A patient 1 day post abdominal surgery presents with hypotension (BP 88/60), tachycardia, diaphoresis, pale skin, and cold, clammy skin. Which intervention should the nurse implement first?

• A. Increase the client's intravenous fluid rate.
• B. Administer an intravenous dopamine drip.
• C. Obtain arterial blood gases (ABGs).
• D. Assess the client's abdominal dressing.

Answer: (A)

When a postoperative patient is hypotensive with tachycardia and cold, clammy skin, the body is showing signs of reduced circulating volume and poor tissue perfusion. The first priority is to rapidly restore intravascular volume with isotonic IV fluids to improve preload and cardiac output, which can quickly improve blood pressure and perfusion to vital organs. Starting a vasopressor like dopamine or sending for ABGs can come next if hypotension persists after fluids or if a different shock type is suspected; ABGs help assess status but won’t correct the instability on their own. While fluids are being administered, continue to monitor closely and check the abdominal dressing for ongoing bleeding, as ongoing blood loss may necessitate additional interventions, such as blood product administration.