Question

A 36-year-old man is admitted to your unit 4 hours after a surgical reduction of a compound fracture of the femur. His other health problems include hypercholesterolemia, for which he takes atorvastatin (Lipitor) 80 mg once daily, and bipolar disorder for which he takes lithium (Eskalith) 600 mg once daily. He has an IV of dextrose 5% in 0.45% saline infusing at a rate of 150 mL/hr. His blood pressure is now 96/70, down from the last reading of 128/80 obtained in the postanesthesia recovery area. His pulse is 84 and regular, and his pulse oximetry is 99%. In assessing him for possible shock, you note that the catheter drainage bag contains 800 mL of pale urine. His last output, measured 1 hour ago, was 1100 mL. According to the operative record, his output during the 3-hour surgery was 1800 mL. His total IV intake for the surgical and postoperative period was 1500 mL. He is to have his IV and Foley catheter removed when stable.

1. Is his output cause for concern? Provide a rationale for your response.

2. Will you discontinue the IV and/or the Foley? Why or why not?

3. What symptoms of shock are present?

4. What are the possible causes of his urine output volume? 5. What is your best course of action?

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Answer 1

1No,The usual daily urine volume in the adults is 1 to 2 l.A general rule is that the output is approximately 1ml of urine per kilogram of body weight per hour in all age groups.

2 Since his BP is low we cannot rule out the chances of shock,catheters are necessry for rapid fluid replacement and reversal of haemodynamic instability based on the patients response to therapy at .Iv fluids are infused at a rapid rate until systolic blood pressure or CVP increases to a satisfactory level above the baseline measurement.Infusion of RL is useful because it approximates plasma electrolyte composition and osmolality,restores circulation and serves as an adjunct to blood component therapy.So it will not be wise to discontinue Iv catheter .Foleys is also required to measure the intakeout put which is an indicator to determining signs of shock.

3 One of the main symptom of shock is low BP .Here the patients BP declined from 128/80 to 96/70 indicating a warning.

4His out put may be decreasing presenting the chances of shock.

5 Accurate and frequent assessments of Intake and output ,vital signs,CVP,level of consciousness ,breathsounds and skin colour should be performed to determine when therapy should be slowed to avoid volume overload.The rate of fluid administration is based on the severity of loss and the patients haemodynamicresponse to volume replacement.