Question

Your patient is a 40 year old woman who is returned to your ambulatory care unit after having a cholecystectomy performed as minimally invasive surgery by laparoscopy. After moving her from the stretcher to her bed, you take her VS pulse is 118 and thready, blood pressure is 88/72 respiratory rate is 28 and pulse oximetry is 88%. When you call her name she opens her eyes but does not answer any questions. • What should you do first? • What manifestations of shock are present based on the information you currently have? • How would you classify this stage of shock? Provide a rationale for your evaluation. • What other assessment data should you obtain? • Given the type of surgery she has undergone, where would you expect bleeding to occur and what manifestations would indicate possible bleeding?

Answer 1

●The immediate action which has to be done are

• Administer oxygen via nasal cannula to treat hypoxia
• Fasten the IV fluid if on flow to increase the blood pressure
• Report to the provider or intensivist immediately for further plan of care
• Provide a painful stimuli to check her level of consciousness, or a GCS monitoring to assess neurological status of the patient

●The manifestation the patient presenting here are

• Hypotension
• Tachycardia
• Tachypnea
• Hypoxia
• Decreased level of consciousness

●The patient is in stage 1 or in initial stage because she is conscious on calling and compensatory mechanism like increased heart rate and respiratory rate to meet the body's requirement

●This evident with tachycardia and tachypnea

●The other assessment needed are

• serum lactate level
• ABG analysis to detect any acid base alterations
• Serum electrolyte variations happens in shock
• Assess the surgical site for any bleeding

●Injury to bile duct resulting in bleeding may rarely occur after cholecystectomy. The symptoms which can be expected are hypotension, decreased urine output,rapid thready pulse, fast respiratory rate.