A 7-year-old child is admitted to the pediatric unit following surgical repair of a ventricular septal defect (VSD). During the postoperative assessment, the nurse notes the child has a heart rate of 58 beats per minute, capillary refill of 4 seconds, and urine output of 0.4 mL/kg/hour over the past two hours. The child's SpO2 is 94% on 2L nasal cannula and the child appears lethargic. Which finding should the nurse identify as most concerning and report immediately to the provider?
- Heart rate of 58 beats per minute with decreased urine output and prolonged capillary refill
- SpO2 of 94% on supplemental oxygen
- Capillary refill of 4 seconds as an isolated finding
- Lethargy in the immediate postoperative period