After fistula repair, the nurse must advise the patient on discharge that?

HPSSC - 2015

Obstetrics and Midwifery Nursing

Hard

Appeared in: HPSSC - 2015

Explanation

Discharge advice after fistula repair must include instructions for both the immediate healing period and long-term prevention of recurrence.
Abstinence from sexual intercourse for approximately 3 months is crucial. This allows the delicate surgical repair to heal completely without being subjected to mechanical stress, which could cause the repair to break down.
Planning for an elective caesarean section for all future deliveries is mandatory. The immense pressure of labor and vaginal birth on the repaired tissue would likely cause the fistula to recur.
Because both abstinence and a future C-section are critical, non-negotiable instructions, the option that includes both is the most complete and correct answer.

Option A: Pelvic floor exercises (Kegels) are contraindicated in the immediate post-operative period. They can create tension and strain on the fresh suture lines and healing tissues, potentially leading to the failure of the repair.
Option B: While advising abstinence for 3 months is a correct and essential part of the discharge instructions, it is not the only critical piece of long-term advice. This option is incomplete.
Option C: While advising that the next delivery must be by caesarean section is a correct and essential part of the discharge instructions, it is not the only critical piece of advice for the immediate healing period. This option is incomplete.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Post-operative discharge teaching for a patient after fistula repair in the correct sequence, documenting the action clearly, and monitoring for the expected response.
The nurse's role in patient education is paramount to prevent fistula recurrence. A failed repair has devastating physical, social, and psychological consequences for the patient.
Clear, empathetic, and firm communication is necessary to ensure the patient understands and adheres to these life-altering restrictions.
In the Indian context, where access to specialized care can be limited, preventing recurrence is a top public health priority. Nurses are at the forefront of this effort through effective patient counseling.

How to Approach the Question

First, identify the core of the question: What is the essential discharge advice after a fistula repair?
Evaluate each option based on standard surgical and obstetric principles. Consider both short-term healing and long-term prevention.
Analyze Option A: Are pelvic floor exercises done immediately after surgery? No, they can strain the repair. This is incorrect.
Analyze Option B: Is abstinence necessary? Yes, to allow healing. This is correct.
Analyze Option C: Is a C-section necessary for future births? Yes, to prevent recurrence. This is also correct.
Notice that both B and C are correct and essential. Look for a composite option. Option D combines both B and C, making it the most comprehensive and best answer.

Concept Tested & Keywords

Concept Tested: Post-operative discharge teaching for a patient after fistula repair.
Stem keywords: fistula repair, discharge, advise
Lead-in keywords: BEST, MOST RELEVANT CLUE
Negative lead-in flag: false

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E6 Gynecology Williams pp. 246-301, 224-269