scenario

[maryann.ihejieto]

A 74 year old man who is 6 hours post bowel resection. He has been transferred from recovery into the unit where you work. patient has infusion of normal saline 0.9% via a peripheral cannula and an epidural for pain control. you approach to do a set of post-op observations. bp 91/49, sats 98, hr139, temp 35, rr 27 and pain score 0.

Nursing practice: from the above, what information would you consider vital to convey to a member of the medical staff to indicate the patient's status and what recommendations would you make.

[traumaRUs, MSN, APRN]

What do you have so far? While our members will offer lots of assistance, it helps if we know what info and answers you have collected. Thanks.

[Esme12, ASN, BSN, RN]

Welcome!

We are always happy to help...what has your research revealed to you?

[KelRN215, BSN, RN]

Well, what do these vitals reveal to you? What is abnormal and why?

[TheNGTKingRN]

Maryann,

I really would like to know what your thoughts are.

What looks abnormal?

[loveofrn, BSN, RN]

Ok, it seems like the op is not responding but I want to see if am on the right track on this scenario.

Since the patient just got out of surgery then it is normal for his temp to be 35 (95 f) because they are usually hypothermia and this is mild hypothermia just below the normal range and my intervention would be to give a warm blanket.

The epidural is really working to control the pain. However, for blood pressure and the heart rate the patient NS would compensate for fluid loss which will increase his bp and lower his heart rate.

For RR to be 27, I will check whether the patient is using his accessory muscles to breath then raised the bed to high Fowler position and I will continue to assess this patient to check his vital for the next 24 hours if there is any improvement.

However, this patient might be at risk for infection such as sepsis. I would tell the doctor to run some test to rule out infection because these vital signs are suggesting infection. Again, the patient just got out of surgery.

PS. I’m about to start clinical next semester and I hope am on the right track.

[psu_213, BSN, RN]

What looks abnormal?

This one sounds like it could be fun…I hope the OP comes back with his/her thoughts.

[psu_213, BSN, RN]

Ok, it seems like the op is not responding but I want to see if am on the right track on this scenario.

Since the patient just got out of surgery then it is normal for his temp to be 35 (95 f) because they are usually hypothermia and this is mild hypothermia just below the normal range and my intervention would be to give a warm blanket.

The epidural is really working to control the pain. However, for blood pressure and the heart rate the patient NS would compensate for fluid loss which will increase his bp and lower his heart rate.

For RR to be 27, I will check whether the patient is using his accessory muscles to breath then raised the bed to high Fowler position and I will continue to assess this patient to check his vital for the next 24 hours if there is any improvement.

However, this patient might be at risk for infection such as sepsis. I would tell the doctor to run some test to rule out infection because these vital signs are suggesting infection. Again, the patient just got out of surgery.

PS. I’m about to start clinical next semester and I hope am on the right track.

You really have some good responses, and I really like to see that from a student who has yet to start clinicals!

Some critical thinking questions:

The elevated HR…what does that represent? Remember it is bowel surgery. Did they give him enough fluids during surgery? Could it be dehydration? What labs would point you in that direction?

You mention sepsis. What in his assessment/VS point to sepsis? What lab(s) would help to establish a (medical) diagnosis of sepsis?

Thinking along the lines of sepsis…what do you want to make sure (medication wise) is ordered for the patient? This is really putting the critical thinking skills to the test--given that the pt just had bowel surgery, be as specific as possible when thinking about what med you want to see ordered.

[loveofrn, BSN, RN]

The elevated HR…what does that represent? Remember it is bowel surgery. Did they give him enough fluids during surgery?

Well, maybe the patient needs oxygen but is sat is 98 which doesn't add up because if sat is 98 then that means there is enough oxygen in the blood to help the body or does it mean there is a decrease in oxygen circulation to other part of the body which leads to high HR.

Could it be dehydration? What labs would point you in that direction?

This depends on assessment, but if it is dehydration then that means the patient does not have enough fluid and which will also means the patient might be constipated. So that means something is wrong with the bowel.

Also the patient will have low urine output (oliguria) if it is dehydration but this scenario is not pointing towards dehydration or is it, well am not sure.

You mention sepsis. What in his assessment/VS point to sepsis? What lab(s) would help to establish a (medical) diagnosis of sepsis?

CBC for infection, colonoscopy for the entire colon, assess his abdomen whether he has active bowel sounds.

[KelRN215, BSN, RN]

You mention sepsis. What in his assessment/VS point to sepsis? What lab(s) would help to establish a (medical) diagnosis of sepsis?

CBC for infection, colonoscopy for the entire colon, assess his abdomen whether he has active bowel sounds.

A colonoscopy is not a lab. And unlikely to be done in the immediate post-operative period on a patient s/p bowel resection.

What is sepsis? What specific test can diagnose the presence of bacteria in the blood?

[TheNGTKingRN]

Sepsis ... I always think low bp, elevated HR, deceased UOP, look at the lactate levels, blood cultures, maybe a UA, and a CBC.