A parent of a 7-year-old girl with a repaired ventricular septal ...

[arivle123]

A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38 C (100.4 F), and now her muscl
 
  a. Immediately bring the child to the clinic for evaluation.
  b. Come to the clinic next week on a scheduled appointment.
  c. Treat the signs and symptoms with acetaminophen and fluids because it is most likely a viral illness.
  d. Recognize that the child is trying to manipulate the parent by complaining of vague symptoms.

Question 2

The nurse notices that a child is increasingly apprehensive and has tachycardia after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be the nurse's initial intervention?
 
  a. Apply warming blankets.
  b. Notify the practitioner of these findings.
  c. Give additional pain medication per protocol.
  d. Encourage child to cough, turn, and deep breathe.

[Dominic]

Answer to Question 1

ANS: A
These are the insidious symptoms of bacterial endocarditis. Because the child is in a high-risk group for this disorder (VSD repair), immediate evaluation and treatment are indicated to prevent cardiac damage. With appropriate antibiotic therapy, bacterial endocarditis is successfully treated in approximately 80 of the cases. The child's complaints should not be dismissed. The low-grade fever is not a symptom that the child can fabricate.

Answer to Question 2

ANS: B
The practitioner is notified immediately. Increases of chest tube drainage to more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in any 1 hour may indicate postoperative hemorrhage. Increased chest tube drainage with apprehensiveness and tachycardia may indicate cardiac tamponadeblood or fluid in the pericardial space constricting the heartwhich is a life-threatening complication. Warming blankets are not indicated at this time. Additional pain medication can be given before the practitioner drains the fluid, but the notification is the first action. Encouraging the child to cough, turn, and deep breathe should be deferred until after evaluation by the practitioner.

[arivle123]

Excellent

[okolip]

TYSM