Peritoneal and blood cultures are sent to the lab and…
Peritoneal and blood cultures are sent to the lab and focused assessments are completed. IV Normal Saline is started at 100cc/hr. The following assessment data is obtained. Anxious and restless in bed Oriented to person and place Shallow depth of respirations Auscultated lung fields clear throughout 2+ radial pulses, 1+ pedal pulses Capillary refill >3 seconds Skin cool and pale Diminished bowel sounds Client denies chest pain, heartburn, and nausea Time 1600 1700 1745 2120 2230 0200 0615 0730 Unit Pre-op Surgery Post-op MS Vital signs Temperature 98.9° F (37.2° C) 99.5° F (37.5° C) 100.9° F (38.3° C) 101.6° F (38.7° C) 102.3° F (39.1° C) 102.5° F (39.2° C) Heart rate 89 beats/min 95 beats/min 88 beats/min 108 beats/min 116 beats/min 120 beats/min Cardiac rhythm NSR NSR NSR ST ST ST Blood pressure 145/67 mm Hg 126/60 mm Hg 120/60 mm Hg 108/57 mm Hg 95/51 mm Hg 90/48 mm Hg Respiratory rate 18 breaths/min 18 breaths/min 22 breaths/min 24 breaths/min 28 breaths/min 28 breaths/min O2 saturation 95% 94% 98% 92% 90% 88% O2 device None None 2L NC 2L NC 4L NC 50% VM Pain Denies Denies Abdomen 4/10 Abdomen 4/10 Abdomen 6/10 Abdomen 6/10 Capillary blood glucose 148 mg/dL (8.2 mmol/L) 136 mg/dL (7.6 mmol/L) 186 mg/dL (10.33 mmol/L) 205 mg/dL (11.39 mmol/L) 260 mg/dL (14.4 mmol/L) Labs RBC 4.8 × 1012/L 4.9 × 1012/L 4.8 × 1012/L WBC 11,000/mm3 (11 109/L) 11,800/mm3 (11.8 × 109/L) 16,000/mm3 (13 × 109/L) Platelet 110,000/mm3 (110 × 109/L) 100,000/ mm3 (100 × 109/L) 90,000/ mm3 (90 × 109/L) BUN 72 mg/dL (25.71 mmol/L 79 mg/dL (28.21 mmol/L Creatinine 4.8 × 1012/L 6.3 × 1012/L APTT 33 sec 55 sec INR 1.3 1.7 Lactate 4.2 mmol/L (41.53 mg/dL) Arterial blood gas pH 7.22 PaO2 60 mm Hg PaCO2 55 mm Hg HCO3− 20 mEq/L Cultures Peritoneal Pending Blood Pending What is the most likely explanation for this client’s condition?
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