S12 · Likely to bleed heavily after surgery
Risk ⚠ URGENT Safety and protection
Definition
The surgical site may bleed more than expected.- Major surgery
- blood thinners
- clotting problems
- slipping stitches
- Soaked dressings
- bloody drain output
- low blood pressure
- fast pulse
- pale skin
📋 Scenario
A patient has just come back from major abdominal surgery and is on blood-thinning injections.
Subjective (S): "I feel a bit sore."
Objective (O): Just back from surgery; drain 40 mL blood-stained fluid in the first hour; pulse 84/ min; blood pressure 122/76; on blood-thinning injections.
Assessment tools for this scenario: CP-SAFE Safety & Falls Score CP-SKIN Skin & Wound Score CP-FLUID Fluid Balance & Nutrition Score
Validated scales to consider: Morse Fall Scale, Braden Scale, TIME wound chart, MUST, fluid chart, glucose
**CarePath diagnosis:** Likely to bleed heavily after surgery related to major surgery and blood thinners (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check dressings, drain output and vital signs at ordered times. | Regular checks of dressings, drain and vital signs show bleeding early, since a rising pulse and falling blood pressure often appear before blood is visible. |
| Keep dressings intact and mark any leaking area. | Intact dressings protect the wound, and marking any leaking area lets staff see whether bleeding is growing. |
| Report quickly rising drain output, bright blood, rising pulse, falling blood pressure or paleness at once. | Fast reports let the surgical team act before blood loss becomes dangerous, as heavy bleeding can lead to shock. |
| Prepare for treatment as ordered if bleeding is suspected. | Being ready, with equipment and orders at hand, saves time if bleeding is suspected. |
**Expected outcomes**
- Drain output stays low and non-bloody.
- Pulse and blood pressure stay in the doctor's range.
- Any bleeding is reported within minutes and treated promptly.
**Linking the data to the diagnosis**
The patient has just returned from major abdominal surgery and is on blood-thinning injections, and says they feel a bit sore. The drain shows 40 mL of blood-stained fluid in the first hour, pulse is 84/min and blood pressure is 122/76. Heavy bleeding has not occurred, so this is a risk diagnosis resting on surgery and blood thinners. If signs of bleeding appear, help is called first. The plan aims for low, non-bloody drain output, pulse and blood pressure in the doctor's range, and any bleeding reported within minutes and treated promptly.
CarePath diagnosis
Likely to bleed heavily after surgery related to major surgery and blood thinners (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Check dressings, drain output and vital signs at ordered times. | Regular checks of dressings, drain and vital signs show bleeding early, since a rising pulse and falling blood pressure often appear before blood is visible. |
| 2. Keep dressings intact and mark any leaking area. | Intact dressings protect the wound, and marking any leaking area lets staff see whether bleeding is growing. |
| 3. Report quickly rising drain output, bright blood, rising pulse, falling blood pressure or paleness at once. | Fast reports let the surgical team act before blood loss becomes dangerous, as heavy bleeding can lead to shock. |
| 4. Prepare for treatment as ordered if bleeding is suspected. | Being ready, with equipment and orders at hand, saves time if bleeding is suspected. |
Expected outcomes
- Drain output stays low and non-bloody.
- Pulse and blood pressure stay in the doctor's range.
- Any bleeding is reported within minutes and treated promptly.
Linking the data to the diagnosis
The patient has just returned from major abdominal surgery and is on blood-thinning injections, and says they feel a bit sore. The drain shows 40 mL of blood-stained fluid in the first hour, pulse is 84/min and blood pressure is 122/76. Heavy bleeding has not occurred, so this is a risk diagnosis resting on surgery and blood thinners. If signs of bleeding appear, help is called first. The plan aims for low, non-bloody drain output, pulse and blood pressure in the doctor's range, and any bleeding reported within minutes and treated promptly.