Nurses' Notes
1010: The nurse receives a client after an ultrasound-guided percutaneous liver biopsy. The initial recovery note states that mild puncture-site soreness improves with supported positioning. At 1025, the dressing remains dry and the client is alert and answers orientation questions correctly. The nurse then observes that blood pressure is falling while the pulse becomes progressively faster. At 1035, the client reports that abdominal pain is increasing with new guarding. The puncture dressing still shows no external drainage. The respiratory assessment now finds that new shortness of breath occurs with reduced breath sounds on one side. The client reports that small sips of water are tolerated without nausea or swallowing difficulty. A repeat blood count shows that hemoglobin has fallen substantially from the preprocedure value. The nurse confirms that the peripheral intravenous line remains patent. The client says that mild right shoulder discomfort has not increased. At 1045, the nurse applies ordered oxygen, maintains intravenous access, and calls the rapid response team. The nurse prepares the client for urgent imaging and additional laboratory testing. The provider is informed that instability developed despite a dry external dressing.
Nurses' Notes
1010: The nurse receives a client after an ultrasound-guided percutaneous liver biopsy. The initial recovery note states that mild puncture-site soreness improves with supported positioning. At 1025, the dressing remains dry and the client is alert and answers orientation questions correctly. The nurse then observes that blood pressure is falling while the pulse becomes progressively faster. At 1035, the client reports that abdominal pain is increasing with new guarding. The puncture dressing still shows no external drainage. The respiratory assessment now finds that new shortness of breath occurs with reduced breath sounds on one side. The client reports that small sips of water are tolerated without nausea or swallowing difficulty. A repeat blood count shows that hemoglobin has fallen substantially from the preprocedure value. The nurse confirms that the peripheral intravenous line remains patent. The client says that mild right shoulder discomfort has not increased. At 1045, the nurse applies ordered oxygen, maintains intravenous access, and calls the rapid response team. The nurse prepares the client for urgent imaging and additional laboratory testing. The provider is informed that instability developed despite a dry external dressing.