The nurse receives laboratory reports on 4 clients. Which report is most concerning and should be reported to the health care provider?

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Blood loss is a common complication of a total knee replacement, and a hemoglobin level of 7 g/dL (70 g/L) is very low (normal adult male: 13.2-17.3 g/dL [132-173 g/L]; normal adult female: 11.7-15.5 g/dL [117-155 g/L]). This client needs to be assessed for any active bleeding as well as for respiratory and cardiac complications (eg, rapid pulse, shortness of breath) resulting from the low hemoglobin level. The health care provider must be notified. (Option A) Normal PaCO₂ is 35-45 mm Hg (4.66-5.98 kPa). Clients with asthma exacerbations, as well as those with panic attacks, pulmonary embolism, and pneumonia, will have rapid breathing. In all of these conditions, this rapid breathing pushes more CO₂ out of lungs, with a mild decrease in PaCO₂ as the body's expected compensatory response. In these clients, retention of CO₂ (or even normal PaCO₂) is more dangerous as it indicates respiratory muscle fatigue (failure) resulting in retention of PaCO₂. (Option B) PaO₂ >80 mm Hg (10.66 kPa) is considered a normal finding. In clients with chronic obstructive pulmonary disease (COPD), airflow out of the lungs is impeded, trapping CO₂ in the lungs. The body adjusts to the higher CO₂ level (which would cause an increase in respirations in a non-COPD client) and then uses the PaO₂ as the drive for breathing. (Option C) Warfarin is prescribed to prevent blood clotting in clients with atrial fibrillation. To be therapeutic and prevent clotting, the dosage of warfarin is adjusted to maintain an INR of 2-3. This client's INR is therapeutic for the diagnosis of atrial fibrillation. Educational objective: Blood loss is a common complication of a total knee replacement. Monitoring the client postoperatively for signs of blood loss and active bleeding is a priority.

The Nurse Receives Laboratory Reports on 4 Clients