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 question?

Guidelines:

Answer 1

A) Supraventricular tachycardia is abnormally fast heart rhythm. Normally the conduction system of heart works in SA node the impulses then travel to AV node and thus to the Purkinje fibres and then to bundle of HIS. SVT begins in atria and then travel to abnormal electrical circuit through AV nice.

Initially mother can place ice packs over eyes for 10-15 sec or frozen vegetables bag is best when she's at home. Also mother can try to give knee chest position to infant for 15 to 30 sec.

Based on hemodynamic assessment and ECG report the treatment can be initiated.treatment falls into abortive categories, acute treatment and preventive care. Abortive treatment include adenosine or cardioversion. Acute treatment includes amiodarone, esmolol, procainamide. Secondary presenting or prophylactic treatment includes beta blockers medications.

B) Decreased cardiac output leads to decrease in stroke volume. It may give rise to angina. In chronic cases tachycardia may lead to systolic heart failure if not treated well in time.

C)Nurse can closely monitor all the parameters of the baby and report it to the treating physician. Any abnormal parameter should be taken care of. She should observe for oxygen saturation and thus hypoxia.

Discussions

Topic 1 shift to left in CBC denotes the infection is in progress.

Topic 2 Leukaemia it is also known as blood cancer caused due to abnormal increase in WBCs. It may produce symptoms like fever, bleeding abnormally and easily, recurrent infections, joint pain , headaches.

Exact cause of leukemia is not known but thought to be of genetic origin, family history. There are many types of leukemia. Blood investigations can help to dete tine the type of cancer james is different from.

Chemotherapy, radiation, stem cells transplant is the treatment of choice for the patient likes james. So the nurse here needs to explain this very clearly and properly to james father