Question

Case Study:

For the case study section only: Only provide short answers for the case study No more than 2 sentence response. Answer all the questions in all case study scenarios.

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:

1. What is the treatment for an unstable patient with supraventricular tachycardia (SVT)?
2. Decreased cardiac output from prolonged SVT would produce what complication?
3. 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.

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

Answer 1

1. Treatment for SVT for an unstable patient:

SVT is defined as the abnormal heart rhythem originating from above the ventricles. It is the most common rhythm disturbances seen in children. The incidence of SVT is generally 1 in every 2500 healthy children. In infants usually the heart rate is above 220 bmp.

The management for SVT includes the following

• Valsalva manoeuvre
• Administeration of Inj Adenosine
• Synchronised DC cardioversion.

In the above case the child will be irritable and unstable and so Valsalva manoeuvre will not be successful. so the best way is to administer IV Adenosine. IF still SVT persists then Synchronised cardioversion can be done starting with 1 kg and increase it to 2j/kg. For cardioversion procedural sedation is required.

2. SVT is never life threatening and treatment outcomes are excellent. Infants maybe diagnosed with SVT as a signs of congestive heart failure along with other symptoms like irritability, rapid breathing, increased heart rate, poor feeding, lethargy.

If the episodes of SVT last many hours more than 24 hours the heart muscles slowly tires an pumps with less and less strength.Symptoms at this time include poor feeding, irritability, vomiting,pale skin color, rapid breathing, unsual sleepiness.. This symptoms progress until the fast rythmstops or is treated. it is better to take the baby to the emergency for treatment.

3. in the above case the Nurse should

• observe the baby and connect to the monitor to know the vital signs.
• Check the airway and breathing.
• Try to calm down the baby as irritability can increase the heart rate
• Check with the doctos for the order and if possible to start with the IV fluids as the capillary refill time is more than 2 secs which shows the baby is dehydrated.

Discussion topic 1

Shift to the left in CBC

CBC is complete blood count which includes WBC, reticulocytes, Hb etc. The meaning of shift to the left side always refers to  the Neutrophils . Here the iimmature neutrophil cells are shifted to the left side which indicates an infection mostly a bacterial infection.