Medical-surgical Nursing Demystified

(^488) Medical-Surgical Nursing Demystified

• Administer blood-thinning agents to prevent enlarging of clot or development
  of new clots in pulmonary embolism.


• Mechanical ventilation if necessary.

NURSING DIAGNOSES

• Ineffective breathing pattern


• Ineffective airway clearance


• Impaired gas exchange


• Ineffective cardiopulmonary tissue perfusion

NURSING INTERVENTIONS

• Monitor vital signs for changes.


• Monitor respiratory status: check respiratory rate, rhythm, and depth; check
  skin color; listen to breath sounds.


• Monitor pulse oximetry level for oxygenation.


• Monitor intravenous site for signs of infiltration.


• Encourage coughing and deep breathing exercises.


• Encourage incentive spirometer use.


• Encourage early ambulation.

Infection

The skin is the body’s first line of defense against infection. During surgery this

line of defense is penetrated. Even though the surgical procedure is performed in

as aseptic an environment as possible, the possibility of infection still exists.

WHAT WENT WRONG?

Wound infections can develop in the postoperative period. The wound may be

contaminated before surgery, such as with penetrating trauma, or may become

infected during healing. The surface of the skin has bacteria that are naturally

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