68-year-old Mr. Antonov is admitted to the med/surg floor following an open cholecystectomy. He has a history of peripheral vascular disease, peptic ulcer disease, and hypertension. He works full-time as an accountant. His wife remains at his bedside, reading and working crossword puzzles on her tablet. She has her husband’s reading glasses in her purse. While asking her husband for help with #53 down on the puzzle, “a school whose teams play at the Pete Maravich Assembly Center,” Mr. Antonov uses his call light and asks the nurse to remove the children from the room, as he cannot sleep with their noise. Upon arriving at the bedside, the nurse asks him to repeat his request. His eyes remain closed. The nurse gently asks again, and Mr. Antonov looks at the nurse, saying, “Huh? What?” before closing his eyes again. His blood pressure is 110/72 mm Hg, pulse is 68 beats per minute, respirations 14 breaths per minute and temperature 100°F. On exam, his abdominal dressing is intact with a dime sized area of serosanguinous drainage. On gentle palpation, Mr. Antonov groans but does not arouse. Bowel sounds are hypoactive. Laboratory values include a lipase of 100 U/L, amylase of 130 U/L, alkaline phosphatase of 125 U/L, alanine aminotransferase of 32 U/L, aspartate aminotransferase of 60 U/L. His white blood cell count is 17.5 × 10⁹/L and neutrophils are 85%. His medications include cefazolin 500 mg IV every 8 hours and morphine 2.5 mg IV every 2 hours as needed for severe pain; hydrocodone/acetaminophen 5 mg/325 mg every 4 hours as needed for moderate pain and acetaminophen 650 mg every 4 hours as needed for mild pain.

1. Which interventions should be included in the plan of care for this client? Select all that apply.
2. Encourage intake of food and fluids and maintain IV hydration as ordered.
3. Restrict client to bedrest.
4. Provide relief from pain to less than a 3 on a scale of 0 to 10.
5. Ensure the client wears their glasses as appropriate
6. Request an order for lorazepam 0.5 mg as needed three times a day
7. Provide a calm environment, comfortable room temperature, and no glaring lighting
8. Encourage family visitation
9. Request an order for zolpidem 5 mg each night.

ANSWER

Comprehensive Plan of Care for Mr. Antonov: Post-Operative Management

When developing a plan of care for Mr. Antonov, a 68-year-old patient following an open cholecystectomy, it’s crucial to consider his medical history, current condition, and individual needs. The primary goals are to ensure his comfort, monitor his post-operative recovery, and promote a healing environment. The following interventions should be included in his plan of care:

Encourage Intake of Food and Fluids and Maintain IV Hydration
Ensuring adequate hydration and nutrition is essential for promoting healing and preventing complications.
Monitoring fluid balance and intake helps prevent dehydration and maintain electrolyte balance.

Provide Relief from Pain to Less than a 3 on a Scale of 0 to 10
Pain management is critical for Mr. Antonov’s comfort and recovery.
Administering appropriate pain medications as ordered, such as morphine and hydrocodone/acetaminophen, will help control pain within acceptable levels.

Ensure the Client Wears Their Glasses as Appropriate
Wearing glasses can improve Mr. Antonov’s ability to communicate and engage with his surroundings.
Proper vision facilitates interaction with family, healthcare providers, and participation in activities.

Provide a Calm Environment, Comfortable Room Temperature, and No Glaring Lighting
A peaceful environment promotes relaxation and rest, aiding in recovery.
Minimizing excessive light and noise supports Mr. Antonov’s ability to rest and heal.

Encourage Family Visitation
Family support plays a significant role in a patient’s emotional well-being and recovery.
Allowing family visitation provides comfort, reduces anxiety, and enhances the healing process.

Request an Order for Lorazepam 0.5 mg as Needed Three Times a Day
Lorazepam, a benzodiazepine, can help alleviate anxiety and promote relaxation.
If Mr. Antonov experiences anxiety, this medication can help manage his emotional well-being.

Monitor for Signs of Infection and Bowel Function
Given Mr. Antonov’s elevated white blood cell count, monitoring for signs of infection is crucial.
Monitoring bowel sounds and drainage from the surgical site can provide insights into his recovery.

Adjust Activity Level Gradually
Encourage gentle mobility and ambulation as tolerated to prevent complications like deep vein thrombosis and aid in recovery.
Gradual increase in activity level helps prevent strain on incision site and enhances overall recovery.

Educate on Pain Management and Medication Administration
Educate Mr. Antonov and his wife on proper pain management techniques and medication administration.
Ensure they understand the prescribed medications, dosages, potential side effects, and the importance of adhering to the prescribed regimen.

By implementing this comprehensive plan of care, healthcare providers can effectively address Mr. Antonov’s physical and emotional needs, promote his recovery, and facilitate a smooth transition from surgery to healing.