24 hours after surgery, surgical wounds are expected to drain small to moderate amounts of serous or serosanguinous drainage. The physician does not need to be notified because this observation is expected and not emergent; however, the doctor would be notified if drainage exceeds these expectations. The soiled dressing should be removed and replaced with a new dressing, and the wound site would not be irrigated unless infected; there are no signs of infection noted. The wound should not be open to air due to the risk of infection. The nurse should always document wound appearance and dressing changes.

Osteoporosis is common among elderly women. Patients require important education on how to live with the disease. Lifestyle changes such as diet and exercise should be promoted by the patient during discharge, and should be specific to the patient’s condition. Of the available options, the most accurate and essential information for the nurse to share should concern physical activity and exercise, as osteoporosis affects bone density and body strength. A recommendation for a doctor that specializes in bone pain may be beneficial, but is not a responsibility of the nurse (education is the priority). Patients with osteoporosis that are being discharged usually take ibuprofen to manage pain (not opioids or acetaminophen). A soccer program may not be appropriate for a 70-year-old woman with osteoporosis; a flyer for an adult walking group might be better.

Osteoarthritis generally presents as asymmetrical joint stiffness and pain, often with bony protuberances (osteophytes) that are either palpable or visible on imaging. Symmetrical joint involvement is more typical in rheumatoid arthritis. Joints will present with signs of inflammation: redness, heat, pain, and swelling, due to the inflammatory nature of this condition.

The anterior drawer test of the knee checks for injury to or instability of the anterior cruciate ligament. During this test the patient lies supine position with knees bent to 90 degrees. The practitioner sits on the both feet of the subject and places both hands around the upper tibia of the patient's symptomatic leg, then pulls anteriorly on the proximal tibia. A positive finding would be excessive anterior translocation or a soft end-feel, indicating a sprain or tear of the anterior cruciate ligament.

Smoking and alcohol ingestion are risk factors for developing osteopenia or osteoporosis. These activities should be discontinued to help prevent against bone loss. Diet and exercise are important factors, but losing 10 pounds or low impact exercise will not increase bone mass. 

The nurse should be aware of potential complications of cast placement, such as compartment syndrome, which can cause nervous, vascular, and muscle damage. Signs and symptoms include tingling distal to the cast placement, severe pain in the casted region, swelling in the cast and distal to the casted region, pallor in the affected region, and muscle weakness. These signs and symptoms would indicate immediate cast removal to prevent further damage to the tissue. Itching under the cast is common and expected, and pain in supporting shoulder of the arm can occur due to the increased weight and positioning of the cast. 3 seconds for capillary refill is within normal limits; extended time for capillary refill in the distal region would be concerning. Warmth in the hand and fingers distal for the casted region would indicate normal circulation as well, but congestion and swelling in the extremity would be worrisome.

Intestinal atresia is a malformation resulting in narrowing or absence of a portion of the intestine. Duodenal atresia is the most common type, followed by ileal atresia. Hirschsprung's disease is an issue of innervation in the large intestine that can result in narrowing due to contraction, but there is no structural malformation in the bowel itself. Malrotation and volvulus are often seen together when a part of the intestine does not anchor or turn correctly during formation (malrotation) and then becomes twisted around itself (volvulus), resulting in constriction and loss of function.

Intussusception occurs when part of the intestine folds into another section of intestine, much like a telescope. This results in sharp, crampy, or colicky abdominal pain, vomit of bile, and bloody red "currant jelly" stool. Black stool and "coffee ground" emesis are both symptoms of upper gastrointestinal bleeding (stomach, generally), while projectile vomiting may be associated with pyloric stenosis.

The most common location for diverticulitis is the sigmoid colon. This area generally has increased pressure as compared to the rest of the large intestine and is especially vulnerable to weakness in the muscle layers of the colon wall.