Scenario:
Patient is a 68-year male patient who has a history of fluid and electrolyte imbalance. Mr. Donald is status post coronary artery bypass graft (CABG) 3 days ago. He also has multiple co-morbidities, colon cancer, anemia, and hypertension. Alterations in fluid and electrolyte status are common in the elderly population. Therefore, maintaining and managing fluid and electrolyte balance is of utmost importance in preventing avoidable events, complications and mortality.
Mr. Donald has a history of colon cancer and sought treatment as soon as he noted visible blood in his stool. His bowel patterns are not regular as he experience severe diarrhea or constipation. Gastroenterologist was consulted by the attending physician.
Now, Mr. Donald had a partial colectomy and a colostomy, day 1 post-op. Morphine via PCA pump and an IVF NS + 20 mEq KCL at 75 mL/hr. Experienced insomnia and required 2 bolus of Normal Saline for hypotension. He has a hemovac and it drained 200 mLs of serous sanguinous drainage over 24 hours. Surgical dressing to the mid abdominal area dry and intact. He has a colostomy bag, currently with no effluent noted. Oxygen via nasal cannula at 4 L/min. O2 sat 95% on 02 at 4L via nasal cannula. Blood sugar are well controlled. He lives alone.
Temperature 37.0 C
Heart rate 118
Respiratory rate 22
Blood pressure 92/50
Oxygen saturation 96%
Hourly urine output 27 ml/hr
Blood sugar 74 mg/dl
1. Which of the following of the vital signs are considered to be within normal parameters for Mr. Donald. What are the normal values for the other vital signs? (2 points)
a. Temperature
b. Pulse rate
c. Respiratory rate
d. Blood pressure
2. His 02 sats are OK, right. A normal 02 sat level for Mr. Donald would be: (2 points)
a. 80-85%
b. 85-90%
c. 90-95%
d. 95-100%
True or false. Rational for your answer 3 points each. 1.5 point deducted for incorrect rational. Refer to the table
Statements T or F Rational
3. He is hypertensive from excessive IV fluids T or F Rational
4. He is hypoxic as a result of the extended anesthetic period T or F Rational
5. He is hypotensive from the preoperative bowel prep T or F Rational
6. He is hypertensive as a result of surgical blood loss T or F Rational
7. He has a post operative wound infection T or F Rational
8. He has severe postoperative pain T or F Rational
9. He is oliguric from hypotension T or F Rational