About
Surgical intervention that removes and/or replaces components of the digestive tract resulting in shrinking of the stomach and ability to hole food.
Assess
Incision, knowledge of procedure, vital signs, dietary intake, fluid volume status.
Complications
Post-operative complications including atelectasis, pneumonia, DVT, PE, infection, hemorrhage, malabsorption, malnutrition, paralytic ileus, bowel obstruction, hernias.
Diagnosis
- Risk for injury related to surgical intervention.
- Risk for infection related to break in skin integrity.
- Impaired skin integrity related to actual surgical incision.
- Risk for imbalanced nutrition less than body requirements related to anatomical changes in digestive tract.
- Acute pain related to surgical procedure.
Goals
- The client will remain free from infection.
- The client will state a decrease in pain after medication intervention.
- The client will verbalize understanding of changes in dietary intake.
- The client will remain free from complications related to surgical intervention.
Interventions
- Assess incision for signs and symptoms of infection including redness, swelling, drainage, fever, elevated white blood cells.
- Assess lung sounds and abdomen frequently.
- Monitor vital signs every 15 minutes X's 2; every 30 minutes X's 2, Every hour X's 2; every 4 hours.
- Assess pain levels frequently.
- Administer analgesics as prescribed.
- Teach client methods to decrease complications of surgery including early ambulation, splinting with coughing and deep breathing, incentive spirometry, SCD's.
- Teach client about dietary considerations including small frequent meals, vitamin replacement, nutrient dense and protein dense food choices.
- Encourage coughing and deep breathing and early ambulation to facilitate movement of respiratory secretions.
- Monitor for post-operative complications.
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