A nurse is assisting with the care of a preschooler who is postoperative following tetralogy of Fallot correction. Which of the following manifestations indicates the child is possibly experiencing decreased cardiac output?

Choice A rationale:
Edema. Edema, the accumulation of fluid in the tissues, is not the primary indicator of compartment syndrome. While edema can occur due to various reasons, it's not specific to compartment syndrome. Compartment syndrome primarily involves increased pressure within a closed space (muscle compartment), which can compromise blood circulation and nerve function.
Choice B rationale:
Mottling. Mottling refers to a patchy, bluish discoloration of the skin that occurs due to poor blood circulation and is often seen in critically ill patients. While it might indicate circulatory issues, it's not a direct sign of compartment syndrome. Compartment syndrome is more closely associated with symptoms such as severe pain, numbness, and decreased or absent pulses.
Choice C rationale:
Urticaria. Urticaria, also known as hives, is a skin rash characterized by raised, itchy, and red or white welts. It is typically caused by an allergic reaction or other factors such as medications. Urticaria is unrelated to compartment syndrome, which involves the compression of nerves and blood vessels within a closed anatomical compartment, leading to ischemia and potential tissue damage.
Choice D rationale:
Pulselessness. Pulselessness is a critical sign that the nurse should monitor when conducting a circulatory check for compartment syndrome. Compartment syndrome occurs when there is increased pressure within a confined space (muscle compartment), leading to compromised blood flow and oxygen delivery to the tissues. The lack of a palpable pulse in the affected area suggests that blood flow is severely compromised. This is a late sign of compartment syndrome and requires immediate intervention to prevent tissue necrosis and long-term complications.

Choice A rationale:
Hct 45% (Choice A) refers to the hematocrit level, which measures the proportion of blood volume occupied by red blood cells. While dehydration can lead to elevated hematocrit due to hemoconcentration, a hematocrit value of 45% is within the normal range for both males and females. Dehydration might cause a mild increase, but more significant elevations would be expected in cases of severe dehydration.
Choice B rationale:
Urine specific gravity 1.035 (Choice B) is an indicator of concentrated urine, which is a characteristic finding in dehydration. Dehydration reduces the body's water content, leading to more concentrated urine with higher specific gravity values. A normal range for urine-specific gravity is typically between 1.005 and 1.030.
Choice C rationale:
Capillary refill of less than 2 seconds (Choice C) is not a finding consistent with dehydration. Capillary refill time measures the time it takes for color to return to the nailbed after pressure is applied. Prolonged capillary refill time might indicate poor peripheral perfusion, which can be a sign of dehydration, but a refill time of less than 2 seconds is considered within the normal range.
Choice D rationale:
A urine output of 35 ml/hr (Choice D) is not indicative of dehydration. In fact, a urine output of 35 ml/hr is relatively normal and suggests adequate fluid intake and hydration. Dehydration would typically result in reduced urine output as the body conserves water.