# Stage 1 — Recognize cues. Review the postoperative handoff and highlight the five findings that most directly support an incisional surgical-site infection with systemic response requiring prompt surgical evaluation.

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> subject: System-Specific Assessments  
> category: ROR

## Question

Stage 1 — Recognize cues. Review the postoperative handoff and highlight the five findings that most directly support an incisional surgical-site infection with systemic response requiring prompt surgical evaluation.

At 0700, the nurse reviews Mr. B's postoperative-day-5 handoff. The record shows blood pressure 124/76 mm Hg and lactate 1.4 mmol/L, but overnight he developed temperature 38.6 C with heart rate 102/min. Yesterday the incision was intact and dry during the afternoon assessment, whereas it now has purulent yellow drainage saturating the current dressing. The abdomen remains soft without rigidity or crepitus, while the incision has erythema extending 5 cm with increasing incisional tenderness. Mr. B remains alert, tolerates a diet, and ambulates with assistance, but his WBC increased from 9.2 to 16.8 x 10^9/L with neutrophilia. The nurse confirms that postoperative prophylactic antibiotics stopped after incision closure and notes two loose staples at the newly draining lateral area. Mr. B has diabetes and obesity, and discharge had been planned for tomorrow.

## Explanation

Five priority cues
The strongest findings are new fever with tachycardia, purulent incisional drainage, extending erythema with increasing tenderness, acute leukocytosis with neutrophilia, and loose staples at the newly draining area. Stable blood pressure and lactate reduce evidence of current shock but do not negate infection. Diabetes and obesity increase baseline risk, while ambulation, diet tolerance, and properly discontinued prophylaxis do not establish the acute problem.

## In-depth explanation

Prioritize current change
New local and systemic changes carry more diagnostic weight than background risk factors. Purulent drainage is particularly important, while expanding erythema and tenderness show progression at the incision.

Do not overread stability
Normal blood pressure and lactate mean Mr. B is not currently showing those markers of hypoperfusion; they do not make a postoperative wound infection routine or safe to defer.

Separate prevention from diagnosis
Diabetes and obesity belong in risk assessment and prevention planning, but the immediate concern is established by the new findings. Stopping prophylaxis after closure is consistent with prevention guidance, not a cause of infection.

NCLEX rule
Highlight new, converging local and systemic findings, not every abnormal or historical detail.

## Clinical scenario

Scenario (Stage 1 — Recognize cues)
At 0700, the nurse receives report on a client whose discharge was planned for tomorrow after an uncomplicated open colectomy recovery.

Clinical judgment target
Identify the five changes that most directly establish the urgent working concern.

## Key concepts

- **Purulent drainage** — Opaque drainage containing inflammatory material from an incision; in current NHSN superficial-incisional SSI surveillance, purulent drainage can satisfy a criterion when the involved level is superficial.
- **Systemic response** — Findings such as fever, tachycardia, and leukocytosis that increase urgency and may support systemic antimicrobial therapy in addition to source control.
- **Source control** — Physical management of the infected focus, such as opening and draining an infected incision, rather than relying on antimicrobial therapy alone.

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