Post Op Care
0Dec 5, '03 by onenutshy101okay, here is the scenario. if anyone can help me with this i would greatly appreciate it or if they could tell me where to look it up, that would help also.
mr jones is a 70 yr old male who underwent colon resection at 8:45am. mr. jones had an extensive colon prep which involved golytly prep and enemas. he has remained npo since midnight last night and does well with his surgery.
post surgery he arrives in the recovery room at 11am, he has a
foley with 90cc clear yellow urine, an ng tube with 150cc of bloody drainage, an iv of lr@125cc per hour. he is drowsy, but
talking.estimated blood loss is 400cc.vs are:bp120/70,heart rate 78, resp18,temp98.2.
one hour after arriving to the floor he is anxious and agitated.
he complains of being cold, his skin is cool with a sluggish capillary refill time of 4 seconds.ng tube now has 200 cc's out since surgery, foley has 110 cc of amber colored urine. vs are:bp 90/55,hr96,thready and weak,resp24,temp99.0.
two hours after returining to the floor, he is confused, he hasn't required any pain meds, his skin is pale, cold and clammy,ng tube with 250cc's of output.vs are:bp74/60, foley has 110cc's, hr132,temmp99.4,resp16.
1.what is most likely wrong with mr. jones?
>2.what is the nurse's immediate response to this situation?
>3.list everything you would do for him, and give a rational why.
0Dec 6, '03 by sharannGotta do your own homework on this one but I'll give you a place to start:
Given his procedure and vital signs and output from ALL tubes and drains, is everything within normal parameters? You need to know the normals in order to know what is AB-normal. Great to see a new student here. Good luck in school. What semester are you in?
0Dec 6, '03 by GldngrlThink about why the heart rate has increased and the blood pressure decreased- the body tries to maintain homeostasis and is compensating. Think about the the amount of the NG drainage and the amount and colour of the urine. Look up symptoms such as hypovolemia, hypotension, tachycardia, and bleeding to help you see the picture and describe the issues. Best wishes-MMB
0Dec 6, '03 by stressednurseYUCK....Why wasn't anything done after the first hour?
Look at volume output
Look at vital signs
Look at patient, and not necessarily in that order.
Call the doctor
If you wait a little bit longer you can practice the ABC's of CPR.
Not being nasty just looks like this patient needed quicker attention about an hour ago.
0Dec 6, '03 by CCU NRSThey are not frequent but they happen, as for what to do always follow your ABC airway, breathing, circulation, Maintain a patent airway, provide whatever is necessary to assist breathing keeping SAT @ least 92% and use volume expander of fluid bolus to increase circulation and bring B/P up and Heart rate down.
Just my opinion
0Feb 15, '04 by seeleyI would say that this patient sounds 'shocky' and is in immediate need of intervention before he ends up perhaps arresting. It was an abdominal case so he likely needs volume and the surgeon needs to be called ASAP! He could just need more volume/ he could be bleeding internally. He needs a stat CBC and lytes drawn too.Doesn't sound like he should have ever left the PACU.