Nursing care of the infant and child with congestive heart failure includes
Force fluids appropriate in age
Organize activities to allow for uninterrupted sleep
monitor respirations during the active period
give larger feedings less often to conserve energy
The Correct Answer is A
Force fluids appropriate in age: It's important to ensure that the child receives an appropriate amount of fluids, taking into consideration their age and weight. This helps prevent dehydration and maintain adequate circulation.
In addition to option A, other important nursing care measures for infants and children with congestive heart failure include:
B. Organize activities to allow for uninterrupted sleep: Infants and children with heart failure may become fatigued easily, so it's important to create an environment that allows for sufficient rest and sleep.
C. Monitor respirations during active periods: Monitoring the child's respiratory rate and effort during active periods helps assess for signs of respiratory distress, which can be a manifestation of congestive heart failure.
D. Give smaller, more frequent feedings to conserve energy: Smaller, more frequent feedings can help reduce the energy expenditure required for digestion, making it easier for the child to eat and conserve energy for growth and development.
The focus of nursing care is to manage the symptoms of heart failure, support the child's overall well-being, and prevent complications. The specific interventions may vary based on the child's age, the severity of heart failure, and the underlying cause.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
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.
Correct Answer is B
Explanation
When obtaining the history of a child with suspected rheumatic fever, the nurse should consider the following information to be most significant:
B. A recent episode of pharyngitis.
Explanation:
Rheumatic fever often follows an untreated or inadequately treated streptococcal pharyngitis (strep throat) infection caused by Group A Streptococcus bacteria. Therefore, a recent episode of pharyngitis is a key piece of information in the context of rheumatic fever. It is important to assess whether the child had a sore throat, fever, and other symptoms of streptococcal infection that may have triggered the development of rheumatic fever.
While the other symptoms (vomiting, lack of interest in food, fever) may be important for the overall assessment and management of the child, they are not as directly associated with the development of rheumatic fever as a recent episode of pharyngitis caused by Group A Streptococcus. Rheumatic fever is an autoimmune response to untreated streptococcal infection, and its diagnosis is often linked to the presence of preceding streptococcal pharyngitis.
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