OK so I'm not a new nurse but I'm new at a certain hospital and maybe need a brush up on somethings or just would like to see what y'all think.
Last night I took care of a cirrhotic pt who came to us because apparently after they took 8 L off her abdomen last week, she started to "leak" from her umbilicus. Her WBC was elevated and the MD wrote "concerning for SBP." When I assessed her, she had no pain and palpating her abdomen she was soft and non-tender. Whenever I have taken care of SBP patients in the past, they've had lots of pain! Isn't that normally true?
She had a low BP and apparently that is normal for her but 80s SBP and I get worried. I waited to see if she would improve and she didn't and so I contacted hospitalist who ordered lactic acid level which came back elevated (2.6). They later ordered a dose of albumin and a 500ml bolus. Her BP never got better and actually decreased to mid 70s SBP. She looked OK, no s/s but how can I just leave her BP that way? Kept bugging the hospitalist and then she ordered ANOTHER lactic acid and bolus of NS.
I've seen liver pts before with low BPs but at what point can I say, oh I can accept a lower MAP because she's a liver patient....? Don't they still "deserve" a MAP of 60 to 65?
The charge had the look that I wasn't worried enough about the pressure (uh...I was bothering the hospitalist multiple times) and the dayshift nurse who knew the patient and thought I shouldn't have been worried at all.
Also, why did the MD order ANOTHER lactic acid so fast? I always thought lactic acid levels were to assess for sepsis, but it almost was as if the MD was using the level to check for improvement in fluid status/hypovolemia?? Or what am I missing?
I know there are a few things mentioned in this post. Thanks to all who respond!