the dressing when soiled is anticipated.

Option 3: Encourage deep breathing exercises every hour

- Answer: [Anticipated]

- Explanation:

Deep breathing exercises are commonly recommended after surgery to prevent complications such as atelectasis (collapse of lung tissue) and pneumonia. These exercises help to expand the lungs and improve lung function. Therefore, encouraging the client to perform deep breathing exercises every hour is anticipated.

Option 4: Apply heat for abdominal pain as needed

- Answer: [Contraindicated]

- Explanation:

Applying heat to the abdominal area postoperatively is contraindicated. Heat can increase blood flow to the area, which may promote bleeding or worsen inflammation. Cold therapy, such as ice packs, is typically recommended for pain relief after surgery. Therefore, applying heat for abdominal pain is contraindicated.

To summarize:

- Ondansetron 4 mg PO for nausea: Anticipated

- Change dressing when soiled: Anticipated

- Encourage deep breathing exercises every hour: Anticipated

- Apply heat for abdominal pain as needed: Contraindicated