Exhibits

For each action, click to indicate whether the actions are indicated or contraindicated for postoperative amputation. Each column must have at least one response option selected.

• Appendicitis: The client presents with sudden onset right lower quadrant pain, fever, nausea, and vomiting, which are classic signs of appendicitis. The pain’s location between the umbilicus and iliac crest aligns with the anatomical position of the appendix. Appendicitis is also supported by imaging and lab findings consistent with inflammation and infection.
• Cholecystitis: This condition is characterized by right upper quadrant abdominal pain, often radiating to the back or shoulder, typically triggered by fatty food intake. It is frequently accompanied by a positive Murphy’s sign, which was not reported here. The location and nature of the client’s pain do not match the presentation of cholecystitis.
• Urinary tract infection: UTIs usually present with symptoms such as urinary frequency, urgency, burning with urination, or suprapubic discomfort. The client explicitly denies burning or urinary symptoms, and genitourinary assessment was within normal limits. These findings make a UTI an unlikely cause of her abdominal pain.
• CT scan results: The CT scan revealed a dilated appendix (7 mm) with fat stranding, both hallmark signs of acute appendicitis. A normal appendix is typically less than 6 mm in diameter. Fat stranding suggests surrounding inflammation, providing radiologic confirmation of the suspected diagnosis.
• Pain localized to the epigastric region: Epigastric pain is more often associated with gastritis, pancreatitis, or peptic ulcer disease. The client’s pain is localized to the right lower quadrant, not the epigastric area, making this finding inconsistent with her presentation and not supportive of appendicitis.
• White blood cell count (WBC): An elevated WBC count of 16,000/mm³ suggests the presence of a systemic inflammatory response, which commonly occurs in appendicitis. This lab value supports the clinical suspicion of infection and inflammation of the appendix.
• Normal bowel sounds and soft, non-tender abdomen: This finding would suggest no significant intra-abdominal pathology or inflammation. In this case, the abdomen is tender with localized severe pain in the right lower quadrant, making this finding unrelated and inconsistent with the diagnosis.

A. Increase frequency of BP assessments: More frequent monitoring is important when vital signs begin to trend downward, but it does not address the potential cause of the drop in blood pressure. Without an intervention to identify the underlying issue, further decline could be missed or untreated.

B. Encourage the client to breathe deeply: Deep breathing is useful in preventing postoperative atelectasis, but it is unrelated to a drop in blood pressure. This action does not target the most immediate concern of potential postoperative bleeding or hypovolemia.

C. Check the abdominal surgical dressing: A significant drop in blood pressure shortly after abdominal surgery may indicate internal or external bleeding. Inspecting the surgical site for signs of haemorrhage such as visible drainage, distention, or saturation of the dressing helps identify early postoperative complications and guides rapid intervention.

D. Review the client's baseline BP trends: While understanding the client’s normal blood pressure is helpful, it does not substitute for an immediate physical assessment when acute changes are occurring. Delaying direct observation to review history could allow a preventable complication to worsen.