T.C. is a 49-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingo-
oophorectomy for abdominal pain and endometriosis.
Postoperatively, she experienced an intra-
abdominal hemorrhage, requiring transfusion with 3 units of packed red blood cells (RBCs). after
discharge, she continued to have abdominal pain, chills, and fever. She was readmitted twice: first for
treatment of postoperative infection and second for evacuation of a pelvic hematoma. Despite treat-
ment, T.C. continued to have abdominal pain, chills, fever, and nausea and vomiting.
T.C. has now been admitted to your unit from the postanesthesia care unit (PaCU) after an explor-
atory laparotomy. Vital signs (VS) are 130/70, 94, 16, 99.7 ° F (37.6 ° C). Respirations are shallow and her
Spo2 is 93% with oxygen at 2 L by nasal cannula. She is easily aroused and oriented to place and person.
She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact
and a Jackson-Pratt drain that is fully compressed and contains a scant amount of bright red blood. Her
Foley to down drain has clear yellow urine. She is receiving an IV of 1000 mL D5.45NS at 100 mL/hr in her
left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a
patient-controlled analgesia (PCa) pump. The settings are dose 2 mg, lock-out interval 20 minutes, 4-hour
maximum dose of 30 mg. When aroused, she states that her pain is an 8 on a scale of 1 to 10.
What concerns you most right now about T.C. and why?
With the shallow respirations, respiratory rate of 16, Spo2
of 93%, and temperature of 99.7 ° F,
T.C. appears to be experiencing postoperative hypoventilation that if not reversed could lead to
development of atelectasis and pneumonia.
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