The nurse has reviewed the Nurses' Notes 1 month later.

Exhibit 1. Nurses' Notes.

Today, 1000: Exhibit 2. Infant here at the provider's office for a scheduled visit.

The infant is in their parent's arms, grimacing.

S1 and S2 auscultated, no murmur noted.

Respirations are symmetric and unlabored with abdominal movement.

Abdomen is soft and flat, bowel sounds present.

Current weight is 4.1 kg (9 lb) The parent states they have exclusively breast- and bottle-fed breastmilk to the infant since birth.

The parent states the infant sometimes chokes with bottle feedings.

The parent noticed that the infant recently started "spitting up" during the night and after feeds, and cries excessively.

They state the infant has been vomiting more forcefully and has become disinterested in feeding.

Today, 1010: Exhibit 3. Provider assessed infant and discussed gastroesophageal reflux with parent.

Education provided.

1 month later: Infant here for follow-up visit.

Infant is calm and alert in parent's arms.

Parent states infant is sleeping through the night.

What notable improvement or change has been observed in the infant's condition during the one-month follow-up visit?

Choice A rationale:

Placing the child on a clear liquid diet for 24 hours following the arterial cardiac catheterization procedure is not necessary. The procedure does not typically require dietary restrictions. However, the healthcare provider may provide specific pre-procedure dietary instructions if needed, but it's not a standard practice.

Choice B rationale:

Instructing the child that they will be on bed rest for 2 days after the procedure is not accurate. While the child may need to rest after the procedure, the duration of bed rest is typically much shorter than 2 days. It's important to provide accurate information to the child to reduce anxiety and promote understanding.

Choice C rationale:

Explaining to the child that they will need to keep their leg straight for 8 hours following the procedure is important and accurate information. Arterial cardiac catheterization often involves the insertion of a catheter through an artery in the leg, and keeping the leg straight helps prevent complications at the insertion site. This information is essential for the child to follow post-procedure instructions correctly.

Choice D rationale:

Telling the child that their dressing will be removed 12 hours after the procedure is not accurate. Dressing removal timing may vary depending on the healthcare provider's protocol, but it's not typically done immediately after the procedure. Providing inaccurate information may lead to confusion and anxiety for the child.

Choice A rationale:

Administer cool, humidified oxygen via nasal cannula. Infants with heart failure often experience respiratory distress due to inadequate oxygenation. Administering cool, humidified oxygen via nasal cannula helps improve oxygen saturation and alleviate respiratory distress. Humidified oxygen prevents the mucous membranes from drying out, making breathing easier for the infant. Cool oxygen is preferred to reduce the work of breathing and to soothe irritated airways, improving the overall comfort of the infant.

Choice B rationale:

Provide less frequent, higher volume feedings. Infants with heart failure may have difficulty feeding due to fatigue and increased respiratory effort. Providing less frequent, higher volume feedings ensures that the infant receives adequate nutrition without becoming overly fatigued during feeding sessions. It allows the infant to obtain the necessary nutrients without putting excessive stress on their weakened cardiovascular system.

Choice C rationale:

Place the infant in a prone position. Placing the infant in a prone position is not recommended in the care of a child with heart failure. Placing the infant in an upright or semi-upright position is more appropriate as it reduces the workload on the heart and improves respiratory function. Placing the infant flat on their back may cause increased pressure on the diaphragm and worsen respiratory distress.

Choice D rationale:

Repeat a digoxin dosage if the infant vomits within 1 hr of administration. Digoxin is a medication commonly prescribed for heart failure. However, if the infant vomits shortly after receiving a dose, repeating the dose is not advisable. Vomiting may indicate that the medication was not properly absorbed, and administering an additional dose could lead to an overdose. Instead, the nurse should consult the healthcare provider for further instructions and closely monitor the infant's condition.