The nurse is assessing a child with a cardiac problem. The child's extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following?

PDA is a congenital heart defect where a blood vessel called the ductus arteriosus, which is supposed to close shortly after birth, remains open. This allows oxygenated blood from the aorta to flow back into the pulmonary artery, leading to increased pulmonary blood flow and congestion. Over time, this can lead to increased pulmonary vascular congestion and potentially cause complications such as pulmonary hypertension and heart failure.

Surgical repair of PDA, often through a procedure known as ligation or closure of the ductus arteriosus, is performed to stop this abnormal blood flow and prevent the associated complications, particularly the increase in pulmonary vascular congestion.

The other options (B, C, and D) are not the primary complications associated with PDA and surgical repair is not performed primarily to address these issues:

B. Decreased workload on the left side of the heart is not a primary reason for surgical repair of PDA, although it can be a potential benefit of closing the ductus arteriosus.

C. Pulmonary infection is not a direct complication of PDA, but the increased pulmonary blood flow associated with a large PDA can make the lungs more susceptible to respiratory infections.

D. Right-to-left shunt of blood is not a typical complication of PDA. PDA typically involves left-to-right shunting of blood, with oxygenated blood flowing back into the pulmonary circulation, leading to complications related to increased pulmonary blood flow.

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.