Congenital Heart Defect NextGen SKINNY Reasoning

Congenital Heart Defect NextGen SKINNY Reasoning Johnny Patterson, 5 months old NCLEX Client Need Categories Covered in Case Study NCSBN Clinical Judgment Model Covered in Case Study Safe and Effective Care Environment Step 1: Recognize Cues • Management of Care Step 2: Analyze Cues • Safety and Infection Control Step 3: Prioritize Hypotheses Step 4: Generate Solutions Health Promotion and Maintenance Psychosocial Integrity Step 5: Take Action Physiological Integrity Step 6: Evaluate Outcomes Part I: History of Present Illness Johnny Patterson was born at 38 weeks gestation and diagnosed with Trisomy 21 (Down Syndrome). At his one-week well checkup at the pediatrician’s office, a prominent heart murmur was auscultated. An echocardiogram revealed a large ventricular septal defect immediately below the aorta. A referral was made to a cardiologist who suggested no immediate interventions because Johnny did not appear to be in any distress. Three weeks later at his second cardiologist appointment, his parents report that Johnny seems to be sleeping more. He seems to have times when he breathes faster than usual and becomes sweaty when he breastfeeds. His weight is 4 kg. At his last visit three weeks ago he weighed 4.4 kg. The cardiologist prescribed 12 mcg digoxin every 12 hours (0.05mg/ml solution is received from the pharmacy) and 8 mg furosemide every day (10mg/ml oral solution is received from pharmacy). What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data: Clinical Significance: 1. Trisomy 21 diagnosed 1. At great risk of Tetralogy of Fallot 2. Prominent heart murmur 2. At great risk of Tetralogy of Fallot 3. large ventricular septal defect 3. Congenital heart defect 4. sleep more and breath faster than normal 4. Signs of heart failure 5. lost weight 0.4kg in 3 weeks 5. Failure to thrive, not getting enough nutrients Johnny’s 5-month visit: What data is RELEVANT and must be NOTICED as clinically significant by the nurse? (NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential) RELEVANT Data: Clinical Significance: 1. johnny now weights 7.2 kg. no tissue noted by provider and Mom expressed no concerns. 2. Digoxin dose increased to 22 mcg BID and furosemide dose increased to 11.4 mg q 24 hours. 1. Normal weight 2. Digoxin dose: 43.2 mcg to 72 mcg daily