A patient who returned from surgery 3 hours ago following a kidney transplant is reporting pain at a 7 on a scale of 0 to 10. The nurse has tried repositioning with no improvement in the patient’s pain report. Unmanaged surgical pain can lead to which of the following problems? Select all that apply

Normal aging decreases lung elasticity, chest wall compliance, and vital capacity. These changes make older adults more prone to hypoventilation, atelectasis, and respiratory infections after anesthesia. Nursing care must focus on pulmonary hygiene: turning, coughing, deep breathing, and using incentive spirometry.

Rationale for correct answer:

2. Turn, cough, and deep breathe every 4 hours: Reduced vital capacity in older adults increases the risk of atelectasis and pneumonia postoperatively. Encouraging frequent deep breathing and coughing expands alveoli, promotes secretion clearance, and improves oxygenation.

Rationale for incorrect answers:

1. Take and record vital signs every shift: Vital signs help monitor overall stability but do not directly address the physiologic change of reduced vital capacity.

3. Encourage increased intake of oral fluids: Fluids are important for hydration and mucous membrane health, but they don’t directly improve vital capacity.

4. Assess bowel sounds daily: Monitoring bowel function is important after surgery, but it does not address the pulmonary risks related to decreased lung function.

Take home points:

• Older adults have decreased lung reserve, making pulmonary complications more likely after surgery.
• Frequent pulmonary exercises (turn, cough, deep breathe, incentive spirometry) are the most effective interventions to prevent atelectasis and pneumonia.

A saturated postoperative dressing with serosanguineous output and physiologic signs of compromise suggests active bleeding and evolving hypovolemia. Timely, systematic interventions can prevent progression to shock.

Rationale for correct answers:

1. Notify surgeon: Saturated dressing may indicate active bleeding; the surgeon must be informed immediately for orders (return to OR, exploratory measures) or further directives.

5. Reinforce the dressing: If a dressing is saturated, do not remove it (removing may disrupt clot); reinforce with additional sterile dressings and apply gentle pressure as ordered to help control external bleeding while arranging definitive care.

Rationale for incorrect answers:

2. Maintain the IV fluid infusion: Maintaining or increasing IV access/fluids preserves venous access for volume resuscitation or blood transfusion and helps stabilize hemodynamics while interventions are arranged.

4. Monitor the patient’s vital signs every 5 to 10 minutes: Frequent vital-sign monitoring detects hemodynamic deterioration early (tachycardia, hypotension, rising respiratory rate) and guides resuscitation decisions.

3. Provide 2 L/min oxygen via nasal cannula: Oxygen may be helpful if the patient shows hypoxia, but it does not stop bleeding or replace lost volume. It’s supportive care and not the highest-priority immediate action when active bleeding is suspected.

Take home points:

• Treat increasing wound drainage and hemodynamic changes as potential hemorrhage.
• Do not remove a saturated dressing unless specifically ordered.
• Reinforce over it and apply pressure; removing it may worsen bleeding and dislodge clots.