A nurse is caring for a client following application of a cast. Which of the following actions should the nurse take first?

• Postoperative ileus: Ileus is a common complication after abdominal surgery due to anesthesia, opioid use, and limited mobility. It presents as delayed return of bowel function, marked by absent bowel sounds and abdominal discomfort. In this case, the child has absent bowel sounds and increasing tenderness, supporting this risk.
• Atelectasis: Atelectasis generally presents with diminished breath sounds and hypoxia, not clear breath sounds. Although the child has shallow respirations and is refusing the incentive spirometer, there are no respiratory findings such as decreased oxygen saturation or adventitious breath sounds that support this condition currently.
• Peritonitis: Peritonitis would present with systemic symptoms like fever, severe abdominal pain, rebound tenderness, or signs of sepsis. The child has mild abdominal tenderness and stable vital signs, which do not indicate peritoneal inflammation at this time.
• Urinary retention: This would be characterized by lack of urination, bladder distension, or discomfort—none of which are noted in the scenario. The child’s urinary output and bladder status are not identified as concerns, making this diagnosis unlikely.
• Absent bowel sounds: This is a key clinical sign of ileus. After surgery, bowel activity should return gradually. Continued absence of sounds, especially along with abdominal tenderness, strongly indicates impaired gastrointestinal motility.
• Shallow respirations: While shallow breathing is often a contributing factor to respiratory complications, in the context of abdominal surgery, it also limits diaphragmatic movement, which can further suppress bowel activity and contribute to postoperative ileus.
• Clear breath sounds: This is a normal respiratory finding and does not support the presence of atelectasis or other pulmonary complications. It suggests that lung fields are adequately ventilated despite shallow breathing.
• Intact abdominal dressing: This is an expected postoperative finding and does not support a diagnosis of infection, wound complication, or ileus. It indicates proper surgical wound healing.

This client has multiple risk factors for pancreatitis, including type 2 diabetes mellitus, hyperlipidemia, and a history of cardiovascular disease. Although the vital signs are relatively stable, the presence of risk factors and a likely clinical presentation (e.g., abdominal symptoms assumed by context) are consistent with pancreatitis. In acute pancreatitis, the pancreas becomes inflamed and digestive enzymes may attack pancreatic tissue.

NPO status is essential to rest the gastrointestinal tract and reduce pancreatic stimulation. Opioids are typically required due to the severity of abdominal pain. Elevated glucose can result from impaired insulin production due to pancreatic inflammation. Jaundice may occur if the bile duct is obstructed due to pancreatic swelling or inflammation.