8-14. DETECTION OF PENDING HYPOVOLEMIC SHOCK
a. Inspect the surgical dressing frequently and report any bleeding to the
supervisor. Also inspect the bedding beneath the patient because blood may drain down
the sides of a large dressing and pool under the patient. When reporting bleeding, note
the color of the blood. Bright red blood signifies fresh bleeding. Dark, brownish blood
indicates that the bleeding is not fresh.
b. Outline the perimeter of the blood stain on the original dressing. Reinforce the
original dressing, and make note on the dressing of the date and time the outline was
c. Document your observations and the action taken in the nurse's notes.
d. Monitor the patient's vital signs as ordered and report any of the following
abnormalities to the supervisor.
(1) A drop in blood pressure (systolic reading below 90 in an adult indicates
possible shock; systolic below 80 means actual shock).
A rapid, weak pulse.
Cool, moist, pale skin.
Tingling of the lips.
(6) Pallor or blueness (cyanosis) of the lips, nailbeds, or conjunctiva (a dark-
skinned persons lips will appear a dusky gray).
e. Administer narcotics only after checking doctor's orders and consulting with
supervisor. If shock is imminent, it may be precipitated by administration of narcotics.
f. Administer fluids to replace volume in accordance with the doctor's orders. The
doctor may order that blood volume be replaced by intravenous (IV) fluids, plasma
expanders, or whole blood products.
8-15. GENERAL NURSING CARE OF A PATIENT IN THE RECOVERY ROOM
a. When the patient is moved to the recovery room, every effort should be made to
avoid unnecessary strain, exposure, or possible injury. The anesthesiologist or anesthetist
goes to the recovery room with the patient, reports his condition, leaves postoperative
orders and any special instructions, and monitors his condition until that responsibility is
transferred to the recovery room nurses. The recovery room nurse should check the
doctor's orders and carry them out immediately.