You are the nurse caring for a 64-year-old male client who is postoperative day four on the medical-surgical unit after having an emergency right colectomy due to cancer. The client is NPO with a nasogastric (NG) tube to low intermittent suction. The client has a history of smoking and no other health problems.
- Temperature: 99.2° F
- Heart rate: 91 beats/min
- Respirations: 20 breaths/minute
- O2 saturation: 93% on 2L oxygen via nasal cannula
- Blood pressure: 110/68 mm Hg
- Pain: “6/10”
Focused assessment findings:
- Alert and oriented to person, place, and time
- Moves all four extremities, refuses to ambulate
- Apical pulse is regular at 91 beats/minute
- Lungs clear to auscultation, diminished bilaterally
- Bowel sounds hypoactive, abdomen soft, tender in all four quadrants
- Midline abdominal incision well approximated with staples intact, no erythema, Penrose drain intact with scant serous drainage
- Right lower quadrant Jackson-Pratt drain with sutures intact, no erythema, 30 mL of serosanguineous drainage
Using the information from the scenario, create a care plan using the attached template.
Improving Patient Care
1. Describe an example of evidence-based practice (EBP) change or guidelines.
One example of evidence-based practice (EBP) changes or guidelines that may apply to the client’s care in this scenario is early mobilization after surgery. Research has shown that early ambulation can reduce the risk of postoperative complications such as pneumonia, DVT, and atelectasis and can also help to improve overall outcomes and reduce hospital length of stay (Kanejima et al., 2020). EBP guideline related to early mobilization after surgery is the Enhanced Recovery After Surgery (ERAS) protocol, which includes specific recommendations for early ambulation and other interventions to promote recovery after surgery. The ERAS protocol has improved outcomes in various surgical populations, including those undergoing colorectal surgery.
To implement this EBP change or guideline, the nursing team could work with the healthcare provider to develop an individualized care plan for the client that includes specific goals and interventions for early mobilization. This plan could include strategies such as frequent turning and positioning, active range of motion exercises, and early ambulation with assistance as tolerated. The nursing team could also use evidence-based tools such as early mobilization checklists or protocols to guide interventions and ensure the client receives appropriate care.
2. Explain how EBP improves patient care.
The nursing team can improve the client’s care by implementing evidence-based practice (EBP) guidelines related to early mobilization after surgery. By encouraging the client to move and engage in activity as soon as possible after surgery, the nursing team can reduce the risk of postoperative complications such as pneumonia, DVT, and atelectasis and promote faster recovery. This approach can also encourage patient engagement and participation in their care, promote a sense of empowerment, and improve the client’s overall satisfaction with their care (Balvardi et al., 2021). Furthermore, using evidence-based tools and protocols can standardize care and ensure that all clients receive the same level of care based on the best available evidence. Implementing EBP guidelines related to early mobilization can improve the quality and consistency of care provided to the client, leading to better outcomes and an improved overall experience.
Balvardi, S., Pecorelli, N., Castelino, T., Niculiseanu, P., Alhashemi, M., Liberman, A. S., … & Fiore, J. F. (2021). Impact of facilitation of early mobilization on postoperative pulmonary outcomes after colorectal surgery: a randomized controlled trial.
Annals of Surgery,
Kanejima, Y., Shimogai, T., Kitamura, M., Ishihara, K., & Izawa, K. P. (2020). Effect of early mobilization on physical function in patients after cardiac surgery: a systematic review and meta-analysis.
International Journal of Environmental Research and Public Health,