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Pediatric Case Study #2: Infant with Congenital Heart Defect
Scenario Directions: Please complete the following Pediatric Case Study #2 in paragraph form for each question. Each question is worth (1) point for a total of (10) points. Once completed via Word.doc, please upload submission for grading. Multiple attempts allowed; most recent will be graded.
Three-week-old J.T. and her parents arrive at the cardiac cath lab for her cardiac catheterization. She was born at term with Down syndrome, and her pediatrician is concerned because of lack of weight gain and poor feeding. You are getting her and her parents prepared for the procedure.
1. As you obtain her history and take vital signs, which statements or findings would be concerning and suggestive of heart failure (HF)? Select all that apply and explain your answers.
Peripheral pulses +3
Heart rate: 195 at rest
Rectal temperature: 97.8°F (36.6°C)
“J. gets damp and sweaty when she feeds.”
“J. takes 30 to 40 minutes to take 2 to 3 ounces (60 to 90 ml) of formula.”
“J. seems to have fewer wet diapers than when we brought her home from the hospital.”
Case Study Progress
After the catheterization, J.T. returns to the unit in a crib. The orders shown in the chart have been written.
Physician’s Orders
Daily weights: Current weight 8.8 pounds (4 kg)
Strict intake and output
O2 per nasal cannula as needed to maintain O2 saturation greater than 93%
VS every 15 minutes × 4, then every 1 hour × 4, then every 4 hours
Digoxin (Lanoxin) 70 mcg PO now, then 35 mcg PO every 6 hours for 2 doses
Furosemide (Lasix) 4 mg PO now, then 4 mg PO every 12 hours
2. You are reviewing J.T.’s medications. J.T’s mother states the following rationale for starting J.T. on digoxin (Lanoxin): “I need to give this to J. to decrease her blood pressure so her heart doesn’t have to work so hard.” Is this true or false? Explain your answer.
3. You have a student nurse working with you. The student nurse asks whether there are any precautions to observe when giving digoxin to a neonate. Describe medication safety precautions that should be observed when giving this medication.
4. Which of these are potential signs of digoxin toxicity in an infant? (Select all that apply.)
Vomiting
Bradycardia
Tachycardia
Decreased blood pressure
Lack of interest in feeding
Case Study Progress
You administer the ordered medication and proceed with your assessment.
5. Which of these are possible complications to monitor for after a cardiac catheterization? (Select all that apply.)
Hematoma
Vasospasm
Hemorrhage
Hyperglycemia
Transient dysrhythmia
Decreased pulse in unaffected leg
6. You are preparing to administer J.T.’s furosemide. Your drug reference gives the following therapeutic dose for edema in a neonate: 1 mg/kg per dose every 12 to 24 hours. Is the ordered dose of 4 mg a safe dose for J.T?
Case Study Progress
You note the following serum metabolic panel results for J.T.
Laboratory Results
Glucose 85 mg/dl
Ca (Calcium) 9.1 mg/dl
Na (Sodium) 142 mEq/L
K (Potassium) 3.3 mEq/L
Cl (Cloride) 101 mEq/L
7. Which laboratory finding would concern you, and why? Explain your answer.
8. The cardiologist tells J.T.’s parents that J.T. has a ventricular septal defect (VSD). On the diagram, circle the area affected by this defect.
9. True or False? This defect would create decreased pulmonary flow. Explain your answer.
Case Study Progress
The cardiologist consults with the family, and it is decided that J.T. will be discharged to home the following day with medications and close monitoring. J.T. will return in several months for surgical repair of the VSD.
10. You begin your discharge teaching. Describe the information you will include in teaching. Must include the following:
Medication administration
Diet
Care of dressing site
Follow up (i.e., when to call for signs of CHF or resp distress)
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