A nurse is assessing a client post-cholecystectomy for complications. Which finding requires immediate intervention?

Choice A reason: Oral analgesics are less effective in acute pancreatitis due to severe pain and potential gastric dysmotility from inflammation. IV opioids provide faster, more reliable pain relief, as oral absorption may be impaired, making this a less appropriate choice for acute pain management.

Choice B reason: A high-fiber diet is contraindicated in acute pancreatitis, as it stimulates digestion, increasing pancreatic enzyme secretion and worsening inflammation and pain. Patients are typically kept NPO (nothing by mouth) to rest the pancreas, making this an inappropriate intervention for pain control.

Choice C reason: IV opioid analgesics, such as morphine or fentanyl, are the preferred treatment for severe pain in acute pancreatitis. They provide rapid, effective analgesia by acting on central pain receptors, reducing discomfort without stimulating pancreatic activity, making this the priority intervention for pain management.

Choice D reason: Applying a warm compress to the abdomen is contraindicated, as heat may increase inflammation and blood flow to the pancreas, worsening pain and tissue damage. Pain management in pancreatitis relies on pharmacological interventions, making this an incorrect and potentially harmful action.

Reasoning:

Choice A reason: Mild incisional pain is expected post-cholecystectomy due to surgical trauma and tissue healing. It is managed with analgesics and does not indicate an acute complication requiring immediate intervention, unlike signs of potential bowel obstruction or peritonitis, which are more urgent.

Choice B reason: Absence of bowel sounds suggests paralytic ileus or bowel obstruction, a serious post-cholecystectomy complication. This may result from surgical manipulation or peritonitis, requiring immediate intervention to prevent perforation or sepsis, as it indicates impaired gastrointestinal motility, making this the priority finding.

Choice C reason: Yellow-tinged skin (jaundice) may indicate bile duct obstruction post-cholecystectomy, a concerning but less urgent complication than absent bowel sounds. It requires evaluation but does not pose an immediate threat like ileus or sepsis, making it a lower priority for intervention.

Choice D reason: A temperature of 99.5°F is a low-grade fever, common post-surgery due to inflammation. It requires monitoring but is not immediately life-threatening compared to absent bowel sounds, which could indicate a surgical emergency like obstruction or peritonitis, necessitating urgent action.