Nurse Ashley is caring for a 6-year-old female patient in an outpatient doctor's office

Patient Results

Leukocytes:

Nitrates

Urobil

Protein

PH 6.5

Blood

Spec Gravity 1.020

Ketones

Bilirubin

Glucose

Based on the patient's presentation, what would the nurse anticipate her diagnosis to be?

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.

Assessing pulses is a critical step immediately after a cardiac catheterization procedure because it helps determine the adequacy of blood flow to the extremities and any potential vascular complications. Cardiac catheterization involves the insertion of a catheter through blood vessels, which can temporarily affect blood flow. Checking pulses in the affected limb (e.g., the leg or arm where the catheter was inserted) is essential to detect any signs of vascular compromises, such as decreased or absent pulses, which could indicate complications like arterial thrombosis or embolism. Prompt recognition of such issues is crucial for timely intervention to prevent potential complications or limb damage.

The other options are also important but should be addressed after the initial assessment of pulses:
A. Pain: Assessing pain is important, but it should come after checking pulses. If the child reports pain, it could indicate discomfort or complications related to the procedure, which may require further evaluation and intervention.
C. Catheterization report: Reviewing the catheterization report is necessary for a comprehensive understanding of the procedure and its findings, but it is not the immediate priority when assessing the child's post-procedure condition.
D. Hemoglobin and hematocrit levels: Checking hemoglobin and hematocrit levels is important to monitor for potential bleeding complications that may occur during or after the procedure, but it is a secondary assessment compared to evaluating pulses. If there are significant changes in these levels, they may require further investigation and intervention.

In summary, assessing pulses is the initial priority after a cardiac catheterization procedure in order to promptly identify any vascular issues or complications that need immediate attention.