The nurse is caring for four patients who have abdominal surgical wounds. Which patient in this surgical nurse's assignment does the nurse assess to be at greatest risk for wound dehiscence?
A) A 68-year-old-man with diabetes on postoperative day 5
B) A 60-year-old man on low-dose corticosteroids prior to surgery on postoperative day 1
C) A 40-year-old woman with no past medical history on postoperative day 5
D) A 40-year-old obese woman on postoperative day 2
A) A 68-year-old-man with diabetes on postoperative day 5
Explanation: A) Three factors that are commonly associated with wound dehiscence are diabetes mellitus, high-dose corticosteroid use, and infection. Some additional individual factors that favor dehiscence are increased mechanical strain on the wound, age greater than 65 years, dehydration, malnutrition, hypoproteinemia, malignancy, and obesity. The incidence of dehiscence peaks at approximately 5-9 days after surgery. Therefore, the 65-year-old man with diabetes on postoperative day 5 is at greatest risk.
B) Three factors that are commonly associated with wound dehiscence are diabetes mellitus, high-dose corticosteroid use, and infection. This patient is taking low-dose corticosteroids and is under 65 years of age, placing him at a lower risk for wound dehiscence than a 68-year-old man. Also, the risk for dehiscence peaks at 5-9 days after surgery, this patient is on the first postoperative day.
C) This woman is within the 5-9 day postoperative range for the incidence of dehiscence but has none of the factors that are associated with wound dehiscence.
D) Obesity is an individual factor that favors dehiscence, but this patient is only 40 years of age and on postoperative day 2. The incidence of dehiscence peaks at approximately 5-9 days after surgery. Because of her obese state, this patient still needs to be monitored for proper wound healing without complications.
You might also like to view...
Order the following stages of Roberts' Seven-Stage Crisis Intervention Model
1. ________ Deal with feelings and emotions. 2. ________ Generate and explore alternatives. 3. ________ Rapidly establish rapport. 4. ________ Psychosocial and lethality assessment. 5. ________ Identify the major problems or crisis precipitants. 6. ________ Follow up. 7. ________ Implement an action plan.
The nurse is caring for a 10-year-old in traction. While performing a skin assessment, the nurse notices that the skin over the calcaneus appears slightly red and irritated. Which action would the nurse take first?
A) Reposition the child's foot on a pressure-reducing device. B) Apply lotion to his foot to maintain skin integrity. C) Make sure the skin is clean and dry. D) Gently massage his foot to promote circulation.
What element must be included in the process of securing informed consent?
A) A timeline of when the treatment is expected to occur B) Written information on what the post procedure outcomes will be C) Information regarding the risks involved in the proposed procedure D) An explanation of the nature of all associated treatment provided by the nurse
One compensatory mechanism that helps maintain oxygen availability to the fetus during maternal exercise is
A. A decrease in maternal hematocrit B. Transient increase in uterine blood flow C. An increase in uterine oxygen uptake