Practice Quiz

CCRN Critical Care Nursing

Category - Adult

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The nurse is called in to see a 47 year old patient who underwent abdominal surgery to remove abdominal tumors. He anxiously tells her that he feels oozing around his incision. When the nurse assesses the site, she notes part of the bowels protruding through a dehiscence in the wound. The first thing the nurse would need to do:
  1. Use sterile technique to cover the wound with warm sterile saline soaks.
  2. Call the doctor and prepare the patient for surgery.
  3. Administer pain medication and antibiotics.
  4. Administer intravenous fluids to replace fluid lost from the wound.
Explanation
Answer: A - The first thing the nurse would do when discovering an evisceration of the bowel through the wound dehiscence would be to use sterile technique to cover the wound with warm sterile saline soaks. Keep the patient in bed and stay with him. If another nurse is near, request that they call the doctor for you so you can monitor the patient closely.
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