You are a new graduate nurse on your second rotation in a 40-bed acute surgical ward specialising in cardiothoracic-surgery. It is 1800hrs on your afternoon shift and you have been allocated the care of a 70-year-old male who has been transferred to your ward 6 hours ago from the Intensive Care Unit (ICU). The patient has been recovering in the ICU for 2 days following heart bypass surgery.
Past Medical History: NIDDM, IHD, HT, Obesity
You introduce yourself to the patient and begin your observations. You note that the patient is cool to touch and clammy (Temp 35.9). The patient's radial pulse is 140. Blood pressure is 95/70 and respiratory rate is 28 breaths a minute. The patient has an IV cannula in the right hand that has IV fluids (Hartmann's Solution) running through an IV pump at 65mL hour. The patient has an IDC in place and the urine output for the last 4 hours is 20mL .
Other Clinical Signs: SpO2 95% on nasal prongs at 4L/min
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Lab Results: ABG
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UEC's
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FBC
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pH 7.33
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Na 140 mmol/L
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Hb 90 g/L
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Pa02 75 mmHg
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K 4.7 mmol/L
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WCC 7.0 x 109/L
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PaC02 35 mmHg
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Cl 100 mmol/L
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PLT 300 x 109/L
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HC03 18 mmol/L
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Urea 15 mmol/L
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Creat 115 μmol/L
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Questions
1. Based on the information given in the (above) case study start by prioritising and justifying your immediate care of this patient?
2. You also need to interpret both clinical and lab results, and
3. What physiological processes may be responsible for the abnormal clinical or lab results?