A nurse is caring for a postpartum client in an outpatient setting.

Exhibits

Complete the following sentence by using the lists of options.

The client is at highest risk for developing

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as evidenced by the client

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Findings Requiring Immediate Follow-Up:

B. Hemoglobin and Hematocrit:
The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly lower than normal (14-18 g/dL for hemoglobin and 40-52% for hematocrit). This is indicative of anemia, which could be due to chronic blood loss, potentially from a gastrointestinal source (given the history of dark, tarry stool). Anemia can lead to symptoms such as weakness, dizziness, and fatigue, and if severe, it could lead to hypovolemic shock.
C. Stool results:
The hemoccult stool test is positive, indicating gastrointestinal bleeding, likely from an upper GI source (e.g., ulcers or gastritis). Combined with the client's symptoms of gnawing abdominal pain, a burning sensation radiating to the back, and a history of dark, tarry stools (which suggests melena), this is concerning for a peptic ulcer disease (PUD) or even a gastric ulcer. This finding warrants immediate follow-up to evaluate the cause and assess for complications such as active bleeding or perforation.
E. Blood Pressure:
The client’s blood pressure is 90/50 mm Hg, which is hypotensive and likely a sign of hypovolemia due to blood loss (from the GI bleeding indicated by the positive hemoccult test). Hypotension is a concerning finding, especially in a client with anemia and symptoms of abdominal distress. Immediate intervention is needed to address the blood pressure and prevent further complications, such as shock.
F. Temperature:
The client’s temperature is 37.5°C (99.5°F), which is slightly elevated (normal is typically 36.1-37.2°C or 97°F-99°F). While not dramatically high, a low-grade fever could suggest an infection (e.g., due to H. pylori, which is positive in this client, or an associated gastric infection or inflammation). In this case, it could indicate a need for monitoring, as infections can exacerbate symptoms and complications, particularly in the setting of a GI ulcer or bleeding.
H. Heart Rate:
The client's heart rate is elevated at 118 beats per minute (tachycardia). Tachycardia in this setting could be a compensatory mechanism for hypovolemia due to the blood loss suggested by the low hemoglobin/hematocrit and positive stool test. The elevated heart rate could also be a sign of pain, anxiety, or systemic response to the GI distress. Regardless, tachycardia is a significant finding in the context of hypotension and anemia and requires immediate follow-up to prevent cardiovascular complications.

Findings That Do Not Require Immediate Follow-Up:
A. Current Medications:
The client is taking Ibuprofen, which is a nonsteroidal anti-inflammatory drug (NSAID). While NSAIDs can cause gastrointestinal irritation and increase the risk of bleeding (particularly in the presence of ulcers), the client’s current medications do not require immediate follow-up as a standalone issue. However, if a diagnosis of ulcer or gastrointestinal bleeding is confirmed, the use of NSAIDs should be discontinued.
D. WBC Count:
The client's WBC count is 6,700/mm³, which is within the normal range (5,000-10,000/mm³). This does not indicate infection or significant inflammation. Given the context of the client’s symptoms and lab results, there is no immediate concern with the WBC count at this time.
G. Respiratory Rate:
The client’s respiratory rate is 18/min, which is within the normal range (12-20 breaths per minute for adults). There is no indication of respiratory distress or abnormal breathing patterns in this patient, so no immediate follow-up is required in this area.

Rationale

Findings Indicating Improvement Laboratory Results:

Hemoglobin 12 g/dL (Normal range: 14 to 18 g/dL)

Although the hemoglobin level is still slightly below the normal range (it was 9.1 g/dL prior to the transfusion), it has increased from 9.1 g/dL to 12 g/dL, showing improvement after the blood transfusion. This indicates that the transfusion has helped to raise the hemoglobin level, improving oxygen-carrying capacity.

Hematocrit 36% (Normal range: 40% to 52%)

The hematocrit level has also increased from 27% to 36%. While still below normal, this is an improvement, suggesting the transfusion is starting to correct the client’s anemia and restore normal blood volume.

Vital Signs:

Blood Pressure 112/74 mm Hg

The blood pressure has improved significantly from 76/45 mm Hg (at 1200) and 78/49 mm Hg (at 1230). An increase in blood pressure to 112/74 mm Hg indicates the client is now hemodynamically stable, and the transfusion has helped to address the hypotension. The blood pressure is now in a normal range (typically around 120/80 mm Hg), and it is no longer dangerously low.

Heart Rate 95/min

The heart rate has decreased from 118/min and 121/min (at earlier times) to 95/min. This drop

indicates that the client’s heart is not having to work as hard to compensate for the low blood volume,

suggesting improvement in circulatory status.

Oxygen Saturation 100% via 2 L/min nasal cannula

Oxygen saturation is now normal at 100%. This is an improvement compared to the previous status of 98% on room air, which indicates that the client is now receiving adequate oxygenation, and the supplemental oxygen may be effectively maintaining oxygen levels.

Physical Exam:

General: No distress

The client is no longer in apparent distress, which is an important sign of improvement. Prior to the transfusion, the client was described as diaphoretic and uncomfortable, but now the client is stable and not in distress.

HEENT: Oropharynx clear, mucous membranes moist and pink

The mucous membranes are now moist and pink, which suggests adequate hydration and oxygenation. This is an improvement, as the previous finding indicated the client’s mucous membranes were pale (which can be a sign of anemia or dehydration).