The nurse is caring for a school-age child who has had a cardiac catheterization.The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood.The most appropriate initial nursing action is to:
A)notify physician.
B)apply new bandage with more pressure.
C)place the child in Trendelenburg position.
D)apply direct pressure above catheterization site.

Question

Quizplus · Accepted Answer

If bleeding occurs,direct continuous pressure is applied 2.5 cm (1 inch)above the percutaneous skin site to localize pressure over the vessel puncture.Notifying a physician and applying a new bandage can be done after pressure is applied.The nurse can have someone else notify the physician while the pressure is being maintained.It is not a helpful intervention to place the girl in the Trendelenburg position.It would increase the drainage from the lower extremities.

The Nurse Is Caring for a School-Age Child Who Has