An 8-year-old patient presents to his clinic, complaining of dizziness, headaches, and epistaxis. The nurse took the patient's vital signs and noticed that he had high blood pressure in his arms and bounding upper extremity pulses; however, when she proceeded to check his lower extremity pulses, they were weak, and his legs were pale and cool to touch. What does this patient present signs of?

Decreased cardiac output is a common consequence of various cardiac conditions in children. In this scenario, the child's cool extremities and thready pulses indicate poor peripheral perfusion, which can occur when the heart is not effectively pumping blood to meet the body's demands. Decreased urinary output is another sign of poor cardiac output, as reduced blood flow to the kidneys can result in decreased urine production.

The other options may contribute to decreased cardiac output, but they are not the primary factors indicated by the clinical findings:

A. Increased afterload: Increased afterload can make it more difficult for the heart to pump blood effectively, but it is not the primary cause of the symptoms described.

C. Decreased contractility: Decreased contractility can reduce the heart's ability to pump blood, contributing to decreased cardiac output, but it is not the primary factor indicated by the clinical findings.

D. Increased stroke volume: An increase in stroke volume typically results in improved cardiac output, not diminished cardiac output as seen in this scenario.

Infants with congenital heart defects, including VSD, may have increased caloric needs due to the added work of their hearts. Congestive heart failure can lead to poor weight gain and failure to thrive. Therefore, increasing the caloric density of the formula is a common approach to providing the necessary nutrition for growth and development. This can be achieved by using specialized high-calorie infant formulas or fortifying breast milk.

The other options are not the primary supportive measures for an infant with congestive heart failure in this context:

B. Oxygen therapy to ensure oxygen saturation is > 98%: While oxygen therapy may be necessary for infants with congenital heart defects, it is not the primary supportive measure to address failure to thrive. Oxygen therapy primarily aims to ensure adequate oxygenation but does not directly address caloric intake.

C. Sedatives to keep the infant from crying: The use of sedatives is not a typical approach to managing congestive heart failure in infants. Addressing the underlying cause, optimizing nutrition, and providing supportive care are more appropriate strategies.

D. Emergent surgical correction of the defect: Surgical correction of a VSD is typically considered for specific indications, such as significant hemodynamic compromise, but it is not the first-line intervention for all cases of VSD, especially if the primary concern is failure to thrive. Treatment decisions for VSD are made based on the specific clinical presentation and severity of the defect.