The nurse is discussing discharge teaching with the client who is three (3) days post-operative abdominal aortic aneurysm repair. Which information should the nurse include in the teaching?
Notify HCP of any redness or irritation of incision.
Do not lift anything more than 20 pounds.
Inform client that there may be pain not relieved with pain medication.
Stress the importance of having daily bowel movements.
Correct Answer : A,B,C,D
The information that the nurse should include in the discharge teaching for the client who is three days post-operative abdominal aortic aneurysm repair is as follows:
Notify the healthcare provider (HCP) of any redness or irritation of the incision: This is important because redness or irritation can be signs of infection or other complications at the surgical site. Prompt reporting allows for early intervention and management.
Do not lift anything more than 20 pounds: Following abdominal aortic aneurysm repair, it is crucial to avoid heavy lifting or straining as it can put excessive pressure on the surgical site and potentially lead to complications such as incisional hernia. Restricting lifting to no more than 20 pounds helps to protect the incision and promote proper healing.
Inform the client that there may be pain not relieved with pain medication: Pain management is an essential aspect of post-operative care. However, it is important for the client to understand that complete relief of pain may not always be achievable with pain medication alone. They should be aware that mild to moderate discomfort may persist during the healing process, but severe or worsening pain should be reported to the healthcare provider.
Stress the importance of having daily bowel movements: After abdominal surgery, it is common for bowel movements to be delayed due to factors such as anesthesia, reduced activity, and pain medication. However, it is crucial for the client to maintain regular bowel movements to prevent constipation and potential complications such as bowel obstruction. The nurse should provide guidance on strategies to promote regular bowel function, such as staying hydrated, eating a balanced diet rich in fiber, and using stool softeners or gentle laxatives as directed by the healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Enalapril (Vasotec) is an angiotensin-converting enzyme (ACE) inhibitor medication commonly used to treat hypertension. One of the potential side effects of ACE inhibitors is hyperkalemia, which is an elevated level of potassium in the blood. Therefore, it is generally recommended for patients taking ACE inhibitors to avoid excessive intake of high-potassium foods.
The charge nurse should intervene because advising the client to increase their dietary intake of high-potassium foods contradicts the precautions associated with taking enalapril. Consuming high-potassium foods while taking this medication can potentially lead to an increased risk of hyperkalemia, which can have serious health consequences.
Let's review the other statements made by the nurse:
"Make an appointment with the dietitian for teaching": This is an appropriate statement as it encourages the client to seek professional guidance on dietary management of hypertension. A dietitian can provide valuable information on healthy eating habits and strategies to reduce blood pressure.
"Check your blood pressure at home at least once a day": This is also an appropriate statement as it promotes self-monitoring of blood pressure, which is important for clients with hypertension. Regular monitoring helps the client track their progress and detect any changes that may require medical attention.
"Move slowly when moving from lying to sitting to standing": This is a correct statement as it advises the client to practice orthostatic precautions. ACE inhibitors, including enalapril, can cause orthostatic hypotension, a drop in blood pressure upon standing. Moving slowly can help prevent dizziness and falls.
Correct Answer is D
Explanation
Wear fitted closed toe shoes daily: It is important for clients with peripheral arterial disease to wear properly fitted closed toe shoes. This helps protect the feet from injury and provides support. Closed toe shoes also help maintain warmth and prevent heat loss, which is especially important for individuals with impaired circulation.
Let's review the other options and explain why they may not be appropriate:
Soak feet in warm water for an hour each day: Soaking the feet in warm water for a prolonged period can actually worsen symptoms in individuals with peripheral arterial disease. It can cause further dilation of blood vessels, leading to increased blood pooling and potential tissue damage. Therefore, soaking the feet for extended periods of time is not recommended.
Set heating pads on a low temperature: Using heating pads, especially at high temperatures, can be harmful to individuals with peripheral arterial disease. It can increase the risk of burns or thermal injury due to reduced sensation in the affected areas. Heating pads should be used with caution and on a low temperature setting, if necessary.
Use callus remover for corns or calluses: Individuals with peripheral arterial disease have reduced blood flow to the lower extremities, which can impair wound healing. It is important to avoid self-treatment of corns or calluses, as it can increase the risk of skin breakdown and infection. Clients should be advised to consult a healthcare professional, such as a podiatrist, for appropriate management of corns and calluses.
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