A client has returned to the nursing unit from having a cardiac catheterisation. The RN is assessing the client's right pedal pulse (dorsalis pedis) and assesses no pulse present. On further investigation, the extremity is found to be warm and pink, and nail beds blanch well with two to three seconds capillary refilling time. How would the RN explain these findings?

Question

Quizplus · Accepted Answer

A lack of pulse does not necessarily mean that blood flow to the extremity is completely blocked. In this case, the extremity is warm and pink, meaning there is still some blood flow. The lack of pulse could be due to too much pressure being applied over the pulse site, such as from a tight bandage or from the RN's fingers pressing too hard. This is a known complication of cardiac catheterization and can be easily resolved by loosening the pressure over the pulse site. Throwing a blood clot would present with other symptoms such as pain or swelling, and a change in the client's health status would require further assessment and investigation. The RN's watch stopping working is unlikely to have any impact on the assessment of the client's right pedal pulse.

A Client Has Returned to the Nursing Unit from Having