Question

The client diagnosed with a MI is 6 hrs post-right femoral percutaneous transluminal coronary angioplasty (PTCA), also known as balloon surgery. Which assessment data should require immediate intervention by the nurse?

a. The client is keeping the affected extremity straight.
b. The pressure dressing to the right femoral area is intact.
c. The client is complaining of numbness in the right foot.
d. The client's right pedal pulse is 3+ and bounding.

Answer 1

The assessment data that requires immediate intervention by the nurse is option c. The client complaining of numbness in the right foot.

Step-by-step explanation:

Numbness in the right foot post-percutaneous transluminal coronary angioplasty (PTCA) could indicate a potential complication like a vascular issue or nerve damage. This complaint warrants immediate attention due to the risk of reduced blood flow or nerve injury. In this scenario, diminished blood flow could lead to ischemia or compartment syndrome, affecting tissue viability. Prompt intervention is crucial to prevent further complications.

Numbness in the foot suggests a compromised blood supply or nerve function. It might result from inadequate circulation, possibly due to arterial occlusion or nerve compression. Assessing the client's neurovascular status involves checking sensation, motor function, and capillary refill time. Given the time frame post-surgery and the risk of vascular compromise, timely assessment and intervention are critical to prevent potential complications.

Assessing and addressing any signs of diminished blood flow or nerve function is crucial to prevent serious complications. Immediate nursing intervention involves assessing pulses, capillary refill, sensation, and motor function in the affected extremity. Prompt collaboration with the healthcare team and the possibility of urgent revascularization or addressing nerve compromise is essential to mitigate any potential adverse outcomes.so correct option is c.