A patient has a nasogastric (NG) tube following esophagectomy. Following standards of practice, which of the following postoperative instructions should the nurse question the surgeon about?
Calling the physician for any bright red blood in the NG tube
Keeping the NG tube taped and secured to the patient's nares
Notifying the physician for a temperature under 100.5°F
Irrigating the NG tube with 30 mL of normal saline every 6 hours
The Correct Answer is C
A. It is appropriate to notify the physician if bright red blood is found in the NG tube, as this could indicate bleeding, which requires prompt medical attention.
B. It is standard practice to keep the NG tube taped and secured to the patient’s nares to prevent dislodgement and ensure proper function.
C. A temperature under 100.5°F is generally not a cause for concern postoperatively, unless it is persistent or accompanied by other signs of infection. Typically, a low-grade fever is expected after surgery, but further investigation is only warranted for higher fevers or other concerning symptoms.
D. Irrigating the NG tube every 6 hours with 30 mL of normal saline is standard practice to ensure patency of the tube and prevent clogging.
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Related Questions
Correct Answer is D
Explanation
A. Parenteral nutrition (PN) should not be left out for extended periods. Generally, unused PN should be discarded after 24 hours, not 12 hours, to prevent contamination and bacterial growth.
B. The flow rate of PN should be monitored and adjusted carefully, but it should not be increased without orders. Rapid adjustments could cause complications such as fluid overload or electrolyte imbalances.
C. PN solution should be removed from the refrigerator 1 to 2 hours before use to allow it to come to room temperature, but 2 hours may be too long. It should be done cautiously to avoid bacterial growth at room temperature.
D. Monitoring daily laboratory values is essential for assessing the client's nutritional status, electrolytes, liver function, and kidney function. These values help guide ongoing care and detect complications of PN, such as electrolyte imbalances or liver dysfunction.
Correct Answer is D
Explanation
A. Inflammation of the esophagus (esophagitis) may cause symptoms like heartburn or dysphagia, but it would not explain the sudden, sharp pain or rigid abdomen seen with a perforated ulcer.
B. An intestinal obstruction can cause abdominal pain and distension, but the rigid, board-like abdomen is more characteristic of peritonitis from a perforated ulcer, not an obstruction.
C. Additional ulcers could cause pain and bleeding, but they would not explain the sudden, sharp pain and rigid abdomen that typically result from perforation.
D. The sudden onset of sharp, severe pain in the mid epigastric area, along with a rigid, board-like abdomen, are hallmark signs of a perforated ulcer, which causes peritonitis. This is a medical emergency, as the perforation allows gastric contents to leak into the peritoneal cavity, leading to widespread infection.
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