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Jim Smith is 55-year-old male who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. His past history includes obesity, obstructive sleep apnea, HTN, diverticulitis, and inguinal hernia repair x 2.

During surgery his systolic blood pressure dropped to 70 mm Hg. Six units of packed red blood cells and 3 L of normal saline were administered intravenously to restore blood loss and circulating volume. He remained stable during his post-op recovery in the PACU, but in report, you are told his BP was a bit lower 96-104/SBP and P 100-110, but expected. Patient also required oxygen via nonrebreather mask after extubation as his SaO2 hovered around 90-92%.

He arrives to the floor from the PACU. He is receiving 60% oxygen through a nonrebreather face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline intravenously at 125 ml per hour. A urinary catheter is in place. He is settled into bed and monitoring continued.

Your initial assessment:

• Difficulty in breathing, inability to lie flat
• He complains of diffuse abdominal pain. Sharp pain on palpation over the incisional area
• Vitals:
  • Respiratory rate 28/min;
  • Sp02 88%; fine crackles at lung bases.
  • Blood Pressure 100/60;
  • Sinus tachycardia at 120/min
  • Temp 101
• Urinary catheter draining concentrated urine, less than 30 ml/hr

The care provider orders ABGs. The results come back as such:

• pH 7.35,
• Pa02 59;
• PaC02 27;
• HC03 16,
• 02 sat 89%.

What would be your first actions in the nursing care of this patient with the rationale for your interventions? What do this lab values mean? Explain the etiology behind these lab values with the case study patient

• The patient is a great risk for what syndrome? Explain your answer

Fill out a concept map for the patient in the case study. Feel free to us the space below to also add to the map