An infection control nurse is reviewing the medical records of several clients. Which of the following infections should the nurse report to the Centers for Disease Control and Prevention?

A. Case manager: A case manager coordinates care for clients with chronic conditions or complex health needs. For a newborn with an atrial septal defect, the case manager can arrange follow-up appointments, provide education to the family about monitoring for symptoms, and ensure access to cardiology services. This referral supports continuity of care and helps prevent complications.

B. Physical therapist: Physical therapy focuses on improving mobility, strength, and motor function. While important for certain conditions, a newborn with an atrial septal defect typically does not require routine physical therapy unless there are additional developmental or musculoskeletal concerns. It is not the primary referral for cardiac follow-up.

C. Occupational therapist: Occupational therapy helps clients develop fine motor skills and perform daily activities. For a newborn with a heart defect, OT is usually not indicated unless developmental delays or feeding difficulties are present. Cardiac management and follow-up are more urgent concerns at discharge.

D. Nurse manager: The nurse manager oversees nursing staff and unit operations rather than providing direct patient follow-up or discharge planning. Referral to the nurse manager does not address the newborn’s ongoing care needs after discharge and is not part of standard interprofessional follow-up for an atrial septal defect.

A. Turn off the heparin drip: The client’s aPTT is significantly elevated and is accompanied by active bleeding, indicated by hematuria. Stopping the heparin infusion is the most immediate action because it removes the source of ongoing anticoagulation and helps prevent further bleeding. This stabilizes the situation before additional corrective measures are taken.

B. Administer protamine sulfate: Protamine sulfate is the reversal agent for heparin and may be required, but it should be given after the heparin infusion is stopped. Administering it without stopping the drip allows continued anticoagulation, reducing the effectiveness of the reversal. The reversal medication is a secondary intervention.

C. Repeat the aPTT now and in 1 hr: Rechecking coagulation labs is appropriate to monitor progress, but it does not address the immediate risk of ongoing bleeding. Delaying action while repeating labs can allow further anticoagulation and worsening hemorrhagic symptoms. Lab monitoring becomes relevant only after the heparin drip is stopped.

D. Obtain a portable chest x-ray: A chest x-ray would not address the current problem of excessive anticoagulation and active bleeding. There is no indication of a thoracic complication requiring imaging at this moment, and performing this step would delay urgent action. The priority is to stop the heparin and control bleeding.