A 37-yr-old female patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?

A. Decrease in cardiac output: A Swan-Ganz (pulmonary artery) catheter rarely causes an immediate decrease in cardiac output unless complications like arrhythmias or pulmonary artery rupture occur. Monitoring hemodynamics helps detect changes, but this is not the most common risk during insertion or removal.

B. Damage to the mitral valve: The catheter passes through the right atrium and right ventricle into the pulmonary artery, so the mitral valve is not in the pathway. Injury to the mitral valve is unlikely, making this a low-risk complication.

C. Myocardial infarction: Myocardial infarction is not a typical complication of Swan-Ganz catheterization unless coronary perfusion is severely compromised by another underlying condition. It is not directly caused by the catheter itself.

D. Ventricular dysrhythmias: As the catheter passes through the right ventricle, it can mechanically irritate the ventricular myocardium, leading to premature ventricular contractions, ventricular tachycardia, or other dysrhythmias. This is the most common and expected complication during insertion and removal, requiring continuous ECG monitoring.

A. Obtain blood cultures from two sites: Obtaining blood cultures before initiating antibiotics is the highest priority because it ensures accurate identification of the causative organism. Administering antibiotics prior to culture collection can result in false-negative cultures, delaying targeted therapy and potentially worsening the infection.

B. Schedule a transesophageal echocardiogram: Echocardiography is important for assessing valvular damage or vegetations in infective endocarditis, but it does not take precedence over obtaining cultures, which are critical for guiding immediate antimicrobial therapy.

C. Administer ceftriaxone 1g IVPB Q 12 hours: Timely administration of antibiotics is essential, but it should follow culture collection. Administering antibiotics before cultures could compromise diagnostic accuracy, affecting subsequent treatment decisions.

D. Give acetaminophen 650mg PO Q 6 hours PRN for fever: Antipyretics relieve symptoms but do not treat the underlying infection. While important for comfort, managing fever is secondary to establishing the causative pathogen and initiating appropriate antimicrobial therapy.