A patient receiving a continuous infusion of normal saline at 125 mL/hour post abdominal surgery becomes drowsy with abdominal pain and headache. Urine output is 800 mL over 24 hours, CVP is 15 mmHg, and crackles are present. Which intervention should the nurse implement first?

A patient receiving a continuous infusion of normal saline at 125 mL/hour post abdominal surgery becomes drowsy with abdominal pain and headache. Urine output is 800 mL over 24 hours, CVP is 15 mmHg, and crackles are present. Which intervention should the nurse implement first?

• A. Review last administration of IV pain medication.
• B. Decrease IV fluids, to keep vein open rate.
• C. Administer PRN dose of acetaminophen.
• D. Calculate total intake and output for last 24 hours.

Answer: (A)

The main idea here is to consider medication effects as the first potential cause of the new symptoms. Drowsiness and headache after surgery can be from CNS depression due to IV analgesics, especially opioids given continuously. By reviewing the most recent IV pain medication administration, you can determine if the drowsiness and headache are related to dosing, accumulation, or an adverse reaction. If the analgesic is contributing to the symptoms, you can adjust or hold it, which is safer than jumping to changes in fluid management before you know the cause. The signs of fluid overload (low urine output, high CVP, crackles) are important, but they’re addressed after ruling out a medication-related cause. So the first action is to check the last IV pain med administration to guide the next steps.

The main idea here is to consider medication effects as the first potential cause of the new symptoms. Drowsiness and headache after surgery can be from CNS depression due to IV analgesics, especially opioids given continuously. By reviewing the most recent IV pain medication administration, you can determine if the drowsiness and headache are related to dosing, accumulation, or an adverse reaction. If the analgesic is contributing to the symptoms, you can adjust or hold it, which is safer than jumping to changes in fluid management before you know the cause. The signs of fluid overload (low urine output, high CVP, crackles) are important, but they’re addressed after ruling out a medication-related cause. So the first action is to check the last IV pain med administration to guide the next steps.