A patient, recovering from a laparoscopic cholecystectomy one day ago, has an increased gastric carbon dioxide level and decreased arterial pH. Even with an indwelling urinary catheter, the nurse questions if the bladder is emptying

Question

Which of the following orders should the nurse question regarding the care of this patient? 1. insert urinary catheter to assist in monitoring intra-abdominal pressure
2. prepare for surgery to place catheter into peritoneal cavity
3. keep head of bed elevated 30 degrees at all times
4. utilize urinary catheter to assist in monitoring intra-abdominal pressure

Answer 1

1

Rationale: The patient is experiencing classic signs of abdominal compartment syndrome. The most accurate and direct way to monitor intra-abdominal pressure is to insert a catheter directly into the peritoneal cavity. The best way to determine alterations in intra-abdominal pressure is to utilize a urinary catheter to assist in measurement of pressure because this method is less invasive. However, since the nurse is not sure that the patient's bladder is empty, this method would not be appropriate and should be questioned by the nurse. The other two orders are appropriate. Elevating the head of the bed helps with respirations and surgery to place a catheter into the peritoneal cavity will help decompress the abdomen and decrease intra-abdominal pressure.