A nurse is caring for an older adult client who has just returned from PACU after receiving a spinal anesthetic during knee surgery. For which of the following findings should the nurse notify the provider?

A. The CD4-T-cell count is a critical indicator of immune function in individuals with HIV. CD4 cells are a type of white blood cell that HIV targets and destroys, leading to immune deficiency. A lower CD4 count indicates greater immunosuppression and increased susceptibility to opportunistic infections. Monitoring CD4 counts helps guide decisions regarding antiretroviral therapy (ART) initiation and monitoring response to treatment.
B. White blood cell (WBC) count measures the body's immune response and can fluctuate due to various factors. A WBC count of 5,000/mm3 is within the normal range, but it alone does not provide specific information about the client's HIV status or immune function compared to the CD4 count.
C. Platelets are involved in blood clotting, and a platelet count of 150,000/mm3 is within the normal range. Platelet counts are important for assessing bleeding risk but are not directly related to HIV progression or immune status.
D. A positive Western blot test confirms the presence of HIV antibodies in the blood. It is used for definitive HIV diagnosis after an initial positive screening test (such as ELISA). While important for diagnosis, once HIV is confirmed, ongoing monitoring of CD4 counts and viral load (not directly mentioned in the options) becomes more crucial for managing the disease.

A. A decrease in systolic blood pressure from 140 mm Hg to 120 mm Hg could indicate hypotension. Postoperatively, especially after receiving a spinal anesthetic, hypotension can occur due to vasodilation or decreased sympathetic tone. This change in blood pressure warrants notification of the provider because significant hypotension can lead to inadequate perfusion to vital organs and tissues.
B. A slight increase in temperature from 37.2°C to 37.5°C (99.0°F to 99.5°F) is a mild elevation and may not necessarily require immediate notification unless accompanied by other signs of infection or instability. It could be related to the stress response post-surgery. However, if there are other concerning signs (e.g., increased heart rate, worsening pain), the nurse should reassess and consider further action.

C. A decrease in pulse oximetry from 98% to 96% indicates a mild decrease in oxygen saturation. While this change alone may not be alarming, the nurse should assess the client's respiratory status and potential causes (e.g., positioning, respiratory depression from anesthesia). Oxygen saturation levels below 95% generally require intervention, but 96% is still within a normal range for most clients.
D. An increase in pain from 4/10 to 6/10 indicates worsening pain. Postoperatively, increasing pain may indicate inadequate pain management, worsening condition at the surgical site, or other complications such as hematoma or infection.