A nurse on a mother-baby unit is caring for a 2-day-old baby boy. The patient was seen by a urologist at 0000 and was diagnosed with hypospadias, Which order by the pediatrician is contraindicated?

Decreased cardiac output is a common consequence of various cardiac conditions in children. In this scenario, the child's cool extremities and thready pulses indicate poor peripheral perfusion, which can occur when the heart is not effectively pumping blood to meet the body's demands. Decreased urinary output is another sign of poor cardiac output, as reduced blood flow to the kidneys can result in decreased urine production.

The other options may contribute to decreased cardiac output, but they are not the primary factors indicated by the clinical findings:

A. Increased afterload: Increased afterload can make it more difficult for the heart to pump blood effectively, but it is not the primary cause of the symptoms described.

C. Decreased contractility: Decreased contractility can reduce the heart's ability to pump blood, contributing to decreased cardiac output, but it is not the primary factor indicated by the clinical findings.

D. Increased stroke volume: An increase in stroke volume typically results in improved cardiac output, not diminished cardiac output as seen in this scenario.

The symptoms described, including vomiting, coughing, and looking flushed, are concerning for a potentially severe allergic reaction, which can be life-threatening. This could be indicative of anaphylaxis, a severe allergic reaction that requires immediate medical attention.

Administering CPR (Option D) is not appropriate at this point unless the child becomes unresponsive and stops breathing, which would be a very late sign of anaphylaxis. In such a situation, CPR would be necessary, but the primary focus should be on calling 911 and obtaining immediate medical assistance.

Option A, giving Benadryl, can be part of the treatment for an allergic reaction, but it should not be the first or only action taken in a severe allergic reaction. Immediate medical evaluation and potential administration of epinephrine are more critical.

Option B, recommending symptomatic treatment for the cough, is not appropriate in this situation. The priority is recognizing the potential severity of the allergic reaction and seeking immediate emergency care.

Therefore, the nurse should advise the mother to call 911 to ensure that the child receives prompt medical attention and assessment for anaphylaxis.