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Discussion

Case Study help

I'm working on a case study from Winningham's critical thinking book and I'm stuck on this question. I just need some guidance or hints because I'm really stuck.

Scenario

M.N. age 40 is admitted with acute cholecystitis, elevated WBC, and a fever of 102F. She has undergone an open cholecystectomy and has been transferred to your floor. It is the second day postop. She has a NGT to continuous low wall suction, on perpheral IV and a large abd dressing. her orders are as follows: progress diet to low-fat diet as tolerated; D51/2NS with 40mEq KCL at 125 ml/hr; TCDB q2h; IS q2h while awake; dangle in AM, ambulate in PM; morphine sulfate 10mg IM q4h prn pain; ampicillin 2 g IVPB q6h; CXR in am.

Progress Report: Her VS are 148/82, 118, 24, 101F Sao2 is 88%.

based on her vital signs, what do you think could be happening to M.N. and why?

Sepsis would involve hypotension, if it's atelectasis, I can't find any literature that lists these vital signs as part of the presentation

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    What are common post op complications for the surgical patient?

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    • Author

    Pain, infection, atelectasis, blood clot, effects from anesthesia...that's all I can think of. The case study unfolds into an atelectasis case, but I can't find a reference stating hypertension, tachycardia, or a fever can be symptoms of atelectasis.

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    This is interesting. I am not sure how the fever relates to the atelectasis..she was admitted with eleveated WBC's and they remain elevated after sx, which could explain the fever. My first thought was pulmonary embolism but pts usually have hypotension. Please update if your professor provides a rationale.

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    • Author

    I found a paragraph in my textbook that says the following: "Clinical signs are decreased or absent breath sounds, noisy respirations, decreased O2 sat., chest asymmetry, sternal retractions, accessory muscle use, trachea deviated form midline, fever, tachypnea, dyspnea, tachycardia, diaphoresis, pleural pain, increased restlessness, anxiety." That pretty much has all the symptoms if anxiety is causing the hypertension.

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