Child with a cardiovascular disorder

Child with a cardiovascular disorder

Child with a cardiovascular disorder

Case 1: Baby boy Ellis, 2 hours old, is being evaluated in the newborn nursery by the nursing staff. Findings include T 37°C; apical heart rate 140 bpm; respirations 58 breaths per minute; BP (arms) 70/47, (calves) 62/39; head circumference 34 cm; chest circumference 31 cm; length 48 cm; weight 2,700 g. The infant is crying.

i. Based on the physical findings, what should be the nurse’s priority?

The nurse should first focus on the breathing rate and heartbeat of the child. The baby has a slightly high apical heart rate and temperature.  Incorrect. Go review normal VS for a newborn,

Therefore, the baby’s temperature need to be reduced to normal and he also needs to be put on oxygen to help him with breathing until his breathing system has developed fully.

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Look at the BPs again.. Why are UE BPs higher then LE? This is the question/

ii. What assessment /tests should the nurse expect to be done on this infant?

Cardiovascular magnetic resonance imaging,

fetal echocardiogram,  the baby is born.. no longer a fetus

chest x-ray, pulse oximetry, cardiac catheterization, and electrocardiogram tests are expected to be done on the infant (Hockenberry & Wilson, 2018).

iii. What should the nurse include in the teaching plan for the parents of this infant?

c. Need to answer the above correctly first.

The nurse needs to inform the parents that the child is receiving intravenous (IV) fluids or having adjustments to make his breathing easier. He or she should also assure the parent that their baby is doing well. The nurse should teach the parents on how to care for their child once he is discharged. For example, they should always keep the baby warm to prevent cyanosis, observe the baby keenly and report to the doctor anytime the baby lacks enough oxygen and they should look out for symptoms like blue skin color and difficulty in breathing for this diagnosis, and also understand how to give medicine to the baby (Hockenberry & Wilson, 2018).

CASE 2: Jennifer Collins, 13 years old, is admitted to the pediatric floor with a diagnosis of probable acute rheumatic fever?

1. What would the nurse include when performing an initial assessment?

Nursing assessment for probable acute rheumatic fever include;

· History – the nurse will interview the caregiver to get an up to date history of the child. He or she will enquire about any recent respiratory infection or sore throat and also find out the time that the symptoms begun.

·

· Physical exam – the nurse will begin with a thorough review of all systems and note the physical condition of the child, look out for any signs and classify them as either major or minor manifestations, check temperature and pulse, examine swollen or painful joints, subcutaneous nodules, and look for any signs of chorea (Carapetis et al., 2005).

. History of recent streptococcal infection

. History of joint pain and/or fever

. Past history of ARF

. Observation for Sydenham chorea

. Observation for erythema marginatum

. Palpation of the surfaces of the wrist, elbows, and knees for firm, painless, subcutaneous nodules

. Presence or absence of heart murmur

.

0. What tests would the nurse expect to be done on Jeniffer? The diagnosis of acute rheumatic fever is confirmed.

The following tests are expected to be done on Jeniffer;

· Throat culture test

· Rapid antigen detection test – this is used to detect group A streptococci antigen which allows the diagnosis of streptococcal pharyngitis to be made.

· Antistreptococcal antibodies test – when antistreptococcal antibodies are at their peak that is when the features of rheumatic fever begin to show. This is the best test to confirm acute rheumatic fever for people who show chorea as the only diagnostic criterion.

· Heart reactive antibodies – this is a test to see if tropomyosin is elevated in persons with acute rheumatic fever.

· Rapid detection test for D8/17 – this is a immunofluorescence technique for identifying the B-cell marker D8/17 and see if it is positive.

· Other tests will be chest radiography and Echocardiography.

0. What would the nurse be sure to include in the discharge teaching plan for Jennifer and her family?

As the baby gets discharged, the nurse should include the following in the teaching plan for Jeniffer and her family; they should always be very keen on any symptoms of rheumatic fever and see the doctor immediately because there is no cure for rheumatic fever but the symptoms can be treated (Carapetis et al., 2005). Also, the child will need to be to be taken back to the hospital for follow ups with cardiology as symptoms of valve damage may not be detectable until later in the future. Also, matters hygiene should be included in the teaching plan. This is because many studies have shown that there are higher occurrences of rheumatic fever in places with poor sanitation and overcrowding.

References

Carapetis, J. R., McDonald, M., & Wilson, N. J. (2005). Acute rheumatic fever. The Lancet, 366(9480), 155-168.

Hockenberry, M. J., & Wilson, D. (2018). Wong’s nursing care of infants and children-E-book. Elsevier Health Sciences.