Summary
Highlights
A new nurse, Jess, receives a patient handover from Rick about a 27-year-old male, two days post-op from a left knee replacement. The patient is alert but drowsy, has a Foley catheter, a clean dressing to be assessed by a physician, a left knee immobilizer, and a PCA pump with morphine. His last vitals were blood pressure 98/65, respiratory rate 11, heart rate 90, temperature 36.7, and pain level 3.
Rick notes the patient's blood pressure is low and respiratory rate is borderline. He asks about the patient's normal vitals, which were higher: 120/76 BP and 14-16 respiratory rate. Rick highlights that the patient is trending down and questions Jess about the PCA pump settings and usage history, suggesting that the morphine could be contributing to the patient's drowsiness and low blood pressure. He emphasizes checking the PCA history to assess its effectiveness and side effects.
Rick asks Jess if BUN and creatinine levels were checked, connecting it to the patient having no other fluids running and being on a morphine pump. He explains that morphine can decrease these levels, potentially causing drowsiness and lower blood pressure. He directs Jess to check the morphine pump first given his symptoms.
Rick and Jess enter the patient's room. The patient, Mr. Martinez, states he feels sleepy. Rick checks the PCA pump display, confirming that the patient hasn't been pushing the button frequently because he doesn't 'feel too great' when he uses it. Rick asks Mr. Martinez if he would like them to call the doctor to see about a different pain medication or dose.
Rick instructs Jess to get another set of vitals. He also confirms that Jess has updated the urine output, which is 150. They assure Mr. Martinez they will be back shortly after consulting the doctor.