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A nurse on a pediatric unit is caring for a 5-week-old infant.

Exhibits

Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again.

Nurses' Notes

2000:

Infant awake and alert in parent's arms in bedside chair. Trunk, arms, and hands warm to palpation. Edema noted to hands, feet, and periorbital area. Weak bilateral femoral pulses. Lower extremities cool to palpation. Lungs clear bilaterally on auscultation. Mucous membranes pink and moist.

2200:

Infant asleep in crib. Heart rate regular, no murmur on auscultation.

Vital Signs

2000:

Blood pressure 98/60 mm Hg right arm: 60/40 mm Hg right leg Heart rate 168/min

Respiratory rate 34/min

Temperature 37° C (98.6° F)

Oxygen saturation 97% on room air, right wrist

A.

Trunk, arms, and hands warm to palpation

B.

Edema noted to hands, feet, and periorbital area

C.

Weak bilateral femoral pulses

D.

Lower extremities cool to palpation

E.

Mucous membranes pink and moist

F.

Blood pressure 98/60 mm Hg right arm: 60/40 mm Hg right leg Heart rate 168/min

G.

Respiratory rate 34/min

Answer and Explanation

The Correct Answer is ["B","C","D","F"]

Findings that require follow-up:

  1. Edema noted to hands, feet, and periorbital area: Edema in these areas, especially periorbital edema, could indicate fluid retention, possibly from heart failure, kidney issues, or circulatory problems. This should be further evaluated to determine the underlying cause.
  2. Weak bilateral femoral pulses: Weak femoral pulses could suggest a circulatory problem or arterial insufficiency. This is concerning as it could indicate a vascular or cardiac issue that requires immediate investigation.
  3. Lower extremities cool to palpation: Cool lower extremities may indicate poor circulation, which can be caused by a cardiovascular issue, such as shock or impaired circulation, which needs immediate attention.
  4. Blood pressure discrepancy (right arm: 98/60 mm Hg, right leg: 60/40 mm Hg): A significant difference in blood pressure readings between the arms and legs (known as a differential blood pressure) can indicate conditions like coarctation of the aorta (a congenital heart defect), which requires immediate follow-up.


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Related Questions

Correct Answer is ["A","B","C"]

Explanation

A. "I should eat extra food on busy days when I am more active." Physical activity lowers blood glucose levels. Eating extra food prevents hypoglycemia during periods of increased activity.
B. "I should increase my intake of sugar-free fluids when I am sick." During illness, maintaining hydration is essential. Sugar-free fluids help prevent dehydration without causing hyperglycemia.
C. "I should eat a snack 30 minutes before my baseball game starts." A pre-activity snack helps maintain blood glucose levels during exercise, reducing the risk of hypoglycemia.
D. "I should wait 2 hours after eating before playing with my friends." There is no need to delay physical activity for 2 hours after eating unless instructed otherwise by a healthcare provider.
E. "I should have a 16-ounce glass of milk if I start feeling weak or shaky." A smaller portion of fast-acting carbohydrates, like 4 ounces of juice or 15 grams of glucose tablets, is recommended for treating hypoglycemia.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}

Explanation

1. Failure to thrive: The infant has poor weight gain despite being hungry after vomiting. Projectile vomiting, as described, often leads to insufficient caloric intake, putting the infant at risk for failure to thrive.

2. Dehydration: Repeated vomiting results in fluid loss, putting the infant at high risk of dehydration, which is common in conditions like pyloric stenosis, suspected here due to the symptoms and palpable abdominal mass.

3. Intussusception typically presents with intermittent, severe abdominal pain, "currant jelly" stools, and sometimes a sausage-shaped mass, which are not noted in this scenario.

4. Meckel diverticulum can cause painless rectal bleeding or obstruction symptoms but is not associated with projectile vomiting or a palpable mass.

5. Hirschsprung disease presents with failure to pass meconium, abdominal distension, and chronic constipation rather than the projectile vomiting seen here.

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