I'm trying to figure out what my second diagnosis for this patient should be. Based on the information I gathered and assessment data I think that fluid volume deficit should be used. But not sure because of what my ND book says. So this is the same patient from my previous post, the one with pleural effusions. Now I'm trying to address the low BP issue. Her BP's were as low as 92/49 and HR up to 115 at times. She reported lightheadedness, dizziness, but no other symptoms. She actually looked much better than she had the day before and other than having trouble taking a deep breath she was fine. But her H&H was 8.4 & 25. Also RBCs were 2.88. This data is what made me think fluid volume deficit. She had several surgical procedures on 8/28 (gastrectomy-removal of mass, spleenectomy, total abd hysterectomy, partial choly, and hiatal hernia repair). She was admitted on 9/10 due to pain on inspiration, SOB, and worsening cough. This is when they discovered abd fluid collection and the pleural effusion (multiple loculated). The cause of the pleural effusion was unknown, but they did a thoracentesis (exudate). Then on the 16th she had a thoracotomy and afterwards a chest tube was placed for drainage. She had about 300ml of drainage all together, serosanguinous, but it was serous when I left and had slowed way down. Her respiration's were shallow, crackles in LLL, but O2 99 and RR 16-20. ABGs were normal.
She has CKD stage 3, but it is well controlled and she has no complications from that at all. At least not that I witnessed. She also has osteoarthritis, RA, HTN, a history of anemia, and vitamin D deficiency.
She had an order for lotrel, but the amlodipine was held and benazepril given. Other meds that she got while I cared for her were flonase, patanol, and claritin.
Do you guys think that I'm wrong about fluid volume deficit rt blood loss? I'm just trying to figure out why her BP was low and how critical this is. Her RN wasn't too concerned. And the patient was acting like she was fine. She actually looked better than she had the day before. I just thought that it was important to make interventions to ensure that it doesn't drop any more. But I'm not sure if blood loss is even the cause. I know the meds are affecting it, but then there's the decreased H&H and RBC.
