solved

Andy is a 37-year-old African male who arrives to the surgical ward following surgical removal of his gallbladder (Laparoscopic) . Vital signs post-op- temp – 37 0C, resp 16 rpm, p 78 bpm. Oxygen is being administered at 2 liters via nasal cannula. A pulse oximeter is placed on his left forefinger, and his oxygen saturation is measured at 95%. The patient is arousable but easily drifts off to sleep.
Patient history obtained during the preoperative phase of care showed that he was a 2 pack per day smoker, does not exercise and eats out alot. He states because of his job, he eats alot of fast food. He denies taking any prescribed or over-the-counter medications. Patient weight is documented at 110 kg (242.5lbs)
Further assessment post-op assessment, patient demonstrates normal skin perfusion with good capillary refill in all extremities. He has a hemovac drain in his abdomen with a small amount of yellowish discharge. The wound site and sutures are clean and dry without bleeding or discharge. No Foley catheter is in place; when questioned, he denies the need to void. Completing a head-to-toe assessment shows no other alterations from baseline.
Andy wakes when the second set of vital signs is obtained. (Order V/S q15 min for 1 hour, every 30 mins for 2 hours and then, every 4 hours for 24 hours) .He reports that his pain is 6 on a 10-point scale. He states that he has pain in his shoulder and pressure in his abdomen. Morphine (5 mg) is ordered.
At 45 minutes after admission, the patient’s oxygen saturation is noted to be 90%. Andy is instructed on how to use the incentive spirometer. His oxygen flow is increased to 4 liters/minute by nasal cannula. No change in the patient’s oxygen saturation is noted despite compliance with the respiratory exercises. His wife is in the waiting room and was further question about her husband’s cigarette use and any other respiratory issues her husband may have had prior to surgery. She reported that he was experiencing nasal congestion and signs of a developing cold.
At one hour after admission, the patient’s oxygen saturations remain at 89% to 90%, his respiratory rate is 16 breaths per minute, and he is more difficult to arouse. The nurse notifies the physician of the changes in his status. Oxygen delivery is changed to a face mask at 4 liters/minute without improvement in the oxygen saturation level. All other parameters remain stable.
Despite the improvement in the patient’s status, the oxygenation issue remains worrisome. Respiratory exercises are continued, eventually demonstrating an improvement in oxygen saturations to a high of 94%. The next morning, the patient is discharged to home with necessary instructions.

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