When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate?
A. Check the dressing and drains for frank bleeding.
B. Call the physician.
C. Continue to monitor vital signs.
D. Start oxygen at 2L/min per NC.
Correct Answer: C. Continue to monitor vital signs.
The nurse should continue to monitor the client because this value reflects a normal physiologic response. Immediately after surgery, the client’s hematocrit reflects a falsely high value related to the body’s compensatory response to the stress of sudden loss of fluids and blood. Activation of the intrinsic pathway and the renin-angiotensin cycle via antidiuretic hormone produces vasoconstriction and retention of fluid for the first 1 to 2 days post-op. By the second to third day, this response decreases, and the client’s hematocrit level is more reflective of the amount of RBCs in the plasma.
Option A: Fresh bleeding is a less likely occurrence on the third post-op day but is not impossible; however, the nurse would have expected to see a decrease in the RBC and hemoglobin values accompanying the hematocrit. Blood loss in the study by Berg et al. was quantified in 1-1.5 blood units, which equals 560-840 mL, in line with the present study and that from Pape et al.
Option B: The physician does not need to be called. Blood loss is a surgical complication that should be especially aware of in at-risk patients such as those with cardiovascular or anemic problems. Given the results within blood measurements, the observation that there is a decrease in hemoglobin and hematocrit after performing surgery should be taken into consideration, especially in patients at risk of anemia, such as women with metrorrhagia, dysmenorrhea in athletes, etc.
Option D: Oxygen does not need to be started based on these laboratory findings. Platelet replacement may be required to reduce the risk of bleeding. Premedication with antihistamine and antipyretics reduces transfusion reaction side effects.
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