Ms. Espinosa is a 58-year-old patient who had abdominal surgery for diverticulosis and removal of a tumor two days ago. Her nurse, Dulce, implemented pain-control strategies to help her become more mobile for recovery. Up until now, she was getting out of bed and rating her pain at a level of 6 on a scale of 0 to 10. The patient still tends to guard her incision by placing her hand over the wound when moving.

Ms. Espinosa weighs 140 lbs and is 5 ft 2 inches tall. She has tried to cough more during her postoperative deep-breathing exercises. Dulce is caring for her for the third day in a row and begins the morning shift by inspecting her surgical wound. The wound is approximately 18 cm in length and closed with steel sutures. Dulce notices separation of the wound between two sutures at the bottom of the incision. There is a small amount of sanguineous drainage. The area is inflamed, and she asks the patient if the incision is tender when she gently palpates around the area. Ms. Espinosa states, "Ow, that is painful. I think I pulled it when I repositioned last night." She also rates pain at this time as being at a level of 5. Dulce checks Ms. Espinosa’s vital signs and notes that her temperature is 34.2°C. Dulce also inspects the intravenous access device in the patient’s left forearm. It is intact, and there are no signs of phlebitis at the IV site.

Ms. Espinosa knows that she will have activity restrictions, and her husband will be a resource to her once she returns home. Her discharge has been planned tentatively. Her family depends on her income. Now she begins to share concerns with Dulce about being able to return to work after surgery. She does not consistently attend to the nurse during instructions of her home care instructions. She also verbalizes some concern by asking Dulce, "The doctor told me that I would not be able to lift anything heavy, and I'm not so sure if I understand. The way my incision looks, will I need to do something to it?"

**Objective and Subjective Data:**

- **Objective Data:**
- Separation of wound between two sutures
- Small amount of sanguineous drainage
- Inflamed incision area
- Temperature of 34.2°C
- IV access intact, no phlebitis

- **Subjective Data:**
- Patient reports pain at level 5
- Concerns about understanding postoperative care instructions
- Concerns about ability to return to work

**Nursing Diagnosis Priorities:**

1. Acute Pain related to surgical incision.
2. Risk of Infection related to wound separation.
3. Anxiety related to concerns about postoperative recovery and return to work.

**Interventions:**

1. Administer prescribed pain medication as needed.
2. Monitor the surgical wound for signs of infection.
3. Educate the patient on proper wound care and activity restrictions.
4. Encourage the patient to express concerns and questions.
5. Provide clear, written instructions for postoperative care.

**Evaluation:**

1. Patient reports decreased pain levels.
2. Wound shows no further signs of infection or separation.
3. Patient demonstrates understanding of postoperative care instructions.
4. Patient expresses reduced anxiety regarding return to work and recovery process.