The nurse just received a postoperative patient from the PACU to the medical–surgical unit. The patient is an 84-year-old woman who had surgery for a left hip replacement
Which of the following concerns should the nurse prioritize for this patient in the first few hours on the unit?
A) Beginning early ambulation
B) Maintaining clean dressings on the surgical site
C) Close monitoring of neurologic status
D) Resumption of normal oral intake
Ans: C
Feedback:
In the initial hours after admission to the clinical unit, adequate ventilation, hemodynamic stability, incisional pain, surgical site integrity, nausea and vomiting, neurologic status, and spontaneous voiding are primary concerns. A patient who has had total hip replacement does not ambulate during the first few hours on the unit. Dressings are assessed, but may have some drainage on them. Oral intake will take more time to resume.
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