A client is being evaluated for discharge from the postanesthesia care unit. The client's blood pressure has been 120/76 with a preoperative baseline of 124/80. This client has moderate bleeding and is vomiting every 20 minutes
Which other assessment would mandate the client stay in postanesthesia care until more stable? 1. Moderate pain
2. Blood pressure 120/76
3. Able to ambulate
4. Pulse oximeter 93%
Moderate pain
Rationale: This client who is experiencing moderate bleeding and frequent vomiting would receive a score of 8 on the PAD. If the client also complained of moderate pain, the PAD score would fall to 7, which would require the client to stay longer in the unit. A blood pressure of 120/76 is within 20% of baseline, the ability to ambulate, and a 93% pulse oximeter reading would all indicate the client is stable enough to discharge.
You might also like to view...
A patient has been newly diagnosed with myasthenia gravis. What important teaching will the nurse provide the family?
A) If one dose of medication is missed double the next dose B) The warning signs of drug overdose C) How to encourage activity when the patient is tired D) Importance of monitoring level of consciousness
The nurse should monitor the client taking verapamil for:
a. hypotension. c. diarrhea. b. hypertension. d. euphoria.
Which are appropriate interventions for the nurse to include in the plan of care for a child who is receiving traction? Select all that apply
1. Monitoring breath sounds 2. Assessing neurovascular status every 2 hours 3. Repositioning every 2 to 3 hours 4. Using moleskin to protect the skin from rough edges 5. Encouraging the parents cuddle with their child
In burn injury patients, the rule of nines and the Lund and Browder chart are used to estimate:
a. depth of burn injury. b. possibility of infection. c. degree of systemic involvement. d. total body surface area burned.