A client is bleeding profusely due to a labor complication….
A client is bleeding profusely due to a labor complication. The client is rushed to the c-section room and the health care provider determines the client has had a uterine rupture. The recovery nurse is doing an assessment. Prior to the c-section the client’s vitals are: temperature 37.0 C (98.6 F) blood pressure 132/88, pulse 88, respirations 18. Quantitative Blood Loss: (QBL) = 3,000 mL Pre Surgical Baseline & Clinical Status Assessment Parameter Findings Status/Notes Temperature 37.0°C (98.6°F) Within Normal Limits Blood Pressure 132/88 mmHg Baseline Pulse 88 bpm Baseline Respirations 18 breaths/min Within Normal Limits Which of the following findings in the assessment would most clearly suggest severe hypovolemia or “late” sign of shock and be most concerning?