A nurse is caring for a school-age child who is receiving a continuous IV infusion through the right antecubital vein. Which of the following findings should the nurse recognize as a complication of IV therapy?

Rationale for correct choices

• Pulmonary embolism: The client exhibits sudden onset of dyspnea, chest discomfort, tachypnea, hypoxemia (oxygen saturation 92% on 2 L O₂), and appears in respiratory distress, all of which are classic signs of a pulmonary embolism. Postoperative orthopedic patients, especially after hip arthroplasty, are at high risk due to immobility, venous stasis, and hypercoagulability.

• Recent surgery: The client’s recent total hip arthroplasty increases the risk of thromboembolic events. Surgical procedures, particularly major orthopedic surgeries, create a hypercoagulable state and contribute to venous stasis, which can precipitate a pulmonary embolism.

Rationale for incorrect choices

• Pneumothorax: Pneumothorax typically presents with unilateral chest pain, sudden shortness of breath, and decreased or absent breath sounds on one side. The client’s crackles are bilateral and S3/S4 heart sounds are present, which are not consistent with pneumothorax.

• Pneumonia: Although the client has fever and crackles, the sudden onset of symptoms and acute respiratory distress are more consistent with pulmonary embolism rather than pneumonia, which usually develops gradually. Additionally, the timing shortly after surgery favors a thromboembolic event over an infectious process.

• Tobacco use: The client reports no history of tobacco use, making this an irrelevant risk factor for the current acute episode.

• Activity level: While immobility can contribute to thrombus formation, the client ambulated with assistance earlier, and the more significant risk factor remains recent surgery, which directly predisposes to pulmonary embolism.

A. Administer oxygen via nasal cannula at 2 L/min: Oxygen may support maternal and fetal oxygenation, but it does not treat the underlying cause of hypotension following spinal anesthesia. It is a supportive measure, not the first-line intervention.

B. Place the client in a knee-chest position: This position is not recommended for treating hypotension due to spinal anesthesia. The priority is to improve perfusion through fluid resuscitation and positioning that enhances venous return, such as left lateral tilt.

C. Assist the client to the bathroom: Ambulation is unsafe for a client experiencing hypotension after spinal anesthesia and could worsen hypotension or cause falls. The client should remain supine or in a safe position until blood pressure is stabilized.

D. Give 500 mL bolus of lactated Ringer's: Administering a rapid IV fluid bolus is the first-line intervention for hypotension related to spinal anesthesia. It increases intravascular volume, improves venous return, and helps restore blood pressure to maintain maternal and fetal perfusion.