It is 1130 and M.N., age 65, is being admitted to your surgical floor after having undergone an open cholecystectomy for acute cholecystitis. She has a nasogastric tube to continuous low wall suction, one peripheral intravenous (IV) line, and a large abdo
Physician's Orders
Clear liquid diet; progress low-fat diet as tolerated
D5 ½ NS with 40 mEq KCl at 125 mL/hr
Turn, cough, and deep breathe q2h
Incentive spirometer q2h while awake
Oxygen per protocol to maintain Spo2 at 95%
Dangle in am
Morphine sulfate 10 mg IM q4h prn for pain
Ampicillin (Omnipen) 2 g IVPB q6h
Chest x-ray in am
Are these orders appropriate for M.N.? State your rationale.
• M.N. should remain on nothing-by-mouth (NPO) status and not receive a diet order until she
resumes bowel sounds and passes flatus. It usually takes 48 to 72 hours for the bowels to resume
peristalsis after abdominal surgery. Then the nasogastric tube will be removed and M.N. can start
eating.
• You need to know M.N.'s potassium level before administering an infusion containing this level of
potassium.
• Morphine sulfate should be given intravenously in small doses (1 to 2 mg) at more frequent
intervals (q1- 2h as needed). IM (intramuscular) injections are both painful and unnecessary.
• M.N should dangle the evening of surgery and be out of bed to a chair and progressively
ambulating beginning the next day.
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