A 45-Year-Old Woman Is Evaluated on Postoperative Day 3 Due

question 152

Multiple Choice

A 45-year-old woman is evaluated on postoperative day 3 due to nausea and vomiting.  The patient underwent a total abdominal hysterectomy for symptomatic uterine fibroids, and the surgery was complicated by ureter injury and stent placement.  She was placed on a clear liquid diet on postoperative day 2, when she began to have some nausea.  Since then, the patient has had multiple episodes of vomiting but no hematemesis.  She has not passed flatus or had a bowel movement since the surgery.  Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, and pulse is 80/min.  The abdomen is mildly distended and has decreased bowel sounds.  The incision is tender to palpation but has no surrounding erythema or discharge.  Laboratory results are as follows: Abdominal x-ray is shown in the exhibit.  In addition to intravenous fluid administration, which of the following is the best next step in the management of this patient?

• A)Bowel rest and serial examinations
• B)Broad-spectrum antibiotics
• C)Rectal enema
• D)Small bowel follow-through
• E)Urgent surgical exploration

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Definitions:

Control Limits

Statistical boundaries in process control systems that indicate the maximum and minimum values a process should operate within to maintain quality control.

P-chart

A P-chart is a type of control chart used in statistical quality control to monitor the proportion of defective items in a series of samples and determine whether a process is in control.

Process Output

The final product, result, or service generated by completing a specific process.

R-chart

A type of control chart used to monitor the range within a sample to evaluate the variability of a process.