Three-week-old J.T. arrives at the cardiac catheterization lab for her cardiac catheterization with her parents. She was born at term with Down syndrome, and her pediatrician is concerned because of lack of weight gain and poor feeding. You are getting the patient and her parents prepared for the procedure.

As you obtain her history and take vital signs, which statements/findings would be concerning and suggestive of heart failure (HF)? (Select all correct answers and provide supporting rationales for each.)

“J. takes thirty to forty minutes to take two to three ounces of formula.”

Rectal temperature: 36.6° C

“J. gets damp and sweaty when she feeds.”

HR: 195 at rest

Peripheral pulses = +3

“J. seems to have fewer wet diapers than when we brought her home from the hospital.”

a, c, d, f
Signs of HF include tachycardia, tachypnea, poor feeding, fatigue, and weight loss, which might progress to weight gain as a result of edema. You might see signs of respiratory distress and decreased urinary output. The temperature, 36.6 ° C (97.7 ° F), and pulses are normal.

What teaching topics would you include as you prepare J.T.'s parents for the procedure?

CASE STUDY PROGRESS

After the catheterization, J.T. returns to the unit in a crib. These orders were written:

Physician's Orders

Daily weights: current weight of 4 kg

Strict intake and output

2LPM NC as needed to maintain O 2 saturations greater than 95%

VS every 15 minutes × 4, then every 1 hour × 4, then every 4 hours

Digoxin (Lanoxin) 60 mcg PO now, then 20 mcg PO every 12 hours

Furosemide (Lasix) PO 4 mg now, then every 12 hours

What interventions and education would you include in your post-procedure assessment? (Include rationale for each.)

You are reviewing her medications. What is the purpose of starting J.T. on digoxin (Lanoxin)?

You have a student nurse working with you and she asks why the first ordered dose is high. What is the explanation for the digitalizing dose?

The student nurse asks whether there are any precautions to observe when giving digoxin to an infant. What medication safety precautions should be observed when giving this medication?

A digitalizing dose of digoxin is 30 mcg/kg/day, given as 50% of the dose initially, and then one quarter of the initial dose in each of two subsequent doses at 12 hour intervals. The concentration of medication in the bottle is 0.05mg/mL. (You must show your work)

Calculate the initial loading dose. ____ mcg/dose to ____mcg/dose.

How many mL of the initial dose would you administer? ___mL to ___mL

Calculate the two subsequent doses. ____mcg/dose to ____mcg/dose.

How many mL of the subsequent doses would you administer? ___mL to ___mL

Is the order that you received from the physician safe to administer? Why or why not?

CASE STUDY PROGRESS

You administer the ordered medication and proceed with your assessment.

Which of these are possible complications to monitor for after a cardiac catheterization? (Select all correct answers and provide supporting rationales for each.)

Hemorrhage

Hematoma

Hyperglycemia

Dysrhythmia

Decreased pulse in unaffected leg

Vasospasm

You are preparing to administer J.T.'s furosemide. Your drug reference gives the following therapeutic range: 0.5-1 mg/kg/dose every 8-24 hours. Is the ordered dose of 4 mg a safe dose for J.T? (You must show your work)

CASE STUDY PROGRESS

You note the following serum metabolic panel on J.T.

Lab Results

Glucose 85 mg/dL

Calcium 9.1 mg/dL

Sodium 142 mEq/L

Potassium 3.3 mEq/L

Chloride 101 mEq/L

Which lab finding would concern you, and why (provide supporting rationales)?

CASE STUDY PROGRESS

The cardiologist consults with the family, and it is decided that J.T. will be discharged to home the following day with medications and close monitoring and will return in several months for surgical repair of AV Canal.

Explain the congenital heart defect to the parents using layman terms.

Explain to the parents, in layman terms, why their daughter has been started on digoxin and furosemide.

Explain to the parents the signs and symptoms of digoxin toxicity. Is this child at risk for toxicity? Is there any way to prevent toxicity from occurring?

Why is the surgical interventions scheduled months in the future instead of immediately?

You begin your discharge teaching. What will you include? (Consider nutrition, follow up appointments, education, medication administration, when to call the provider, etc)