The nurse is caring for a client who is 24 hours postoperative cholecystectomy. The client has a meperidine (Demerol) PCA pump. Which symptom should be reported to the physician immediately?
1. Constipation
2. Respiratory rate of 18 breaths per minute
3. Urine output of 15 mL per hour
4. Blood pressure of 130/80 mmHg
3
Rationale 1: Constipation does not need to be reported immediately.
Rationale 2: Respiratory rate of 18 breaths per minute is a normal respiratory rate for an adult.
Rationale 3: Renal status and urinary output should be monitored. The nurse should report a scanty urine output.
Rationale 4:The blood pressure is slightly elevated but not a priority.
Global Rationale: Renal status and urinary output should be monitored. The nurse should report a scanty urine output. Constipation does not need to be reported immediately. Respiratory rate of 18 breaths per minute is a normal respiratory rate for an adult. The blood pressure is slightly elevated but not a priority.
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