A nurse is monitoring a client who is receiving a unit of packed red blood cells (RBCs) following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?

Choice A reason: Platelets 190,000/mm3 is within the normal range of 150,000 to 450,000/mm3. This result does not indicate a bleeding risk or a need to adjust the warfarin dose.

Choice B reason: Hct 44% is within the normal range of 37% to 47% for females and 42% to 52% for males. This result does not indicate anemia or polycythemia, which could affect the warfarin therapy.

Choice C reason: PT 45 seconds is above the normal range of 11 to 13.5 seconds. This result indicates that the blood is taking too long to clot, which increases the risk of bleeding. The nurse should notify the provider and expect a decrease in the warfarin dose.

Choice D reason: Hgb 16 g/dL is within the normal range of 12 to 16 g/dL for females and 14 to 18 g/dL for males. This result does not indicate anemia or polycythemia, which could affect the warfarin therapy.

Choice A reason: Administering low dose aspirin is not appropriate for clients with hemophilia A because aspirin can inhibit platelet function and increase the risk of bleeding. Hemophilia A patients already have a deficiency in clotting factor VIII, and adding aspirin can exacerbate bleeding tendencies.

Choice B reason: Preparing for an autologous blood transfusion is not a standard treatment for hemarthrosis in hemophilia A. The primary treatment involves factor replacement therapy to address the underlying clotting deficiency. Blood transfusions are generally reserved for severe cases of anemia or significant blood loss.

Choice C reason: Obtaining a stool specimen is unnecessary because the client’s symptoms are localized to the knee rather than the gastrointestinal tract. This procedure is used to detect GI bleeding and does not address the acute hemarthrosis described. Focusing on a stool sample would delay the essential care needed to stop the joint hemorrhage. Priority must be placed on interventions that directly manage the active bleeding site.

Choice D reason: Applying ice to the knee triggers vasoconstriction, which directly limits internal bleeding into the joint space. This action follows the RICE protocol to reduce inflammation and provide immediate pain relief. By cooling the area, the nurse helps stabilize the injury and prevents further swelling. It is a vital step in minimizing long-term damage to the joint's synovial tissue.