Learning Issue: Janice is at risk of Deficient Fluid Volume
As a learning issue I will be discussing the importance of haemodynamics in relation to monitoring vital signs and urine output, checking blood results and relate these factors to Janice’s deficient fluid volume.
Janice is at risk of deficient fluid volume related to active loss secondary to presence of indwelling drainage tubes; wound drainage, inadequate intake of fluids secondary to surgical procedure, failure of regulatory mechanisms with third spacing of body fluids secondary to the effects of anaesthesia and blood loss during surgery (Swearingen, 2007.p.52). It is important to monitor Janice’s vital signs every half an hour for the first hour and then hourly for the next four hours of the postoperative period, in particular her blood pressure. Blood pressure should not be less than systolic 100mmHg. As a Nurse, it is important to notice a change in readings more than 20mmHg below Janice’s normal range suggesting immediate intervention to avoid irreversible organ damage due to hypo perfusion (Swearingen 2008.p.158). Monitoring and measuring Janice’s urinary output every hour for the first 4 hours, then 4 hourly thereafter ensures that Janice’s urinary output is observed closely. Anything less than 30mL/hr would also suggest hypo perfusion. If the kidneys are not producing enough urine, they are also not producing enough of the hormone renin which helps control blood pressure. Swearingen (2008) states that it is important for the nurse to be aware of the physiological dynamics of surgical diuresis. After a major surgical procedure that produces high physiologic and psychological stress, increased secretion of antidiuretic hormone (ADH) causes fluid retention within the vascular space.
Checking Janice’s blood results and paying attention to Haemoglobin (Hb) levels and Red blood cells are important. Janice’s Hb is 87L and Red blood Cells (RBC) 2.8L. This indicates anaemia. (Brown...
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