After undergoing a cardiac catheterization, a patient has a large puddle of blood under his buttocks.
What should be the nurse’s priority action?

Choice A rationale:

B-type natriuretic peptide (BNP) is a hormone produced primarily by the ventricles of the heart in response to stretching of the heart muscle fibers. It plays a crucial role in regulating blood volume and pressure by promoting the excretion of sodium and water by the kidneys. Elevated levels of BNP in the blood are strongly suggestive of heart failure, as the heart muscle is working harder to pump blood, leading to increased BNP production.

Key points supporting A as the correct answer:

BNP is a highly sensitive and specific marker for heart failure. Studies have demonstrated its accuracy in diagnosing heart failure, even in early stages when symptoms may be subtle.

The patient's clinical presentation aligns with heart failure. Vital fatigue and shortness of breath are both classic symptoms of heart failure, resulting from the heart's inability to meet the body's demands for oxygenated blood.

Other choices are less likely based on the information provided. Pleurisy (inflammation of the lining of the lungs), cardiomyopathy (disease of the heart muscle), and valve dysfunction can all cause shortness of breath, but they would not typically lead to elevated BNP levels unless heart failure is also present.

Additional considerations:

BNP levels can be influenced by factors other than heart failure, such as age, kidney function, and certain medications. However, in the context of a patient with typical heart failure symptoms, an elevated BNP level strongly supports the diagnosis.

BNP testing is often used to guide treatment decisions in patients with heart failure. Serial BNP measurements can help assess the effectiveness of therapy and monitor for disease progression.

Choice A rationale:

Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.

Administering digoxin could further slow the heart rate and worsen the patient's symptoms.

Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:

While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.

The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:

Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.

It is not indicated for sinus bradycardia.

Choice D rationale:

Transcutaneous pacing is a non-invasive method of pacing the heart.

It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.

This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.