A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times?

Choice A: Pneumonia

Reason: Postoperative patients, especially those who have undergone abdominal surgery, are at a higher risk of developing pneumonia. This is due to the fact that pain and discomfort can prevent them from taking deep breaths and coughing effectively, which are essential actions to clear the lungs of secretions. The nurse’s notes indicate that the client is refusing to turn and cough due to pain, which further increases the risk of pneumonia. The use of splinting with a pillow when coughing is a technique to help reduce pain and encourage effective coughing, but if the client refuses to comply, the risk remains high.

Choice B: Deep Vein Thrombosis (DVT)

Reason: Deep vein thrombosis is a significant risk for postoperative patients, particularly those who are immobile. The client in this scenario has refused to wear intermittent pneumatic compression devices, which are designed to prevent DVT by promoting blood circulation in the legs. Immobility and the lack of these devices increase the risk of blood clots forming in the deep veins of the legs. If a clot forms and travels to the lungs, it can cause a life-threatening pulmonary embolism. The nurse’s notes emphasize the importance of these devices, but the client’s refusal to use them puts them at a higher risk of developing DVT.

Choice C: Pressure Ulcers

Reason: Pressure ulcers, also known as bedsores, are a common complication for patients who are immobile for extended periods. The client’s refusal to change positions increases the risk of pressure ulcers developing on areas of the body that are in constant contact with the bed. These ulcers can be painful and lead to serious infections if not managed properly. Regular turning and repositioning are crucial in preventing pressure ulcers, and the nurse’s notes highlight the importance of this practice.

Choice D: Urinary Retention

Reason: While urinary retention can be a postoperative complication, it is less likely in this scenario because the client has a Foley catheter in place, which is draining to a bedside bag. The catheter helps to ensure that the bladder is emptied regularly, reducing the risk of urinary retention. Therefore, this is not one of the primary risks for this client based on the provided information.

Choice E: Hemorrhage

Reason: Hemorrhage, or excessive bleeding, is a potential risk after any surgery, including a total abdominal hysterectomy. However, the nurse’s notes indicate that the abdominal dressing is dry and intact, and only scant vaginal bleeding has been observed. This suggests that there is no significant bleeding at this time. While hemorrhage is always a concern, the current observations do not indicate an immediate risk.

Choice A: Decreased fat in stools

Pancrelipase is a combination of digestive enzymes, including lipase, protease, and amylase, which help break down fats, proteins, and carbohydrates. One of the primary benefits of pancrelipase is its ability to improve fat digestion and absorption. Clients with pancreatic insufficiency often experience steatorrhea, which is the presence of excess fat in stools, making them bulky, greasy, and foul-smelling. By aiding in the digestion of fats, pancrelipase reduces the fat content in stools, leading to more normal bowel movements.

Choice B: Decreased watery stools

While pancrelipase can improve overall digestion, it is not specifically known for decreasing watery stools. Watery stools can result from various conditions, including infections, inflammatory bowel disease, or other gastrointestinal disorders. Pancrelipase primarily targets the digestion of macronutrients and may not directly affect the consistency of stools unless the watery stools are due to malabsorption of fats.

Choice C: Decreased mucus in stools

Mucus in stools can be a sign of inflammation or irritation in the gastrointestinal tract, often associated with conditions like irritable bowel syndrome (IBS) or infections. Pancrelipase does not specifically target mucus production in the intestines. Its primary function is to aid in the digestion of fats, proteins, and carbohydrates, rather than addressing mucus-related issues.

Choice D: Decreased black tarry stools

Black tarry stools, also known as melena, are typically a sign of gastrointestinal bleeding, particularly from the upper GI tract. This condition requires immediate medical attention and is not related to the use of pancrelipase. Pancrelipase is not indicated for treating or preventing gastrointestinal bleeding and would not affect the presence of black tarry stools.