Patient Data
Based on the results of the echocardiogram, the physician has decided to repair the ventricular septal defect via cardiac catheterization. What should the nurse’s focused assessment include before the cardiac catheterization? Select all that apply.
Obtain a history of allergic reactions
Document lying, sitting, and standing blood pressures
Perform a mini mental exam on the child
Determine when the child last ate
Locate and mark the pedal pulses
Measure the child’s height and weight
Correct Answer : A,B,D,E
Choice A reason: Obtaining a history of allergic reactions is crucial because the child will be exposed to various substances during cardiac catheterization, such as contrast dye, which could potentially cause an allergic reaction.
Choice B reason: Documenting lying, sitting, and standing blood pressures is important to assess for orthostatic hypotension, which could indicate volume depletion or cardiovascular problems that need to be addressed before the procedure.
Choice C reason: Performing a mini mental exam on the child is not typically part of the pre-procedure assessment for cardiac catheterization, especially given the young age of the child.
Choice D reason: Determining when the child last ate is essential because the child needs to have an empty stomach to reduce the risk of aspiration during sedation.
Choice E reason: Locating and marking the pedal pulses is important to establish baseline data so that post-procedure, any changes in the strength or presence of these pulses can be quickly identified, indicating potential complications.
Choice F reason: Measuring the child’s height and weight is generally part of a routine assessment but is not specifically focused on the pre-cardiac catheterization assessment unless dosing of medication or anesthesia is required based on weight.
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Related Questions
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}
Explanation
- Choice A: No Understanding
- Reason: An echocardiogram is a non-invasive procedure that uses ultrasound waves to create images of the heart.
- Choice B: Understanding
- Reason: Parents can indeed show their child a movie or read a book during the procedure as it helps keep the child calm and still, which is conducive for a transthoracic echocardiogram².
- Choice C: No Understanding
- Reason: An echocardiogram is generally not a painful procedure. It is non-invasive and involves placing a transducer on the chest to capture images of the heart².
- Choice D: Understanding
- Reason: The echocardiogram will indeed produce an image of the structure of the heart, which is essential for diagnosing and assessing conditions like VSD.
- Choice E: Understanding
- Reason: Echocardiography uses sound waves to produce images of the heart, which can show how well blood is moving through the heart and heart valves.
Correct Answer is C
Explanation
Choice A reason: Assessing body temperature is a routine post-procedure check but not the most critical for thrombocytopenia.
Choice B reason: Monitoring skin elasticity is not directly related to the risks associated with thrombocytopenia following a bone marrow biopsy.
Choice C reason: Observing the aspiration site is crucial because thrombocytopenia increases the risk of bleeding, and the site must be monitored for any signs of hemorrhage.
Choice D reason: Measuring urinary output is important but does not take precedence over monitoring the biopsy site for bleeding in a thrombocytopenic patient.
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