A patient recovering from Whipple's procedure is being transferred to the medical–surgical care area. On which interventions should the nurse focus to determine if the patient is developing a complication from the surgery?
Select all that apply.
1. assessing heart rate every 2 hours
2. monitoring urine output ever hour
3. turning and repositioning every 2 hours
4. measuring blood pressure every 2 hours
5. assisting to a standing position every 4 hours
Correct Answer: 1, 2, 4
The major complications following Whipple's procedure are hemorrhage, bile leak, hypovolemic shock, and hepatorenal failure. The nurse should measure blood pressure and heart rate every 2 hours. Urine output should be measured. Turning and repositioning and assisting the patient to a standing position will not help prevent complications from this procedure.
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