Question

Question: What clinical findings require immediate intervention for this client? Select all that apply

1. Absence of bowel sounds
2. Board-like abdomen
3. Diaphoretic and skin cool to touch
4. Heart rate
5. Blood Pressure
6. Platelet count
7. WBC count

Time	0830	1030
Blood Pressure	120/82	100/64
Heart Rate	88 bpm	128 bpm
Respiratory Rate	20/min	32/min
Temperature	100.2 F	100 F
O2 saturation	96%	91%
Urine Output	150 ml's in 3 hours	60 ml's in 2 hours

                                                                                          Laboratory Data

Time	0830	1030
Platelet Count	150,000	152,000
Hemoglobin	13 g/dL	10 g/dL
Hematocrit	48%	46%
WBC count	4,800	5,000

Answer 1

The following clinical signs need immediate intervention:

• Absence of bowel sounds and board like abdomen: it indicates either obstruction, perforation, injury or inflammation. This patient will most probably need laparotomy.
• Diaphoresis indicates sympathetic overactivity.
• Skin that is cool to touch, fall in BP and rise in heart rate over a short period of time indicates shock
• There is decrease in oxygen saturation which can also be due to shock
• The urine output has decresed to 30mlper hour. An output leads than 30ml per hour is oliguria in. A 60kg patient. So this patient needs fluid resuscitation and possibly vasopressors and inotropes to ensure renal perfusion.
• Fall in Hb. Possible bleeding. If further fall occurs, patient may need transfusions also