arrives in the PACU following surgical removal of his gallbladder.

Surgical
intervention using the laparoscopic approach is successful.

Patient A's airway and ability to maintain respiratory stability are evaluated
immediately. His respiration is 16 breaths per minute, and his heart rate is 78
beats per minute. Oxygen is being administered at 2 liters via nasal cannula. A
pulse oximeter is placed on his left forefinger, and his oxygen saturation is
measured at 95%. The patient is arousable but easily drifts off to sleep.

A transfer of care report on the patient is received from the operating room staff.
His operative course was unremarkable. Patient history obtained during the
preoperative phase of care showed that he was a 2 pack per day smoker, and he
denies taking any prescribed or over-the-counter medications. Patient A's weight is
documented as 110 kg.

Further assessment of the patient demonstrates normal skin perfusion with good
capillary refill in all extremities. He has a drain in his abdomen with a small
amount of yellowish discharge. The wound site and sutures are clean and dry without
bleeding or discharge. No Foley catheter is in place; when questioned, he denies
the need to void. Completing a head-to-toe assessment shows no other alterations
from Patient A's baseline:;;
Patient A wakes when the second set of vital signs is obtained. He reports that his
pain is 6 on a 10-point scale. He states that he has pain in his shoulder and
pressure in his abdomen. Morphine (5 mg) is ordered for the pain, and 4 mg is
administered IV. His wife is in the waiting room, and she comes into the unit to
visit and sits by his bed reading while the patient dozes off.

Repeat vital signs are obtained every 15 minutes for the first hour. At 45 minutes
after admission, the patient's oxygen saturation is noted to be 90%. PACU staff
suction secretions from the patient's throat, and he is instructed on how to use
the incentive spirometer. His oxygen flow is increased to 4 liters/minute by nasal
cannula. No change in the patient's oxygen saturation is noted over the next 15
minutes despite compliance with the respiratory exercises.