Case study progress

C.W.’s condition deteriorates. On the third day after admission she experiences intractable abdominal pain and unrelenting nausea and vomiting. C.W. is taken to the operating room because of probable SBO and is readmitted to your unit from the post anesthesia care unit. During surgery, 38 inches (96 cm) of her small bowel was found to be severely stenosed, with 2 areas of visible perforation. Much of the remaining bowel is severely inflamed and friable. A total of 5 feet (152 cm) of distal ileum and 2 feet (61 cm) of colon have been removed, and a temporary ileostomy was established. She has a Jackson-Pratt (JP) drain to bulb suction in her right lower quadrant (RLQ), and her wound was packed and left open. She has 2 peripheral IV lines, a Salem Sump nasogastric tube (NGT), and a Foley catheter. Her vital signs (VS) are 112/72, 86, 24, 100.8° F (38.2° C) (tympanic). You attach her NGT to low-continuous wall suction per the postoperative orders.

4. You begin a thorough postoperative assessment of C.W.’s abdomen. What does your assessment include? List the steps in the order in which the assessment should be completed.

5. A nursing student enters C.W.’s room and auscultates her abdomen. She looks at you and excitedly announces that she hears good bowel sounds. You take the opportunity to teach her the proper method of auscultating bowel sounds on a patient who has NGT to low-continuous wall suction. How would you correct her error?