Reference no: EM133758017

Question

A nurse is assisting with the care of a client following a total hip replacement. Exhibit 1 Exhibit 2 Exhibit 3 Exhibit 4 Assessment Postoperative Day 3 1400: Alert and oriented to person, place, and time. Skin warm and dry. Lungs clear, auscultated throughout all lung fields. Regular heart rhythm. No nausea or vomiting noted, bowel sounds present in all four quadrants. Last bowel movement 1 day ago. Peripheral pulses strong 2 bilaterally, capillary refill 4 seconds. Voided 200 mL of clear amber urine in the last 2 hr. Incision dressing clean and dry to left hip. Partial-thickness pressure injury directly over sacral area, nonblanchable erythema. Client reports pain as 8 on a scale of 0 to 10, and client reports aching/cramping in left calf. Client has a history of hypertension and hypercholesteremia. For which of the following assessment findings should the nurse notify the provider?

Partial-thickness injury over sacral area Urine characteristics Aching/cramping in left calf Capillary refill Peripheral pulses Pain level Left hip incision dressing Last bowel movement.