You are caring for a 6 year old female patient name Rita in the hospital.  She is 2 hours post-op from acute appendicitis.  She had a laparoscopic appendectomy. She is sleepy but arousable and can answer short questions. Her last set of vital signs are: b/p 100/68, p 90, r 26, t 98.1, sats 96%. Her vitals 30 minutes before that were: b/p 120/79, p 74 r 20, t 98.3, sats 99%. You check her abdomen and there are 4 well approximated incisions on her abdomen, closed with surgical glue.  One incision on her lower left quadrant appears to be swollen and appears to have some red drainage seeping from under the surgical glue.  Rita is moaning and grimacing with her eyes closed in the bed. She has a 20g IV in her left forearm and is running LR at 100ml/hr, she has 02 at 2l/m via NC in place. She has an indwelling Foley catheter and you have drained 40ml of urine in the 2 hours she has been in your care. Rita’s mom and dad are anxiously sitting in her room, asking questions regarding her recovery from surgery and when she will be discharged.

Based on the information provided, it is evident that Rita is a 6-year-old female patient who recently underwent laparoscopic appendectomy for acute appendicitis. She is currently 2 hours post-op and is in a state of sleepiness but can be roused and respond briefly to questions. Evaluating her vital signs, it can be observed that her blood pressure is 100/68, pulse rate is 90, respiratory rate is 26, temperature is 98.1°F, and oxygen saturation is 96%. Comparing these to her previous set of vital signs taken 30 minutes earlier, there are certain notable differences. Initially, her blood pressure was 120/79, pulse rate was 74, respiratory rate was 20, temperature was 98.3°F, and oxygen saturation was 99%.

On conducting an abdominal examination, it is observed that four well-approximated incisions are present on Rita’s abdomen, which have been closed using surgical glue. However, one incision located in her lower left quadrant appears to be swollen and is exhibiting signs of red drainage seeping from beneath the surgical glue. Additionally, Rita is experiencing discomfort, as evident from her moaning and grimacing while keeping her eyes closed in the bed. Her current intravenous access includes a 20g IV in her left forearm, through which lactated Ringer’s solution is being infused at a rate of 100 ml/hr. She is also receiving supplemental oxygen via a nasal cannula at a flow rate of 2 liters per minute. Furthermore, an indwelling Foley catheter is in place, and within the 2 hours under observation, 40 ml of urine has been drained.

During this time, Rita’s anxious parents have been present in her room and have expressed concerns regarding her recovery from surgery and the anticipated duration until discharge. In light of this situation, it is essential to comprehensively assess and manage Rita’s post-operative condition to ensure her recovery is smooth and without complications.

Firstly, the slight alteration in Rita’s vital signs between the two measurements should be closely monitored. The decrease in blood pressure from 120/79 to 100/68 may be indicative of hypotension, which could result from intraoperative fluid shifts, blood loss, or inadequate fluid resuscitation. Monitoring Rita’s blood pressure could help steady and maintain her hemodynamic stability. Similarly, considering the increased respiratory rate from 20 to 26 breaths per minute and the slightly reduced oxygen saturation from 99% to 96%, it would be prudent to evaluate her respiratory status for possible complications such as atelectasis or respiratory tract infection. Close observation of her respiratory effort, lung sounds, and oxygen saturation trends can guide appropriate interventions if needed.

The swollen incision accompanied by red drainage beneath the surgical glue raises concerns of a possible infection at the site. It is important to assess the area for signs of inflammation, such as warmth, increased redness, tenderness, or purulent discharge. Prompt notification of the surgical team or healthcare provider is necessary to initiate appropriate wound care and potential antibiotic therapy. Additionally, Rita’s moaning and grimacing indicate discomfort, suggesting the possibility of pain. Assessing the intensity, location, and character of her pain would guide appropriate pain management strategies to ensure her comfort and well-being.

Furthermore, the intravenous access and fluid infusion rate should be closely monitored to maintain adequate hydration and perfusion. Given Rita’s reduced urine output of 40 ml in 2 hours, it is important to assess for signs of dehydration or inadequate renal perfusion. Monitoring her fluid intake and output, along with the real-time assessment of her hydration status, would guide adjustments to her fluid therapy. Similarly, attention should be paid to the urine output and appearance, as any changes may indicate underlying renal or urinary complications.

Finally, it is crucial to provide Rita’s parents with comprehensive information regarding her recovery and anticipated length of stay. Open and honest communication, combined with education regarding the expected post-operative course, potential complications to watch for, and the factors influencing discharge readiness, will help alleviate their anxiety and enable them to actively participate in Rita’s care.

In conclusion, caring for Rita, a 6-year-old female patient who underwent laparoscopic appendectomy for acute appendicitis, requires vigilant monitoring of her post-operative condition. This involves regularly assessing her vital signs, closely examining her surgical incisions, managing pain, ensuring adequate hydration and perfusion, and providing clear communication and education to her parents. By implementing these measures, Rita’s recovery can be optimized, minimizing potential complications and promoting a successful discharge.