Question

Tommy, a 3-year-old boy with tetralogy of Fallot, has just returned to his hospital room from the cardiac catheterization recovery room. His mother calls you to the bedside to tell you that he is vomiting and bleeding. You arrive to find Tommy anxious, pale, crying, and sitting in a puddle of blood.

Questions

1. Evidence—Is there sufficient evidence to draw conclusions about Tommy’s situation?

2. Assumptions—Describe an underlying assumption about each of the following:

a. Risks of cardiac catheterization

b. Association between vomiting and bleeding after cardiac catheterization

c. Concerns related to acute blood loss

3. What priorities for nursing care should be established for Tommy?

4. Does the evidence support your nursing interventions?

Answer 1

Cardiac catheterization is an invasive procedure by which a thread made of metal is entered into through the Periferal arteries directly into the heart and some information are collected about the condition of hearts blood circulation and any structural heart defects.

1. There are many complications arrise after cardiac catheterization. Nausea, vomiting, bleeding, hemorrhage are some common complications of cardiac catheterization. These are not sufficient evidence to conduct an evaluation about Tommy's condition.

2. a) There are some serious risks develops after a cardiac catheterization. There are mainly = bleeding, brushing, internal hemorrhage, puncture of blood vessels, nausea, vomiting etc.

Some late risks are = heat attack, heart blocks, kidney failure, allergic reaction due to die injected into artery, puncture site infection etc.

b) vomiting may occurs due to administration of pre medications administer before the cardiac catheterization procedure like as warferine or clopidogral, prasugral etc. Or vomiting occurs due to anxiety.

Bleeding may occurs due to arterial puncture and not proper pressure dressing at the invasion site.

c) There may be arise sever conditions due to acute blood loss. The outcomes of acute bleeding are mainly hypovolemic shock, hemorrhagic shock, fatigue, breathing difficulty in breathing, heart attack, confusion, unconciousness etc.

3. The child Tommy is in a emergency condition. The priority nursing care for Tommy are =

- Assessment if the condition of the child.

I. Assess the severity, duration, location, amount of bleeding.

ii. Monitor the vital signs.

iii. Respiratory and cardiac assessment.

iv. Assessment of the puncture site.

- Nursing implementation =

I. The puncture site has to be opened and a clear new sterile pressure dressing has to be done to prevent farther bleeding.

ii. The child has to be kept calm the child and made him quite.

ii. Vital signs has to be monitored and record them to gain a basic idea about patient condition.

iii. Proper IV fluids has to be administered as per physician prescribed to replace fluid loss.

iv. Moist Oxygen therapy has to provide to the child to prevent breathing difficulty.

v. Proper psychological support has to provide to the mother and a brief explanation of the child's condition has to provide.

vi. Proper medications has to be administered as per physician recomend to stop bleeding.

4. Yes the evidences support the nursing interventions. As the interventions I have done after proper assessment of the child's condition.