Sheila Dalton - Surgical Pain Management

Sheila Dalton is a 52-year-old woman who has a history of chronic low back pain and COPD. She had a posterior spinal fusion of L4-S1 today. She had an estimated blood loss (EBL) of 675 mL during surgery and received 2500 mL of Lactated Ringers (LR). Pain is currently controlled at 2/10 and increases with movement. She was started on a hydromorphone patient-controlled analgesia (PCA) with IV bolus dose of 0.1 mg and continuous hourly rate of 0.2 mg. Last set of VS in post-anesthesia care unit (PACU) P: 88; R: 20; BP: 122/76; requires 4 liters per n/c to keep her O2 sat 90 percent. You are the nurse receiving the patient directly from the PACU. Personal/Social History: Sheila is divorced and currently lives alone in her own apartment. She has two grown children from whom she is estranged. What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: EBL of 675 mL 2500 mL of LR administered during surgery Pain is currently controlled at 2/10 Hydromorphone PCA with bolus dose of 0.1 mg and continuous hourly rate of 0.2 mg Requiring 4 liters per n/c to keep sat 90% An EBL 500 mL is a clinical RED FLAG that requires increased vigilance by the nurse. How will this im