During a postoperative assessment of a client who had a total knee arthroplasty, the nurse recognizes a sudden decrease in hemoglobin level.
What should the nurse suspect?

Choice A rationale

The use of herbal supplements can pose risks, such as increased bleeding if the patient takes ginkgo or garlic, or interactions with anesthesia. However, these are generally manageable through preoperative screening and temporary cessation of the supplements. While important, they do not represent the same level of systemic risk for major postoperative complications, such as myocardial infarction or heart failure, as a documented history of established cardiovascular disease does in the elderly population.

Choice B rationale

Being under age 40 is actually a protective factor rather than a risk factor for complications. Younger patients typically have better physiological reserves, faster healing rates, and fewer comorbidities compared to older adults. Most complications in total knee arthroplasty are associated with advanced age, which often brings decreased bone density and impaired cardiovascular function. Therefore, youth generally correlates with better outcomes and a lower likelihood of experiencing systemic complications during or after the surgical procedure.

Choice C rationale

A vegetarian diet is not a significant risk factor for surgical complications, provided the patient maintains adequate protein and iron intake for wound healing. While extreme nutritional deficiencies can impair recovery, most vegetarians meet their nutritional needs through varied food sources. Protein is essential for collagen synthesis, but a meat-free diet does not inherently predispose a patient to poor surgical outcomes unless it is poorly managed and results in severe anemia or protein-energy malnutrition.

Choice D rationale

A history of heart disease is a major risk factor for complications during and after total knee arthroplasty. The stress of surgery and anesthesia can strain the cardiovascular system, leading to arrhythmias, myocardial ischemia, or heart failure. Furthermore, heart disease often necessitates the use of anticoagulants, which complicates intraoperative bleeding management and postoperative DVT prophylaxis. Patients with cardiac issues have a reduced ability to compensate for the hemodynamic shifts that occur during major orthopedic operations.

Choice A rationale

Pressure injuries typically present as localized areas of tissue necrosis or skin breakdown over bony prominences such as the sacrum or heels. While they can involve inflammation if infected, the classic signs of redness, swelling, and warmth specifically at a surgical incision site are more indicative of a localized inflammatory response to pathogens. Pressure injuries are graded by stages rather than the acute inflammatory symptoms often seen with post-surgical wound complications or cellulitis.

Choice B rationale

Dehydration involves a systemic fluid volume deficit that manifests as poor skin turgor, dry mucous membranes, and concentrated urine. It does not cause localized redness, swelling, or warmth at an incision site. While adequate hydration is essential for the biochemical processes of wound healing, its absence leads to delayed healing or tissue friability rather than the classic signs of inflammation. Normal skin turgor and moist membranes are indicators of a balanced fluid status in patients.

Choice C rationale

Malnutrition, particularly protein-calorie malnutrition or vitamin C deficiency, impairs the synthesis of collagen and slows the inflammatory phase of wound healing. However, it is not a direct cause of acute redness, heat, and swelling at a surgical site. Chronic nutritional deficits may lead to wound dehiscence or delayed closure, but the immediate presence of warmth and edema usually signals an active immune response to a foreign invader or internal injury within the tissue.

Choice D rationale

Infection is the primary hypothesis when a surgical incision displays redness, swelling, and warmth. These are the cardinal signs of inflammation caused by the immune system responding to microbial invasion. Pathogens trigger vasodilation and increased capillary permeability, leading to the heat and edema observed. A normal white blood cell count ranges from 5000 to 10000 mm, and an elevation beyond this range often confirms the nurse's suspicion of a localized or systemic infection.