Question

When caring for a patient the second postoperative day after abdominal surgery for removal of a large pancreatic cyst, the nurse obtains an oral temperature of 100.8° F. Which action should the nurse take first?

a. Have the patient use the incentive spirometer.
b. Assess the surgical incision for redness and swelling.
c. Administer the ordered PRN acetaminophen (Tylenol).
d. Ask the health care provider to prescribe a different antibiotic.

Answer 1

The nurse's first action when a postoperative patient presents with a mild fever should be to encourage the use of the incentive spirometer to prevent lung-related complications. This is in preference to immediately assessing the incision or changing medications.

Step-by-step explanation:

Understanding Postoperative Care and Fever Management

Upon observing a patient with a postoperative fever of 100.8° F on the second day following abdominal surgery for the removal of a large pancreatic cyst, the primary action a nurse should take is to have the patient use the incentive spirometer. This first step is crucial in promoting lung expansion and preventing atelectasis or pneumonia, which are common causes of fever during the early postoperative period. Assessing the surgical site is also important but may not be the immediate cause of the fever. Administering PRN acetaminophen can be considered after evaluation of the possible causes of the fever. Lastly, requesting a prescription for a different antibiotic might not be necessary at this point, as the elevation in temperature is mild and could be related to atelectasis rather than an infection.