Post Op Care

[onenutshy101]

okay, 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.

[sharann, BSN, RN]

Gotta 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?

[canoehead, BSN, RN]

I would look up his code status....and kick in the butt whoever admitted him to the floor and didn't do Q15min checks.

[onenutshy101]

I am in the second semester, we have never HAD to go over any of this information, and it is quite a doozy from what we have had to do previously. Actually, I graduate in August of 2004. Thanks though for your help.

[Gldngrl]

Think 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

[stressednurse]

YUCK....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.

Think SHOCK

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.

[CCU NRS]

They 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

[onenutshy101]

I have to say thank you, of course from what I understand this is a scenario, not a real patient, but you never know. I was leaning towards a bleed or some type of reaction, but I wasn't sure exactly what it needed.

[Geeg]

With postop bellies suspect hypovolemia.

[seeley]

I 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.

Seeley

[sharkiern357]

This patient sounds as if he is suffering from hypovolemic shock. This is a common complication if abdominal surgery. Secondary complication could be internal bleeding. The diagnosis has to be based on patient examination and factual evidence such as studies. The assessment should include a head to toe with focus on the abdominal cavity. Lab should include a CBC and CMP this will rule out dehydration vs internal bleed. Next a CAT scan of the abdomen for bleeding, obstruction. No contrast should be used secondary to fear of perforation. The Doctor of course should be notified immediatly to obtain this orders and should have been contact at the first signs of distress with technically occured within the first hour of the patients care.