3. The patient may have:
• Saturated postoperative dressings
• Excessive amounts of blood in
wound drainage system
• Peri-incisional swelling and
hematoma
• Increased HR to severe tachycardia
4. • Early CNS signs of blood loss
Subtle changes in LOC
Anxiety
Irritability
Restlessness
Decreased alertness
5. • Later CNS signs:
Confusion
Combativeness
Lethargy
Coma
• Delayed CRT (>3 sec), diminished
peripheral pulses (< +2)
• Cool extremities and pale, mottled
or cyanotic skin
6. • Slightly elevated RR to severe
tachypnea
• Hypotension
• Narrowing of pulse pressure
• Thirst
• Bruising around umbilicus or
retroperitonially in flank areas
(internal bleeding)
8. • Get help and notify surgeon
• Discontinue thrombolytics or
anticoagulants
• Control external bleeding with
direct pressure
• Do not remove saturated
dressings, as this may also remove
any clot formation
9. Reinforce with additional
dressing and pressure
• Administer supplemental oxygen;
maintain patent airway
• If IV not in place, obtain large
gauge (#18) IV access
Have IVF ready to hang
10. • Monitor VS frequently
• Document patient’s status, phone
call to physician or NP, physician
or NP response
12. • Assess LOC, orientation and VS
HR, RR, BP
• Assess for orthostatic
hypotension, if possible
• Assess SaO2 via pulse oximetry if
available
Note: may be unreliable due to
decreased peripheral perfusion
• Assess skin for
color, temperature, moistness, tur
14. • Monitor VS and oxygenation
status
• If patient previously typed and
cross-matched, call blood bank to
see if any blood available
• Monitor output from Hem-o-Vac,
JP drain, NGT, urinary catheter
• Check laboratory values
15. • Provide emotional support to
patient/family
• Chart patient status and convey to
physician or NP
17. • Assist with insertion of a central
line
• Obtain stat laboratory tests
Hgb/Hct, ABGs, electrolytes, blo
od T/C
• Prepare the patient for surgery
• Administer colloidal infusions
• Insert Foley catheter
