Question

Michael is a 7-week-old breastfed infant with a 2-day history of irritability and poor feeding.

Subjective Data

Mom states that her infant has been “fussy” for the last 2 days.

He feeds for only a “few” minutes at a time.

He is breathing heavily and fast for 2 days.

Objective Data

Weight: 4.8 kg

Vital signs: temp, 36.8º C; pulse, 250 bpm; resp, 65 breaths/min; blood pressure, 84/58 mm Hg

Breath sounds clear to auscultation

Oxygen saturation: 95%

Central capillary refill: 4 seconds

Questions:

What is the treatment for an unstable patient with supraventricular tachycardia (SVT)?

Decreased cardiac output from prolonged SVT would produce what complication?

In this clinical situation, what actions should the nurse take? Prioritize the actions.

Discussions

Discussion Topic# 1: What is a “shift to the left” in a CBC?

Discussion Topic# 2: A father brings in his 3-year-old son, James, who was initially running a fever. He was given Tylenol, and the fever went away for 2 days. Now, however, the fever is back, and he has noted dark spots on his body and a lump in his armpit. He has been lethargic and has not wanted to eat for the last 24 hours. The physician suspects acute lymphocytic leukemia and has ordered blood chemistry studies, immunophenotyping, and bone marrow aspiration and biopsy.

The father is upset and wants to know what is leukemia and how did his son catch it? How would the nurse address this questio

Answer 1

Discussion topic 1

1. Treatment of an unstable patient with SVT

The treatment of SVT depends on the degree of compromise imposed by the dysrhythmias. In some cases VAGAL MANEUVERS, such as applying ice to the face, massaging the carotid artery, or having an older child perform a VALSALVA MANEUVER, have terminated SVT. If vagal MANEUVERS fail or child is heamodynamically unstable , ADENOSINE (a drug that impairs AV conduction) may be used. Adenosine is given by rapid IV push with a saline bolus immediately after the drug because of its very short half life. If this is unsuccessful or cardiac output is comprised, ESOPHAGEAL OVERDRIVE PACING OR SYNCHRONIZED CARDIOVERSION can be used in the intensive care setting. Long term pharmacologic treatment involves DIGOXIN or possibly PROPANALOL.

RADIOFREQUENCY ABLATION has become first line therapy for some types of SVT.

2. Decreased cardiac output from prolonged SVT produces what complications?

• Heart failure (left ventricular dysfunction)
• Cardiac arrest

3. Nursing actions:

• note skin colour, temperature and moisture
• Check for alteration in level of consciousness
• Assess heart rate & BP
• Inspect fluid balance and weight gain
• Assess heart sounds for gallops
• Monitor for ECG
• Record intake and output
• Closely monitor symptoms of heart failure
• Place child on cardiac monitor
• Administer medications as prescribed by the physician
• Administer oxygen therapy if required
• Monitor bowel functions
• Educate family regarding the symptoms of SVT, & it's treatment
• Parents should be taught to take rapid pulse for a full minute
• Teaching regarding medications its action, dosage, frequency.

​​​​​​​Discussion topic 2

Leukemia: It is a broad term given to a group of malignant diseases of the bone marrow and lymphatic system. It is a complex disease of varying heterogeneity.

Acute Lymphocytic Leukemia:

• it is the primary disorder of the bone marrow where, the normal bone marrow elements are replaced by immature or undifferentiated blast cells.
• characterized by anemia, thrombocytopenia, neutropenia specially granulocytopenia
• Incidence: 1/2000 live births
• Peak age onset: 3-7 years
• ​​​​​​​Male children are more affected than female children