Which of the symptoms below would alert the nurse that an infant may have a cardiac issue? Select the 3 that apply

Rationale:

A. "I understand that my baby will be given multiple IV medications. Some of these medications might include opioids for pain management and antibiotics to protect her from infection.": Pain control and infection prevention are essential after open heart surgery.

B. "I understand that I will need to be careful when picking up my baby, I will need to pick her up by the head and bottom to protect her sternum.": Sternal precautions are critical to prevent strain on the healing sternum.

C. "I understand that it is important my baby continues to do tummy time once a day so her motor development does not suffer while in the hospital.": Tummy time after recent sternotomy can place pressure on the chest incision and stress the healing sternum, increasing risk of complications. It should be delayed until cleared by the surgical team.

D. "I understand that we will be in the hospital for a couple of weeks for treatment and monitoring post-op and then we will need close follow up with cardiology and the surgery team.": Post-op recovery often requires extended hospitalization and long-term follow-up to monitor cardiac function and surgical healing.

Rationale:

A. Bradycardia: Bradycardia is a late sign of increased ICP and typically appears after other symptoms like changes in behavior or consciousness have developed. Early detection focuses more on neurological changes rather than vital sign alterations.

B. Restlessness and confusion: These are early neurological signs indicating altered cerebral function due to increased ICP. Changes in behavior, such as irritability, restlessness, and confusion, often precede vital sign changes and are key for prompt intervention.

C. Large amounts of very dilute urine: This finding suggests possible diabetes insipidus or fluid imbalance, which can occur with severe brain injury but is not an early indicator of increased ICP specifically. It is not a primary sign for monitoring ICP.

D. Widened pulse pressure: Widened pulse pressure is part of Cushing’s triad, a late and serious sign of increased ICP that occurs after the brainstem is compromised. Early signs are more subtle and neurological rather than cardiovascular.