Peds Heart Failure/CHD NextGen Clinical Reasoning (9pages)

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: Johnny’s 5-month visit: Johnny has been seen monthly by the cardiologist. Appointments at three and four months were unremarkable. At his fivedigoxin was increased to 22 mcg two times a day and furosemide increased -month visit, his dosage of also to 14.4 mg because his weight increased to 7.2 kg. Is this a safe dose for both medications? 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: