A nurse is reviewing the medical history of a client who is luted for surgery. Which of the following findings places the client at risk for a complication of incisional hematoma forming?

A) The client who has a nasogastric (NG) tube to suction:
A nasogastric (NG) tube that is used for suction can lead to the loss of gastric fluids, which are rich in potassium. Prolonged suctioning can cause the client to lose significant amounts of potassium, putting them at risk for hypokalemia. Potassium is an essential electrolyte that is vital for proper muscle and nerve function, and its loss can result in symptoms such as weakness, arrhythmias, and fatigue.

B) The client who has a chest tube to water seal:
A chest tube to water seal is used to drain air or fluid from the pleural space, typically following surgery or trauma. While chest tube drainage can lead to fluid loss, it is not directly associated with significant electrolyte imbalances like hypokalemia. The primary concern with chest tubes is fluid balance and preventing infection, but it does not specifically cause potassium loss unless there are other contributing factors, such as excessive diuresis or vomiting.

C) The client who has an indwelling urinary catheter to gravity drainage:
An indwelling urinary catheter primarily allows for the drainage of urine, and while it may contribute to fluid and electrolyte loss (especially if there is excessive urination or diuresis), it is not directly linked to hypokalemia unless the client is receiving medications (e.g., diuretics) that cause potassium loss through urine. The catheter itself does not significantly increase the risk of hypokalemia unless other factors are involved.

D) The client who has a tracheostomy tube attached to humidified oxygen:
A tracheostomy tube attached to humidified oxygen helps with respiratory support and does not directly affect potassium levels. The primary concern with tracheostomies is airway management, preventing infection, and ensuring proper oxygenation. It is not associated with electrolyte imbalances such as hypokalemia. However, if the client experiences issues such as excessive fluid loss through respiratory secretions or complications like infection, it could indirectly affect electrolyte levels, but it is not a direct cause of hypokalemia.

A) Increased blood pressure:
Fluid overload results in an increased volume of fluid in the vascular system, leading to higher blood pressure. The excess volume places additional strain on the heart and blood vessels, causing an elevation in systolic and diastolic pressure. The nurse should expect to find elevated blood pressure in a client experiencing fluid overload due to the increased blood volume.

B) Increased hematocrit:
Hematocrit is the proportion of red blood cells in the blood, and it tends to decrease, not increase, during fluid overload. This is because the excess fluid in the bloodstream dilutes the blood, lowering the hematocrit level. Therefore, an increase in hematocrit would not be expected in fluid overload.

C) Increased respiratory rate:
Fluid overload, particularly when it affects the lungs (as seen in conditions like congestive heart failure), can cause respiratory distress. The accumulation of fluid in the lungs impairs gas exchange, leading to hypoxia and the body compensating by increasing the respiratory rate. This response helps increase oxygenation and expel carbon dioxide, so the nurse should expect to see an increased respiratory rate.

D) Increased heart rate:
An elevated heart rate, or tachycardia, is a compensatory response to fluid overload. The heart tries to pump the excess fluid through the circulatory system, which increases the heart's workload. As a result, the heart rate increases in an attempt to maintain adequate cardiac output despite the increased blood volume.

E) Increased temperature:
An elevated body temperature is not typically associated with fluid overload. In fact, fluid overload is more likely to present with normal or slightly lower body temperature, especially if there is no infection or inflammatory process present. If there is an increase in temperature, the nurse should consider other possible causes, such as infection or inflammatory conditions.