The nurse is caring for a 73-year-old female client who is 3 days post

The nurse is caring for a 73-year-old female client who is 3 days postoperative for a bowel ob-struction.

The nurse knows that the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day, when aldosterone, glucocorticoids, and antidiuretic hormone (ADH) are increasingly secreted, causing sodium and chloride retention and potassium excretion. Because of this, it is important for the nurse to closely monitor:
1. Urine output
2. Intake of sodium
3. Activity level
4. Oxygen level

ANSWER

ANS: 1
Recent surgery is a condition that places clients at high risk for fluid, electrolyte, and acid-base alterations. Clients continue to be at risk during the acute phase until the underlying process is resolved. For example, the stress response of surgery causes fluid-balance changes in the second to fifth postoperative day, when aldosterone, glucocorticoids, and ADH are increasingly secret-ed, causing sodium and chloride retention, potassium excretion, and decreased urinary output. The client’s diet most likely has not advanced enough to be concerned about excess sodium in-take. The client’s activity level is important, and the nurse should encourage her to increase her activity level. The client’s oxygen level is also important to monitor, but has no direct effect on the fluid, electrolyte, and acid-base alterations