An adult client is transported via ambulance to the emergency department (ED) following a motor vehicle collision. On arrival the client reports experiencing severe upper back pain. The vital signs are a temperature of 98.6° F (37° C) orally, heart rate 145 beats/minute, respirations 26 breaths/minute, and blood pressure 70/40 mm Hg. Which change in assessment findings indicate that the client's condition is deteriorating?