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2. Discuss the nursing interventions for the surgical client when ambulating. (fundamentals pg. 920)

Leg exercises
Encourage client to do leg exercises every 1-2 hours during waking hours. Muscle contractions compress veins, preventing stasis of blood in the veins, which can cause thrombus. Contractions also promote arterial blood flow. This will prepare the client for ambulation.

Moving and Ambulation
Encourage client to move from side to side, at least every 2 hours. This will make it easier for client to get up from bed.

Client should ambulate as soon as possible after surgery in accordance w/ surgeons orders. Usually the evening of the surgery. Early ambulation prevents respiratory, circulatory, urinary and gastro-intestinal complications. As well as general musclo-skeletal weakness. Offer pain medication or determine client comfort prior to scheduling ambulation. Start gradually , assisting the client to a sitting position at side of bed with feet dangling. Teach splinting techniques if necessary. Remember non-skid shoes!!!!

Remain at clients side for safety. Assess client needs IE walker, wheelchair nearby, level of assistance required. Monitor client for toleration IE Orthostatic reactions, increased pain, exertional shortness of breath… Document client participation and toleration.


3. Discuss the nursing implications for the surgical client when pain medication is administered. ( fundamentals pg. 919 ,1143)

Pain is described as a sensory and emotional experience. Pain can have detrimental effects in the post-surgical patient,leading to stimulation of the SNS, tachycardia, shallow breathing, atelectasis, altered gas exchange, immobility, and immunosupression.
Pain is greater 12-36 hours post-op, decreasing by second or third day. During initial post op period PCA’s are used via IV or epidural catheter. The nurse monitors the infusion or amount administered by PCA and assesses clients pain relief. If pain is uncontrolled then PRN medications or analgesics should be given routinely every 2 to 6 hours for the first 24-36 hours. Pre medication can be offered prior to scheduled activities ie wound care, ambulation… anti- inflammatories are also given w/ narcotic analgesics to enhance pain relief. Analgesics work best when taken on a regular basis, before pain becomes severe.
Non-pharmacological measures to aid in controlling pain include back rubs, repositioning, diversional activities, and guided imagery.
Remember pain is whatever the client says it is …
P-Provoked: What brought on your pain?
Q-Quality: What does your pain feel like?
R-Region/ Radiation: Where is your pain located? Does it travel?
S-Severity: On a scale of 1-10, 1 being no pain and 10 the worst, what is yours?
T-Timing: When did the pain start?