Reference no: EM133912444

A 6-week-old female is in the emergency room with chief complaints of lethargy, poor feeding, and respiratory distress. She was well until 2 weeks prior to presentation when she developed a febrile illness with cough, rhinorrhea, and emesis. She subsequently developed progressive respiratory distress. Her parents report that she sweats a lot on her forehead when feeding. Her parents have also noted her to be increasingly lethargic, with tachypnea, and retractions. She was born full-term at 39 weeks of gestation. Delivery was unremarkable except for meconium-stained fluid. Physical assessment findings: VS T 36.8, RR 72, HR 160, BP 92/68. Oxygen saturation in room air is 99%. She is a mildly cachexic, cyanotic infant who was pale, lethargic, and tachypneic, with mild to moderate subcostal and intercostal retractions. HEENT exam is unremarkable. Neck is supple without lymphadenopathy. Her skin is clear with no rashes or other significant skin lesions. Her lungs have scattered crackles with slightly decreased aeration in the left lower lobe. The precordium is mildly active. Her heart is of regular rate and rhythm, with a Grade II/VI holosystolic murmur at the mid-lower left sternal border with radiation to the cardiac apex. The S1 is normal and the S2 is prominent. An S4 gallop is noted at the cardiac apex. There are no rubs or valve clicks. Her abdomen is soft, non-distended, and non-tender. The liver edge is palpable 3 to 4 cm below the right costal margin. There are no palpable masses or splenomegaly. Bowel sounds are hypoactive. Her extremities are symmetric and cool, with peripheral pulses 1+/4+ in all extremities with no radial-femoral delay. The capillary refill is 4 to 5 seconds (delayed).

A chest x-ray shows moderate cardiomegaly with a moderate degree of pulmonary edema. An echocardiogram reveals a large perimembranous ventricular septal defect with non-restrictive left to right shunting. Left ventricular contractility is at the lower range of normal. There is no pericardial effusion.

The child has been diagnosed with ventricular septal defect and heart failure.

QUESTIONS

1. Based on the findings, what is the major problem for this child?

2. Based on the findings, what complication from VSD is the child experiencing?

3. What signs and symptoms presented by this patient support the diagnosis?

4. Write three prioritized nursing diagnoses for this patient.

5. What are some nursing interventions for this child?