A nurse is caring for a child who is postoperative following surgical correction of Tetralogy of Fallot. Which of the following findings should the nurse identify as an indication of heart failure?

Choice A reason: Rhinorrhea, or a runny nose, is a common symptom of RSV and, while it should be monitored, it is not typically an urgent concern that requires immediate reporting to a provider.

Choice B reason: Pharyngitis, or a sore throat, is another symptom that can be associated with RSV. Like rhinorrhea, it should be monitored but does not usually necessitate immediate reporting.

Choice C reason: Coughing is a typical symptom of RSV and is expected. It should be monitored for changes in character or severity but is not generally an urgent concern for immediate reporting.

Choice D reason: Tachypnea, or rapid breathing, is a sign of respiratory distress and is a critical finding in an infant with RSV. It indicates that the infant's ability to breathe effectively is compromised and requires immediate attention from a healthcare provider.

Choice A reason: Using a 20-gauge needle for injections in a 3-month-old infant is not appropriate as it is too large. A smaller gauge needle should be used to minimize pain and tissue trauma.

Choice B reason: Providing a pacifier coated with an oral sucrose solution prior to the injections is an evidence-based practice to reduce pain in infants. The sweet taste of sucrose has a soothing effect and can help to distract the infant from the discomfort of the injection.

Choice C reason: Injecting immunizations into the deltoid muscle is not recommended for a 3-month-old infant as their muscle mass is not yet fully developed. The anterolateral thigh is the preferred site for intramuscular injections in infants.

Choice D reason: Applying eutectic mixture of local anesthetics (EMLA) cream immediately before the injections can help to numb the skin and reduce pain. However, it needs to be applied at least one hour before the procedure to be effective.