The emergency department (ED) triage nurse receives a report from emergency medical services (EMS) on an older adult client being brought to the ED via EMS. After receiving the report, the nurse reviews the client’s electronic medical record (EMR) for history and the most recent medication list.
The client was transferred to ED Bed 5 via stretcher. The client’s spouse is at the bedside. The client states “I feel so much better now except my wrist. It’s really hurting.” Advised to assess and then check with ED physician about something for the pain. VS BP 112/68 HR 99 RR 20. T 98.4° F (36.9° C). SpO2 96% on room air. The client is alert and oriented (A&O x 4), pleasant, and cooperative. PERRLA, skin intact with no bruising except for dorsal left forearm and wrist which is ecchymotic and edematous. Radial pulses are strong and equal (+3). Fingers warm with capillary refill – 3 sec. Lungs clear Abdomen soft with bowel sounds x 4 quadrants. Pedal pulse + x 4 and no pedal edema.
The client is being prepped for an open reduction internal fixation of the left wrist on the morning of day 2.
Which three findings indicate that the client’s hemodynamic status has improved?
A BP increased from 112/68 mm Hg to 122/80 mm Hg.
B Serum sodium decreased from 146 mEq/L (146 mmol/L) to 138 mEq/L (138 mmol/L).
C Serum potassium increased from 5 mEq/L (5 mmol/L) to 5.4 mEq/L (5.4 mmol/L).
D Urine output averaging 18 mL/hour.
E Bowel sounds in all four quadrants.
F Urine output averaging 45 mL/hour.
The Correct Answer and Explanation is:
The three findings that indicate the client’s hemodynamic status has improved are:
A. BP increased from 112/68 mm Hg to 122/80 mm Hg.
E. Bowel sounds in all four quadrants.
F. Urine output averaging 45 mL/hour.
Explanation:
- Blood Pressure Improvement (Option A): An increase in blood pressure from 112/68 mm Hg to 122/80 mm Hg suggests improved hemodynamic status. Blood pressure is a direct indicator of cardiac output and systemic vascular resistance. A stable or rising blood pressure in an older adult, especially following trauma, can reflect enhanced circulation and organ perfusion. In this scenario, the elevation indicates that the client’s cardiovascular status may be stabilizing after potential trauma or fluid shifts.
- Bowel Sounds in All Four Quadrants (Option E): The presence of bowel sounds in all four quadrants is a positive sign indicating adequate gastrointestinal perfusion and function. In the context of hemodynamic status, bowel sounds can reflect good perfusion of the mesenteric circulation. Poor perfusion often leads to decreased or absent bowel sounds due to reduced gut activity, while normal sounds indicate that the gastrointestinal system is functioning appropriately, further suggesting that the overall hemodynamic status is stable.
- Urine Output Improvement (Option F): Urine output averaging 45 mL/hour is a significant indicator of renal perfusion and fluid balance. In healthy adults, normal urine output ranges from 30 to 60 mL/hour. Therefore, an output of 45 mL/hour reflects adequate renal perfusion, which is critical in assessing fluid status and kidney function. Decreased urine output, as seen with values like 18 mL/hour (Option D), could indicate renal impairment or dehydration, thus not aligning with improved hemodynamic status.
In summary, options A, E, and F demonstrate improvements in blood pressure, gastrointestinal function, and renal perfusion, respectively, all of which are crucial indicators of enhanced hemodynamic status in the patient.