A nurse is caring for a patient after urinary diversion surgery. What postoperative nursing assessment is the priority?

Choice B rationale After urinary diversion surgery, such as an ileal conduit, a segment of the bowel is used to create the urinary tract. This manipulation of the intestines puts the patient at high risk for paralytic ileus. Assessing for the return of bowel sounds and the passage of flatus is a priority nursing action to determine when the patient can safely begin oral intake. Standard recovery involves monitoring for abdominal distention and bowel motility to prevent complications. Choice C rationale While monitoring fluid intake and output is important in any urological surgery to ensure kidney function and stoma patency, it follows the assessment of systemic physiological stability. The immediate postoperative period requires ensuring the GI tract is recovering from the use of bowel segments. Normal urine output should be at least 30 mL per hour. Fluid intake is managed intravenously until bowel sounds return, making the assessment of bowel function more critical for progressing the care plan. Choice D rationale Keeping the bed flat is not a standard priority after urinary diversion surgery and may actually be detrimental to respiratory effort. Patients are usually placed in a semi-Fowler position to reduce abdominal tension and promote lung expansion. There is no specific requirement for a flat position unless there are spinal complications or specific surgical contraindications. Proper positioning focuses on comfort and preventing pulmonary complications rather than maintaining a completely flat or supine posture.