An adult client underwent a percutaneous left renal biopsy 4 hours ago. Baseline vital signs in the recovery unit included a blood pressure of 138/82 mm Hg and a heart rate of 76 beats/min. During the current assessment, the client reports a new, deep ache in the left flank and lower back. Vital signs demonstrate a blood pressure of 108/88 mm Hg, a heart rate of 115 beats/min, and a respiratory rate of 22 breaths/min. Based on these physiological changes, which intervention is the priority to minimize further client risk?
- AAdminister the prescribed breakthrough analgesic and document the hemodynamic changes as an expected sympathetic response to localized pain
- BAssist the client into a right lateral decubitus position to offload weight from the puncture site and reassess in 15 minutes
- Initiate a rapid infusion of isotonic intravenous fluids and immediately page the attending physician regarding suspected internal bleedingCevap
- DDelay further interventions until a stat 12-lead electrocardiogram is obtained to determine the specific etiology of the elevated heart rate
Cevap
The priority action is to initiate a rapid infusion of isotonic intravenous fluids and immediately page the attending physician regarding suspected internal bleeding.
The client's narrowing pulse pressure (dropping from 56 mm Hg to 20 mm Hg) combined with significant tachycardia and new-onset deep flank pain strongly indicate early hypovolemic shock due to retroperitoneal bleeding. Hemorrhage is a major complication of percutaneous renal biopsies. The priority risk reduction strategy is to restore intravascular volume with isotonic fluids and notify the provider for definitive intervention to prevent complete cardiovascular collapse.
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Anahtar Kavram
Early recognition and management of hypovolemic shock secondary to retroperitoneal hemorrhage