In the postanesthesia care unit, a patient’s blood pressure falls to 112/60 from 124/70, with a pulse of 72 and warm, dry skin 30 minutes after admission. What is the most appropriate action?

• A. Increase the rate of the IV fluid replacement.
• B. Continue to take vital signs every 15 minutes.
• C. Administer oxygen therapy at 100% via mask.
• D. Notify the anesthesia care provider (ACP) immediately.

Answer: (B)

In the PACU, small fluctuations in blood pressure are common as anesthesia wears off and normal vascular tone returns. Here, the reading shifted from 124/70 to 112/60, but the patient remains well perfused—pulse is 72 and the skin is warm and dry. Those signs suggest the circulatory system is stable and tissue perfusion is adequate. When a patient is hemodynamically stable like this, the priority is to watch for trends rather than intervene immediately. Continuing to monitor vitals at 15-minute intervals allows you to detect any upward or downward trajectory that might indicate evolving instability.

Interventions such as increasing IV fluids, administering 100% oxygen, or notifying the anesthesia care provider are reserved for signs of true instability—evidence of poor perfusion (e.g., cool, clammy skin, tachycardia, altered mental status), hypoxia, or a persistent, clinically significant drop in blood pressure. Since none of those are present, the best course is ongoing monitoring while keeping an eye on the trend.