Report worsening dyspnea, persistent low oxygen saturation, or diminished breath sounds.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse assesses a client several hours after surgery and finds a temperature of 100.2 F. What does the nurse understand about this finding?
Answer: A. A mild temperature elevation in the first 24 to 48 hours after surgery is most often related to atelectasis and the inflammatory response to surgery. Encouraging deep breathing, coughing, and incentive spirometry is appropriate. Persistent or higher fevers later may indicate infection.
Question 2 of 5
A nurse is monitoring T-tube drainage on the first postoperative day after a cholecystectomy. Which amount of bile-colored drainage is within expected limits?
Answer: A. On the first postoperative day, a T-tube commonly drains a moderate amount of bile, around 300 to 500 mL, which then gradually decreases over the following days as the duct heals and bile flows into the duodenum. Output greater than 1,000 mL/day or sudden cessation should be reported, but several hundred milliliters is expected initially.
Question 3 of 5
A client is recovering from surgery and reports a sudden onset of shortness of breath, pleuritic chest pain, and anxiety, with an oxygen saturation of 88 percent. What complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, hypoxia, and anxiety after surgery strongly suggest pulmonary embolism, often from a postoperative DVT. The nurse raises the head of the bed, applies oxygen, and notifies the provider. These acute findings are not typical of constipation, mild wound pain, or simple postoperative fatigue.
Question 4 of 5
On the third postoperative day, a client who has been NPO and on IV fluids has a serum sodium of 128 mEq/L, headache, and confusion. The nurse recognizes which electrolyte imbalance?
Answer: A. A serum sodium of 128 mEq/L is below the normal range, indicating hyponatremia, which can cause headache, confusion, and in severe cases seizures, sometimes from excess hypotonic IV fluid postoperatively. The findings and value are not consistent with hypernatremia, hyperkalemia, or hypercalcemia.
Question 5 of 5
A nurse is caring for a client on postoperative day 2 after a total knee arthroplasty who reports sudden chest pain, shortness of breath, and tachycardia. Which complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, and tachycardia in a postoperative orthopedic patient are classic signs of pulmonary embolism, often from a deep vein thrombosis. This is a medical emergency requiring immediate oxygen, provider notification, and evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is postoperative atelectasis prevention?
It reduces gas exchange and can progress to pneumonia. Prevention centers on deep breathing, early mobility, and lung expansion. It is usually the cause of a low-grade fever in the first 24-48 hours after surgery.
Key points to remember
- Anesthesia, splinting from pain, and immobility lead to shallow respirations and alveolar collapse.
- Incentive spirometry promotes deep sustained inhalation that re-expands alveoli.
- Early signs include decreased breath sounds, crackles, low-grade fever, and a mild fall in oxygen saturation.
- Early ambulation is one of the most effective preventive measures.
- Untreated atelectasis predisposes the patient to postoperative pneumonia.
- Adequate pain control allows deeper breathing and effective coughing.
Common causes
- Collapsed alveoli, shallow breath
- Pain, sedation, immobility
Signs & symptoms
- ↓Breath sounds, crackles
- Low-grade fever first 48h
- Dyspnea, ↓SpO2
Nursing priorities
- Have the patient use the incentive spirometer about 10 times every hour while awake.
- Coach deep breathing and coughing, and splint the incision with a pillow to ease pain.
- Encourage early and progressive ambulation and frequent repositioning.
- Manage pain proactively so the patient can breathe deeply and cough effectively.
- Auscultate lung sounds and monitor oxygen saturation each shift.
Labs & values
Patient teaching
- Use the incentive spirometer hourly: inhale slowly and deeply, hold, then relax.
- Splint your incision with a pillow when coughing or deep breathing to reduce pain.
- Get up and walk as soon as you are cleared, because moving helps your lungs stay open.
Red flags: report now
- Report worsening dyspnea, persistent low oxygen saturation, or diminished breath sounds.
- A fever that persists or rises beyond 48 hours may signal pneumonia rather than simple atelectasis.
- Never skip lung-expansion measures because the patient says coughing hurts; treat pain instead.
References
Clinical references for this topic
