Generally, why would post-operative patients who underwent major surgeries like Mrs. Frances, be maintained on NPO?

Activity 1

Critical Thinking Exercise 1
Case Study : Pre-Operative Patient

Patient Profile:
● Mrs. Frances, an 82-year-old retired librarian is admitted to the hospital with complaints of
abdominal pain, alternating diarrhea and constipation, and blood in her stool.
Pertinent Data:
● Has history of hypertension for 40 years
● Takes Hydrochlorothiazide
● Has history of diabetes mellitus, type 2, since age 60, diet controlled
● Has surgical history that includes a cesarean section at age 30 & appendectomy at age 19
● Has not eaten for 2 days and has had decreasing oral intake for past 2 weeks
● Reports a 10-lb weight loss
● Sleeps poorly at night and is drowsy during the day
● Lives alone and has no immediate family
Physical Examination:
● Alert, well oriented, slightly obese older woman with painful, palpable abdominal mass on LLQ.
Collaborative Care:
● Scheduled for exploratory laparotomy, colon resection, and possible colostomy

1. Based from the presenting data, what factors may influence Mrs. Frances` response to
hospitalization and surgery and why?
2. Given Mrs. Frances’ health history, what pre-operative laboratory tests and diagnostic procedure
do you think will be possibly ordered and why?
Critical Thinking Exercise 2

Case Study: Patient during the Intra-operative Phase

Intra-Operative Period

Page 4 | Perioperative Nursing /mcls
Mrs. Frances was brought in the Operating Room for her planned surgery:
Exploratory Laparotomy, Colon Resection, Colostomy under general anesthesia. Patient
was alert, & conscious, with the following vital signs: BP= 130/80, PR= 72/bpm, RR= 24
cpm, T=36.5 0 C. Patient is on NPO with ongoing IVF of Plain NSS 1L x 8 0 , initial dose of
antibiotic given at the ward.

1. Mrs. Frances was transferred from surgical unit to the Operating Room. As a student
nurse assigned in the OR, what nursing actions should you take when receiving a
patient for operation?
2. The operation is about to begin. Prior operation, the Time-Out Procedure is conducted.
What do you think is the importance of doing time-out procedure?


3. During the operation, you noticed that there was a break in the Surgeon’s gloves. You
called the attention of the surgeon and he said that he will change his gloves later. What
will you do then and why?


Critical Thinking Exercise 3

Case Study: Patient during the Post-operative Phase

Post-Operative Period
Two hours post-operatively, Mrs. Frances was transferred from Post-anesthesia Care
Unit (PACU), to her private room. She is awake, conscious & coherent, has stable vital
signs, with dry wound dressings, with colostomy on her LLQ, and with indwelling foley
catheter. She was instructed to be on NPO until further order and to maintain flat on bed for
at least 6 hours post operatively. She also has an ongoing IV fluid, D5LR 1 liter on her right
hand, running at 30-31 gtts/minute.


1. Generally, why would post-operative patients who underwent major surgeries like
Mrs. Frances, be maintained on NPO?


2. Knowing Mrs. Frances health history, what will you include in your plan of care when