Patient Pathways For Med Surg Nurses – Whipple

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Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Hannah Schlake, BSN RN CMSRN – ICU nurse in Surgical ICU, preceptor and a charge nurse

What You’ll Learn

• What is a Whipple? 
• Pancreatic Pain/Epidural
• Whipple Devices
• Patient Priority
• Patient’s Potassium Levels

Patient Pathways – Whipple Show Notes

• Theoretical whipple patient report given by Hannah
• Whipple is the name of a surgery where they take out the lower part of the stomach, the first part of the intestines, gallbladder, common bile duct, and part of the pancreas.
• Pancreatic pain is intense. Epidural is used for pain management and is ordered by Anesthesia. Epidural is pretty effective, and they can still get up and move throughout their room. There isn’t the up and down of push medications. 
• An NG tube is needed when re-anastomosis things won’t be moving right away. It will go into the stomach and pull out extra fluid/ bile that isn’t going down the intestines the right way. Don’t hesitate to ask for help if you aren’t sure how to care for this properly. 
  • Replacing NG tubes – you need to speak to the surgeon first. They may want to leave it out because it can cause damage to the freshly operated tissue. Make sure to get an order for replacement. Track your output. Be sure that you’re charting it when you check it. Do it at the end of your shift. Make sure you empty them correctly. 
• JP drains need to be labeled per drain on the drain as well as in the chart so the surgeon knows when to discontinue them. That is crucial. Know your orders for each and exactly what you should be doing. Know if they want it stripped, full compression, half compression. 
• A wound vac will likely be used, but keep an eye on it because it will be one more tube you need to watch for when transporting the patient. 
• If possible, use a nasal bridal with your NG Tube (with providers approval)
• Sending drain samples to lab:
  • Make sure to put this on YOUR task list in the morning.
  • Make sure they are labeled in the chart correctly.
  • Order for every morning day 1, 2, 3, and 5. Crucially important.
  • Can be easily overlooked, be sure to have it done before the doctor comes in. 
• The patient’s potassium levels need to be monitored.
  • They’re losing all of the bile from the NG tube, so they are losing potassium.
  • Potassium is often being replaced through IV bags.
  • Oral potassium is possible, but it is so important to stay on top of it.
  • Make sure it is diluted with other fluid or it will burn their vein. 
• Urine output
  • Look out for tachycardia, low blood pressure, temperature too high or too low
    • Can all be indications of infection.
  • Low urine output can mean they aren’t using their kidneys enough or they’re very dry.
  • Make sure that their foley isn’t at zero every time you go in to check them.
  • Watch those things and notify the provider if anything is off. 
• Priority for the patient is within normal limits, keeping a close eye, and being prepared to pass onto the next shift so they know what is normal.
• Pain control is important to have a plan in place as they progress.
• Advancing diet and mobility. 
• Matching your patient’s demeanor is very important.
  • Take a moment and remember what this patient could be stressing about, such as what results could be coming from surgical pathology, on top of the pain they are experiencing.
  • Take in the emotional tone of the room.
  • Be encouraging without being insensitive.
  • Go into it with a neutral temperament and match their energy. 
• When you’re in school it’s hard to go from the classroom to the hospital with the book knowledge and meeting someone with that diagnosis.
  • Remember that no two patients are going to be alike, even with the same diagnosis.
  • Pay attention to what they need. 

More Resources for New Med Surg Nurses

• Major Differences Between ER Nurses and Floor Nurses
• What Do Med-Surg Nurses Do?
• Nursing Time Management Tips
• Code Blue! Surviving Your First Code Blue or RRT
• Nursing Report Basics For Med-Surg Nurses – a free mini course that includes my fav med-surg report sheet and my top abbreviations I would use when taking report!

Are you a new Med-Surg nurse?

Med-Surg Mindset from FreshRN is the ultimate resource for nurses new to this complex and dynamic acute care nursing specialty. Whether you are fresh out of nursing school or an experienced nurse starting out in med-surg for the first time, the learning curve is steep. With input from three experienced bedside nurses, this comprehensive course is all you need to learn all of the unspoken and must-know information to become a safe, confident, and successful medical-surgical nurse.

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