Help! Hypotension care plan!

you don't make a decision on a nursing diagnosis and then try to make a rationale by cramming your facts into it (common nursing student error, though). you take your facts and assessment data and look at them, and that's where your nursing diagnosis comes from. data first, diagnosis second.

so. you have:

a trauma patient with 8 fractured ribs and a pneumothorax

epidural catheter, test dose of 1% lidocaine

blood pressure dropped to critical values (down to 57/35 at one point)

given neo and narcan (had 5mg of dilaudid and 4 mg of morphine previously)

if you're looking for a nursing diagnosis, i don't think you have to look much further than that. he had an actual (not risk-for) episode of decreased perfusion, as evidenced by a bp of 57/35. this was related to vasodilation from his opioids and epidural. does that make sense? what makes you think he's at risk for doing it again, what data support that conclusion? am i missing something? (and spo2s don't have much to do with this)

ok, thanks. I guess I thought that because his oxygen saturation remained normal that he was perfusing well enough. I was really just not sure how to word the diagnosis correctly. That makes sense though. Thanks!

I just wanted to elaborate on the previous post's discussion on the O2 saturation and low BP. There are situations when a person may have low O2 saturation because of low BP. For instance, a person with a significant blood loss. O2 saturation is the measurement of how much O2 is attached to hemoglobin at any given moment. Or, O2/hemoglobin. That's why O2 saturation is expressed as a percentage. Like, 97% in this case. Now, in your patient's case, his vasculature dilated, dropping the BP, related to the vasodilation effects of the test. However, pulseOx remained okay because there wasn't a O2/Hgb issue but a vasculature issue. In your patient's case, you addressed the issue with narcan and such. It terms of ABCs or maslow, the pneumothorax is likely priority. Could be a number diagnoses related to this. Risk for Injury r/t loss of negative pressure in the lungs. As well as others mentioned above. The folks above sound much more seasoned than myself. Just my two cents. Good luck! :)

Well impaired tissue perfusion related due decrease mobility since trauma. Without mobility blood does not flow as with an active patient and when blood sits blood clots so secondary risk for clots.

Are you wanting to focus on tissue integrity or the rx route?

Also if he is a heavy guy with large body fat percentage then remember that the fat can cause drugs such as narcotics to linger or have a longer rebound time.