Report bleeding, an expanding or pulsating hematoma at the insertion site, indicating possible hemorrhage or pseudoaneurysm.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A nurse is caring for a child after a cardiac catheterization. Which assessment is the priority in the first few hours after the procedure?
Answer: B. After cardiac catheterization, the priority is to assess the affected extremity for bleeding or hematoma at the insertion site and to check pulses, color, temperature, and capillary refill distal to the site to detect arterial occlusion or hemorrhage.
Question 2 of 3
A nurse palpates a postpartum client's fundus and finds it boggy and displaced to the right above the umbilicus. What is the most likely cause?
Answer: A. A fundus that is boggy and deviated to the right (usually upward and to one side) is most often caused by a full bladder. A distended bladder displaces the uterus and prevents it from contracting, leading to atony. The nurse should have the client void or perform catheterization, then reassess.
Question 3 of 3
A nurse is caring for a client 6 hours after birth who has not voided. The bladder is palpable above the symphysis pubis and the client reports the urge to void but cannot. What is the nurse's priority intervention?
Answer: A. Postpartum urinary retention is common from edema, decreased bladder tone, and perineal trauma. Non-invasive measures should be tried first: assist to the bathroom, run warm water, pour warm water over the perineum, and provide privacy to encourage spontaneous voiding. Catheterization is reserved for when these measures fail, to reduce infection risk. A distended bladder also predisposes to uterine atony, so prompt emptying matters.
Keep the streak going with more questions like these, each with a full rationale.
What is cardiac catheterization?
It may be combined with angioplasty and stent placement. Memory aid: check the pulse below the puncture, keep the leg straight, and watch for bleeding.
Key points to remember
- Iodinated contrast dye is used, so allergies to shellfish, iodine, or prior contrast reactions must be assessed beforehand.
- After a femoral approach the patient keeps the affected leg straight and lies flat for several hours to prevent bleeding.
- The dye causes a transient warm, flushing sensation and a metallic taste, which is expected.
- Distal pulses, color, temperature, and sensation of the affected extremity are monitored frequently after the procedure.
- Contrast is nephrotoxic, so hydration and monitoring of renal function are important.
- Metformin is typically held before and after the procedure to reduce the risk of lactic acidosis with contrast.
Nursing priorities
- Verify consent and assess for iodine or contrast allergy and baseline renal function.
- Mark and document distal pulses before the procedure for post-procedure comparison.
- Keep the patient flat with the affected extremity straight and the head of bed low after a femoral approach.
- Assess the puncture site for bleeding or hematoma and check distal pulses, color, and sensation frequently.
- Encourage fluids and monitor urine output to flush contrast and protect the kidneys.
Labs & values
Patient teaching
- You may feel a warm flush and a metallic taste when the dye is injected, which is normal.
- Keep the affected leg straight and lie flat as instructed to prevent bleeding.
- Drink extra fluids afterward to help flush the dye from your kidneys.
- Apply firm pressure and call for help if the site starts to bleed.
- Report chest pain, a cold or numb leg, or any bleeding right away.
Red flags: report now
- Report bleeding, an expanding or pulsating hematoma at the insertion site, indicating possible hemorrhage or pseudoaneurysm.
- Report a cool, pale, pulseless extremity or new numbness suggesting arterial occlusion.
- Report chest pain, dysrhythmias, or shortness of breath after the procedure.
- Never raise the head of the bed or flex the affected leg too soon after a femoral approach.
References
Clinical references for this topic
