Ventral Septal Defect Unfolding Case Study Developed by Benita Beard MSN RN Brenda Stepp MSN RN Determine current best practice for nursing and collaborative care strategies in the treatment of individuals with ventral septal defect ID: 437835
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NUR 213Ventral Septal Defect
Unfolding Case Study
Developed by Benita Beard, MSN, RN
Brenda
Stepp
, MSN, RNSlide2
Determine current best practice for nursing and collaborative care strategies in the treatment of individuals with ventral septal defect.
Determine pharmacological considerations related to the management of individuals with a ventral septal defect.
Incorporate principles of growth and development, prioritize the plan of care for the family of and the individual with a ventral septal defect.Determine other physiological and psychosocial concepts and/or exemplars related to ventral septal defect.
Outcomes for Case StudySlide3
Determine the incidence, etiology, populations at risk, and epidemiology of ventral septal defect.
Determine assessment findings and diagnostic testing related to ventral septal defect.
Review fetal circulation and newborn assessment.Recognizing cultural diversity, incorporate the nursing process in providing primary, secondary, and tertiary care for,
and
prevention of, ventral septal defect.
Outcomes for Case StudySlide4
What if ?
Baby Girl H was admitted to the Well-Baby Nursery at 0742.
Admission Data: Temp: 97.2 ®; Heart Rate:144; Respiratory Rate: 42Slide5
Maternal History: 24 y/o Hispanic female, g2p1, 37 weeks by ultrasound, 2 months prenatal care through local health department, O+, Rubella equivalent, HIV Negative, Negative history for drugs, alcohol, smoking; Group B Strep Negative; Questionable Rubella exposure @ 8 weeks gestation
Labor History: Delivered vaginally, membranes ruptured X 4hours with clear fluid, 1
st stage 12 hours, 45 minutes 2nd stage; no episiotomy or lacerations;
Stadol
1 mg administered 2 hours prior to deliveryOther significant information: plans to breast feed; baby bonded for 15 minutes post delivery before transfer to nursery; Father present; speaks limited English but father speaks fluent English
What else do you want to know?Slide6
Weight was 6 lb 2 oz: 18 inchesApgar scores: 7;9
Other assessment findings: Questionable benign murmur noted upon initial assessment; weak cry; color pink with
acrocyanosis; Dubowitz 37 weeks; void and stool noted upon admissionRoutine meds administered
What else do you want to know?Slide7
Discharged at 36 hours of age with both parents and 3 year old brother.Weight 5 lbs, 11oz
No jaundice noted
To return to pediatrician’s office in AM for weight and color checkDischarge DataSlide8
Baby Girl H (Maria) was brought to the Pediatrician’s office for her “baby shots”Weight is 7 lbs 8 oz; T: 97.2 Ax, HR 156, RR 48; Color pale; appears somewhat listless during exam
Immunizations administered
2 Month Check-UpSlide9
Nutritional Assessment: Maria is breast fed but continually falls asleep during feedings. Maria feeds every four hours for a total of 10 to 15 minutes each feeding. Awakes at least twice during the night to feed.
Bonding: Mother is very attentive, smiles at Maria and talks to her during assessment.
What education/follow-up is indicated based on these assessment findings?Slide10
Weight check in 2 weeksFeedings every two to three hours
Other diagnostics that might be indicated?
Follow-upSlide11
Weight is 7 lbs 10 oz; T: 97.2 Ax, HR 164 while sleeping, RR 52; Color pale, skin cool and dry except on forehead which is sweaty; sleeps during exam but weak cry noted during lab draws; Murmur present; PaSO2 94%
2 week follow-up visitSlide12
Ultrasound of heart reveals large Ventral Septal Defect
Labs:
Hct 42, HGB 17Plan is to send to pediatric referral center for Cardiac CatheterizationDiagnosticsSlide13
Pre-Procedural managementPost-Procedural management
Care of the Child Undergoing a Cardiac CatheterizationSlide14
Assessment Findings: Weight 7 lbs 6 oz; T: 97.0 Ax, HR 176 while sleeping, RR 58; Color remains pale, skin cool and dry at time of exam; Hard to arouse during exam; Murmur present; PaSO2 93% at rest
Follow-Up Visit with CardiologistSlide15
Nutritional ManagementMedical ManagementOther Medical and Nursing Strategies that should be considered in the management of a child with heart failure related to a congenital heart defect
Teaching Needs
Plan of Care for the Child with Heart Failure