Alyssa Carter is a 7 year old female who was born at 32 weeks gestation and was diagnosed with a Ventricular Septal Defect (VSD) at one year of age. Alyssa has been medically managed and

Alyssa Carter is a 7 year old female who was born at 32 weeks gestation and was diagnosed with
a Ventricular Septal Defect (VSD) at one year of age. Alyssa has been medically managed and
has not required operative intervention. Her development matches her chronological age. She is
in the second grade in a public elementary school. She is up to date on allimmunizations.
Alyssa presented to the emergency department twice over the past month with complaints of
her “heart pounding”. Each time she was assessed and sent home without intervention.
Alyssa’s mother brings her to the emergency department today again and reports that she was
outside playing and came into the house complaining of her heart pounding and feeling like she
had just gotten off the merry go round. The mom reports she was pale and sweaty. Her mother
had her lie down on the sofa for 30 minutes, but the lightheadedness and pounding in her chest
did not dissipate.
The nurse places Alyssa on the cardiac monitor and notes a regular, narrow, complex rhythm
with a rate of 174.
In your initial post, please address the following questions:
1. What physical assessment findings will the nurse expect?
2. Describe the three priority interventions and the rationale for these interventions the nurse
will perform.
3. The vagal maneuvers are not successful and the ED physician has ordered Adenosine tobe
administered. Describe the pharmacologic action of Adenosine and the key nursing
considerations of administering this medication.
4. Alyssa converts to an NSR at 90 beats per minute after two doses of adenosine. The
physician discharges her with a prescription of oral digoxin. Develop patient/family
medication education for Alyssa prior to discharge.