A nurse is caring for a client who reports pain in their lower extremities following surgery. Which of the following should the nurse address first?

A. The kidneys continue to enlarge due to the cyst growing which increases the girth of your abdomen. Polycystic kidney disease is characterized by the progressive growth of fluid-filled cysts in the kidneys. These cysts cause the kidneys to enlarge significantly over time, which can lead to increased abdominal girth, a common finding in patients with advanced PKD.
B. The inflammation in your kidneys damages the filtration system which causes fluid retention in your abdomen. While PKD does impair kidney function, generalized fluid retention from decreased filtration more commonly leads to peripheral edema or hypertension, not isolated abdominal distension. Ascites is not typically associated with PKD unless there is concurrent liver involvement or severe renal failure.
C. The stones might descend into the ureters, blocking the flow of urine and causing an increase in the girth of your abdomen. Renal calculi can obstruct urine flow and cause hydronephrosis (kidney swelling), but they do not typically lead to noticeable abdominal distension. The increase in girth in PKD is more directly related to cystic kidney enlargement than to stone obstruction.
D. The kidney infection has caused narrowing of the ureters and your abdomen has filled with fluid.
Kidney infections can cause inflammation, but ureteral narrowing from infection is rare and would not cause significant abdominal girth increase. Additionally, abdominal fluid accumulation from infection would present with systemic signs like fever or peritonitis, which are not described here.

A. Neurogenic shock: Neurogenic shock is caused by a loss of sympathetic tone, often due to spinal cord injury, and is characterized by hypotension, bradycardia, and warm, dry skin. The client’s blood loss makes hypovolemic shock more likely than neurogenic shock.
B. Hypovolemic shock: Hypovolemic shock is caused by a significant loss of blood or fluids, which reduces the circulating volume and leads to decreased perfusion and oxygenation of tissues. In this case, the client has lost 800 mL of blood and is experiencing a steady decrease in blood pressure, which indicates hypovolemic shock.
C. Obstructive shock: Obstructive shock occurs when there is a physical obstruction in the circulatory system, such as a pulmonary embolism or tension pneumothorax. The clinical scenario does not suggest an obstruction, making obstructive shock less likely.
D. Septic shock: Septic shock is caused by a severe infection and results in vasodilation and hypotension. While sepsis can lead to hypotension, the client’s blood loss makes hypovolemic shock the more likely diagnosis.