Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs:
temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. Nurse Melinda should suspect:
- A- a postoperative infection.
- B- alcohol withdrawal.
- C- acute sepsis.
- D- pneumonia.
Based on the presented information, the most likely diagnosis for Nurse Melinda to suspect is: A. A postoperative infection.
Here's why:
- Elevated temperature:
A temperature of 101.6° F (38.7° C) signifies a fever, which is a common symptom of infection, especially postoperative infections.
- Tachycardia (increased heart rate):
A heart rate of 126 beats/minute exceeds the normal resting range, further suggesting a possible infection or inflammatory response.
- Tachypnea (increased respiratory rate):
While not as specific as the other signs, a respiratory rate of 24 breaths/minute could be associated with an infection depending on other clinical factors.
- Gross hand tremors:
While trembling can occur in alcohol withdrawal, it's generally more subtle and often accompanied by other withdrawal symptoms like sweating, nausea, and anxiety. In this case, the severity of the tremors suggests a neurological manifestation, potentially related to an infection.
- Hallucinations (screaming for bugs):
This can be a symptom of both alcohol withdrawal and infection, especially with a high fever. However, in the context of recent surgery and the other vital signs, infection is a more likely explanation.
Other Options:
While other choices could also be possibilities:
B. Alcohol withdrawal:
While the client has a history of social drinking, the lack of other typical withdrawal symptoms like sweating, nausea, and anxiety makes this less likely, especially within 18 hours of surgery.
C. Acute sepsis:
The elevated temperature and heart rate raise suspicion for sepsis, but the lack of specific sepsis criteria like hypotension or low white blood cell count makes it less likely in this case.
D. Pneumonia:
The respiratory rate increase could suggest pneumonia, but it's less likely than a postoperative infection considering the recent surgery and lack of specific respiratory symptoms like cough or chest pain.
Therefore, based on the available information, a postoperative infection is the most likely diagnosis for Nurse Melinda to suspect. However, she should conduct a thorough assessment, including reviewing the client's medical history, performing a physical examination, and ordering any necessary diagnostic tests to confirm the diagnosis and determine the best course of treatment.
It's important to note that this is a hypothetical scenario and not a substitute for professional medical judgment. Always consult with a qualified healthcare provider for diagnosis and treatment recommendations.
