Mary has returned to the ward from an oophorectomy as she was present with a 9cm ovarian cyst in which she was under general anaesthesia. I am aware that she is currently conscious and stable.
An oophorectomy is when one or two ovaries are taken out by surgical procedure. Can be completed by either a Laparotomy or laparoscopic surgery. (Staff, 2017)
Marys Care Plan:
Airway: Mary may return with a cough as she would have been extubated before returning to the ward. As Mary smokes 20 cigarettes a day her cough may last longer and may contain sputum (mucous secretion coming from the lungs). For less pain when Mary is coughing advise her to hold a pillow against her stomach to prevent as much impact from the cough on the stomach. Make sure to sit Mary in an upright position as this will allow her to cough. Mary may require pain relief due to the coughing affecting her abdomen. When Mary is asleep make sure she is at a slight tilt to prevent her from lying flat on her back as her tongue can become an obstruction to the airway path. (Paul K. Mohabir, 2018)
Breathing: Mary should take part in breathing exercises to prevent her getting a chest infection. Ensure that Mary is coughing sputum soon after the operation. As Mary is a smoker she may suffer from dyspnoea therefore she may get breathless quicker. Exercises can include; sitting up straight either in her bed or chair, make sure Mary eases her shoulders and to not be tense. Mary should slowly take in a deep breath and hold for 3 seconds. Tell her to slowly release after this time. Mary should repeat the same breath 3 more times and then return to regular breathing pattern. If Mary has shortness of breath and her oxygen saturations are below 95 allow her to use the oxygen mask which can be controlled by an air flowmeter depending on how breathless she is. The nurse can then turn it off when Mary is back to normal. Make sure to recheck oxygen saturations. (Trust, 2016)
Circulation: Mary should be advised to mobilize soon after surgery as this can also prevent a chest infection occurring. Mobilization will also help with recovery because lack of mobilizing Mary may become stiffer. Physiotherapy will help Mary with the following; walking to begin with, for ankles bend the foot down and bring back up, can be done ten times each ankle. Legs, bring one knee up and push the other against the bed tightening the upper thigh, repeat with opposite leg. Another includes raising one leg up straight in front of you repeat with other leg. Mary can relieve pressure from the buttocks by squeezing them in. Abdominal, lay back and breath in deep and hold. Knee rolling will also help her abdomen strengthen. All these exercises will also help with the prevention of any clots forming especially in the legs as they are now being moved and blood is flowing freely. Air compression leg wraps can also be used if Mary is not willing to mobilize with exercises. The movements will also help with the prevention of any pressure sores as blood flow can get to these areas now. (Team, 2018)
? Pain Assessment – Asses Mary for any pain that she might have it may be noticed by physiological factors, immobility or behavioural factors may appear anxious or just an overall change in behaviour. Make sure to assess the area that the incision happened as this area could get infected causing Mary pain. Signs may include swelling to the area, colour getting more red, uncontrolled bleeding or even discharge from the wound. Marys age may also have a contribution to the pain as normally patients who are older will just think they have pain due to getting older and will not associate it with the pain they have from a surgery in Marys case. A pain questionnaire such as the McGill questionnaire can be used to asses Marys pain. Make sure to check the intensity of the pain and whether the pain influences Marys ability to carry out any of her ADL’s (activities of daily living). Use patient language not medical. (Paderla, 1997-2018)
? Pain Management – Pain medication may be given to Mary to relive her from any pain. Start by giving paracetamol and check back with her if any pain has been relieved. If Mary is still in pain a stronger pain relief may need to be given. A PCA (patient-controlled analgesia) can be used as it has a ‘lockout’ affect, only giving the patient a certain amount at a time. Assessment should be made in case Mary has any side effects to the medication. When coughing after returning from surgery give Mary an extra pillow to hold against her stomach to prevent too much expansion of the abdomen. This can also be done by using a towel if no pillows available or if Mary has a preference. (Paderla, 1997-2018)
? Patient Education – Ensure Mary knows the possible reason for her pain. Notify her that there could be a possibility of an infection to site of her incision and allow her to know that her doctor can be called to look at it. If Mary takes any medication to relieve her pain always notify her of what pain relief she is taking and if she would like to know how many she can have a day if necessary.
? Reporting/Recording – Record any pain that Mary is having and report to her doctor that you would like them to come down and review Mary as there could be a chance of infection to the site of the wound.