solved

After getting report from the off coming nurse and starting your initial rounds you go see your first patient; she is in with rectal cancer, R1 goals of care, NG to suction, JP drain insitu, Foley insitu, ostomy to Foley bag. Her output from the previous shift is – Foley has 40 mL output, JP drain output 120 mL yellow and clear, ostomy 1200 mL green/brown and all liquid, NG 800 mL green in color. As you go into the room to see your patient you notice that she has an altered LOC, and you take her vitals, 68/48 on right arm then 65/44 on right arm again, 66/46 on left arm, 150 – 160 HR, T 37.8, RR 26, Sp02 84% on RA.

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