A 72-year-old client is admitted to the intensive care unit following an endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm. The procedure was performed via bilateral femoral artery access. The nurse is performing a continuous post-procedure assessment. Which of the following clinical findings indicate a potential complication that requires IMMEDIATE intervention? (Select all that apply.)
- Urine output totaling 25 mL over the past two consecutive hoursAnswer
- BCore body temperature of 37.7°C (99.9°F) four hours post-procedure
- Sudden, severe lower back pain that radiates to the client's groinAnswer
- Absence of a previously palpable +2 left pedal pulse, confirmed by DopplerAnswer
- ECapillary refill time of 2 seconds in the bilateral lower extremities
- FA 1-cm, non-expanding hematoma at the right femoral catheter insertion site
Answer
The findings requiring immediate intervention are the oliguria (25 mL over two hours), the sudden severe lower back pain radiating to the groin, and the absent left pedal pulse.
The correct findings represent critical, life-threatening complications following an EVAR procedure. A urine output of 25 mL over two hours (12.5 mL/hr) falls significantly below the minimum expected 30 mL/hr, indicating potential renal artery occlusion (due to stent graft migration) or hypovolemia from internal hemorrhage. Sudden, severe lower back pain radiating to the groin is a classic manifestation of a retroperitoneal hemorrhage or an endoleak (graft failure or rupture). The absence of a previously palpable pedal pulse is a hallmark sign of acute limb ischemia, likely caused by graft thrombosis or distal arterial embolization, requiring immediate emergency evaluation.
Step-by-Step Solution
Key Concept
Post-operative monitoring and complication identification following Endovascular Aneurysm Repair (EVAR).