NURS 2864 - Cardiac Catheterization Lab Scenario Student Copy

What is a Patent Ductus Arteriosus (PDA), and why is it classified as an acyanotic congenital heart defect with increased pulmonary blood flow?

A PDA is a persistent opening between the pulmonary artery and aorta that normally closes shortly after birth. It creates a left-to-right shunt where oxygenated blood from the aorta flows into the pulmonary artery, increasing pulmonary blood flow. It is classified as acyanotic because systemic circulation still receives oxygen-rich blood, so cyanosis does not usually occur. Over time, pulmonary overcirculation may cause tachypnea, poor feeding, and heart failure if untreated.

Why does a PDA cause increased pulmonary blood flow, and what complications may develop if the ductus fails to close?

The aorta has higher pressure than the pulmonary artery, so oxygenated blood is pushed back into the lungs, increasing pulmonary circulation. Chronic overcirculation can lead to tachypnea, respiratory distress, poor feeding, growth delay, and eventual heart failure.

One hour after a femoral cardiac catheterization, a toddler wakes up and moves his legs—what are the nurse’s top priorities and immediate actions?

Priorities include preventing disruption of the femoral access site, maintaining hemostasis, managing pain, and monitoring circulation and vital signs. Actions include keeping the leg straight, avoiding hip flexion, using pillows/parent assistance for immobilization, checking vital signs and the access site every 30 minutes, offering comfort measures, administering acetaminophen for pain (160 mg PO for 13.5 kg), keeping the HOB <30 degrees, and calming both toddler and parent.

A toddler sits up and bends the leg post-cath, causing oozing and a swelling lump at the site; vitals HR 132, BP 88/50. What does this indicate, and what is the nurse’s immediate response?

This indicates early hematoma formation from bleeding at the femoral site. The nurse immediately applies firm direct pressure 1–2 cm above the puncture site, keeps the leg straight, calls the provider STAT, assesses distal pulses and limb perfusion, reassesses vital signs, documents hematoma size and oozing, explains actions to the parent, and prepares for possible interventions like pressure dressings or ultrasound.

How should the nurse answer the mother when she asks, “Is that blood? Why is his leg swelling?”

The nurse should explain calmly: “I see a little oozing under the dressing, and that small lump means a bit of blood is collecting under the skin. That can happen when the leg bends too soon after this procedure. I’m putting pressure here to stop the bleeding, and we’re taking care of it right away. He’s safe, and I’ll stay with him while we manage this.”

How should the nurse use therapeutic communication when the tearful mother asks, “Is he going to be okay?”

Use empathy and factual reassurance: acknowledge her feelings, give clear information, and explain the plan. Example: “I can see how worried you are—any parent would feel that way. We caught this early and are applying pressure to stop the bleeding. He is stable, and the provider is on the way. I’ll stay with you both and keep you updated.”

How did the nurse recognize post-catheterization bleeding, and what steps were taken in response?

Bleeding was recognized by slight dressing oozing, formation of a small hematoma, toddler movement, and increased HR. The response included immediate direct pressure, leg immobilization, calling the provider, and frequent circulation and vital-sign checks.

What communication strategies help calm and involve a parent during a post-procedure complication?

Using a calm tone, validating emotions, giving simple explanations, avoiding medical jargon, assigning the parent a helpful role (e.g., calming the child), and providing frequent updates all help reduce anxiety and build trust.

What complications could occur if a toddler’s leg is not kept straight after a femoral cardiac catheterization?

Disruption of the femoral site causing uncontrolled bleeding, rapid hematoma expansion, arterial occlusion (cold, pale, pulseless leg), retroperitoneal hemorrhage, need for transfusion, or emergency surgery. Strict leg immobilization and low activity are essential.

What discharge education should parents receive after a child’s femoral cardiac catheterization?

They should monitor for swelling, firmness, increased bruising, drainage, fever >38°C, infection signs, or a cool/pale/numb leg. Activity restrictions include no running, jumping, straddle toys, or vigorous play for 3–5 days; no tub baths for 48–72 hours. Keep the dressing clean/dry, remove it per instructions, avoid lotions/creams, and give acetaminophen (avoid ibuprofen if advised). Encourage extra fluids to eliminate contrast dye and attend follow-up cardiology appointments. Mild bruising is normal; increasing swelling is not.