A 62-Year-Old Woman on the Postoperative Floor Is Evaluated Due

A 62-year-old woman on the postoperative floor is evaluated due to increasing confusion.  The patient is unable to answer questions, keeps trying to get out of bed, and continues to pull on her intravenous lines.  Six hours ago, she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, staging, and debulking procedure for primary peritoneal cancer.  After the procedure, the patient was placed on a continuous hydromorphone infusion for pain control.  She was stable in the postanesthesia care unit and was moved to the postoperative floor 2 hours ago.  Her medical conditions include type 2 diabetes mellitus, for which she takes insulin, and chronic hypertension.  Temperature is 36.7 C (98.1 F) , blood pressure is 90/50 mm Hg, pulse is 116/min, and respirations are 22/min.  Cardiac examination shows sinus tachycardia with no rubs or murmurs.  The lungs are clear to auscultation.  The abdominal dressing is soaked with blood, and there is blood leaking between the staples at the incision site.  Finger-stick blood glucose level is 150 mg/dL.  Which of the following is the best next step in management of this patient?

A) Administer insulin dose
B) Decrease hydromorphone infusion
C) Order CT chest angiography
D) Order CT scan of the head with and without contrast
E) Perform urgent laparotomy

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free