Question

a nurse is caring for a client who is 3 hr postoperative following abdominal surgery. which of the following assessment data should the nurse report to the provider?
the client urine output has been 50 ml since surgery.
serosanguineous drainage noted on the abdominal dressing.
the clients pain level has decreased since the administration of morphine.
postoperative laboratory results are hgb 15% and hct 40%.

Explanation:

• Option A: Urine output should be at least 30 mL/hour. A 3 - hour postoperative client should have at least 90 mL of urine output. 50 mL in 3 hours is oliguria (low urine output), which can indicate hypovolemia (low blood volume, perhaps due to blood loss or fluid shifts after surgery) or renal problems, and needs to be reported.
• Option B: Serosanguineous drainage (a mix of clear serum and a small amount of blood) on an abdominal dressing is an expected finding in the immediate postoperative period as the body is healing and some fluid and minor bleeding can occur.
• Option C: A decrease in pain level after administration of morphine is the desired effect of the medication. It indicates the analgesic is working and is not a cause for concern to report in terms of an unexpected or adverse event.
• Option D: Hemoglobin (Hgb) of 15% (assuming it's a typo and should be 15 g/dL, normal range for men is 13.5 - 17.5 g/dL and for women 12 - 15.5 g/dL) and hematocrit (Hct) of 40% (normal range for men 40 - 52% and for women 36 - 48%) are within normal or near - normal ranges and do not require urgent reporting.

Answer:

A. The client urine output has been 50 mL since surgery.