Question

Case Study: László Marks

Scenario: László is a preschool child admitted to the hospital with shortness of breath. László’s immunizations are up to date for his age. László’s mother reports that immunizations were administered through the local health department. This is László’s first hospitalization. His mother reports that he has not had surgery, has never fractured a bone, and has never visited the emergency room. However, the family moved to the area “a few years ago” and he has not been seen by a local health-care provider since that time. László’s father has been out of work and the family does not have health-care insurance.

            Over the past few weeks, László’s mother reports that he has complained of headache, dizziness, and shortness of breath on two occasions. His mother also reports that he had a nosebleed last week.

            As part of a thorough cardiac/respiratory assessment, the nurse who is assigned to care for László assesses his blood pressure in the right upper and lower extremities: blood pressure = 98/56 mm Hg right arm and 72/44 mm Hg right leg. His other vital signs are as follows: temperature is afebrile 98.6°F (37.0°C), respiratory rate is 32 breaths per minute, oxygen saturation is 96% (room air), and apical pulse is 100 beats per minute with a regular rate and rhythm. No murmur is heard.

            The nurse documents that László’s radial pulse quality is bounding and that his femoral pulses are weak. László’s lower extremities are slightly cool to touch. His lung sounds are clear bilaterally and he is moving air well, without evidence of respiratory distress. No cough, rales, rhonchi, or wheezes are heard by the nurse. His abdomen is soft and nontender with active bowel sounds in all quadrants. There is no hepatosplenomegaly.

Critical Thinking Questions

1. Which assessments recorded by the nurse are considered significant findings and should be reported to the physician?

2. What is a complication that László may experience related to his coarctation of the aorta?

3. What are the priority nursing diagnoses at this time?

4. What are the expected nursing outcomes related to this scenario?

5. Discuss the nursing interventions related to this scenario.

6. Discuss discharge teaching related to coarctation of the aorta.

Answer 1

1.The significant findings which has to be rorted to the provider are

• Breathing difficulties currently, tachypnea,
• Blood pressure reading which show hypotension
• pulse which is bounding at radial artery and weak at femoral artery
• Cool lower extremity
• Previous episodes of shortness of breath,headache, dizziness twice few weeks before and nosebleed last week.

2.The complication of coarctation of aorta are

• Aorta (stenosis ,rupture, aneurysm)
• Mitral valve regurgitation
• Tricuspid valve regurgitation
• Congestive heart failure
• Coronary artery disease
• Stroke or brain aneurysm

3.The priority nursing diagnosis are

• Ineffective breathing pattern related to poor oxygen exchange as evidenced by shortness of breath ,tachypnea
• Impaired cardiac function related to disease condition as evidence by abnormal pulse rhythm, blood pressure

4.The expected nursing outcomes related to the scenario are

• Maintaining normal respiratory pattern by relieving breathing difficulty
• Maintaining normal blood pressure ranges

5.The nursing intervention related to the scenario are

• Administer medication as per order
• Administer oxygen as per order
• Monitoring vital signs
• Assess the patient for any complications
• Encouraging the patient to do simple activity of daily living

6.The required discharge teaching are

• Instruct mother to administer medication as per order ,not to overdose or underdose
• Monitor for any adverse events and late complications
• Teach mother simple aerobic exercises so that it can be implemented on the child by mother
• Regular and periodic follow up