(7) Ambulate the patient to assist peristalsis and help relieve gas pain, which
is a common postoperative discomfort.
(8) Instruct the patient to tell you of his first bowel movement following
surgery. Record the bowel movement on the intake and output (I&O) sheet.
(9) If nursing measures are not effective, the doctor may order medication or
an enema to facilitate peristalsis and relieve distention. A last measure may require the
insertion of a nasogastric or rectal tube.
(10) Document nursing measures and the results in the nursing notes.
e. Integumentary System. Follow doctor's orders for wound care, wound
irrigations and cultures. In addition to assessment of the surgical wound, you should
evaluate the patient's general condition and laboratory test results. If the patient
complains of increased or constant pain from the wound, or if wound edges are swollen or
there is purulent drainage, further assessment should be made and your findings reported
and documented. Generalized malaise, increased pain, anorexia, and an elevated body
temperature and pulse rate are indicators of infection. Important laboratory data include
an elevated white blood cell count and the causative organism if a wound culture is done.
Staples or sutures are usually removed by the doctor using sterile technique. After the
staples or sutures are removed, the doctor may apply Steri-Strip to the wound to give
support as it continues to heal.
(1) There are two methods of caring for wounds: the open method, in which
no dressing is used to cover the wound, and the closed method, in which a dressing is
applied. The basic objective of wound care is to promote tissue repair and regeneration,
so that skin integrity is restores. Dressings have advantages and disadvantages.
(a) Advantages. Dressings absorb drainage, protect the wound from
injury and contamination, and provide physical, psychological, and aesthetic comfort for
(b) Disadvantages. Dressings can rub or stick to the wound, causing
superficial injury. Dressings create a warm, damp, and dark environment conducive to the
growth of organisms and resultant infection.
(2) At some time, most wounds are covered with a dressing and you may be
responsible for changing the dressing. First, gather needed supplies. Items may be
packaged individually or all necessary items may be in a sterile dressing tray. Some
surgical units have special dressing carts, with agents needed to clean the wound, and
materials to cover and secure the dressing. Next, prepare the patient for the dressing
change by explaining what will be done, providing privacy for the procedure, and assisting
the patient to a position that is comfortable for him and for you. Finally, use appropriate
aseptic techniques when changing the dressing and follow precautions for contact with
blood and body fluids. The most common cause of nosocomial infections is carelessness