The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient’s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54 mmHg. The nurse contacts the provider to report these findings and advocate for which initial order?

Question

The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient&rsquo;s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54 mmHg. The nurse contacts the provider to report these findings and advocate for which initial order?

Accepted Answer

Infuse 1L 0.9% NaCl STAT. Due to the patient&rsquo;s blood loss during surgery, decreasing urine output, decreasing blood pressure, and increasing heart rate, the patient is experiencing a fluid volume deficit and impending shock. The nurse advocates for an isotonic fluid bolus to help prevent impending circulatory collapse. This patient should also be transferred to the intensive care unit for further management. It is possible that a dopamine infusion is necessary but fluid replacement should occur first. The CBC and CMP may not yet reflect the patient&rsquo;s blood loss, so this is not the best initial action (although it should be performed shortly after the bolus). Furosemide is not indicated in the setting of oliguria caused by blood loss.

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