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Ecs congenital cardiac abnormalities (learner).inddCongenital Cardiac Abnormalities
S i m u l a t e d C l i n i c a l E x p e r i e n c e ( S C E ™ ) O v e r v i e w
L e a r n i n g O b j e c t i v e s
Location: General Pediatrics Unit
1. Uses history and assessment fi ndings to plan, prioritize, and provide developmentally appropriate care to the infant patient with Down History/Information:
syndrome (trisomy 21) and congenital heart disease (APPLICATION).
A six-month-old Hispanic infant with Down syndrome (trisomy 21) was diagnosed with atrioventricular canal (AV canal) prenatally and underwent surgical repair shortly after birth. Today, his mother took him to a regularly scheduled 2. Analyzes event history, assessment fi ndings, and laboratory results to follow-up appointment with his pediatric cardiologist. In the cardiologist’s offi ce, a new murmur was discovered. anticipate patient needs (ANALYSIS).
He also had an increased respiratory rate with mildly increased work of breathing. In light of these fi ndings, he was directly admitted to the general Pediatric Unit. He weighs 6.3kg. He has a history of gastro-esophageal refl ux and 3. Evaluates the patient’s response to therapies and interventions failure to thrive. His home medications include digoxin, enalapril, furosemide, metaclopramide, and pantoprazole. He was last fed two hours before being admitted to the unit. A 24ga peripheral IV was placed in the right hand, and was heparin-locked. A 6 Fr nasogastric tube is in place in his left naris. His mother is currently with him. She speaks 4. Provides culturally-competent interventions to a Hispanic family conversational English. The infant has four older siblings, aged 25, 21, 17, and 11. Healthcare Provider’s Orders:
5. Presents a concise shift report for a single patient (SYNTHESIS).
Admit to general Pediatric UnitDiagnosis: Respiratory distress, New onset heart murmur, Failure to ThriveNasogastric (NG) tubeDigoxin 25mcg per NG twice per day at 0600 and 1800Furosemide 6mg per NG twice per day at 0600 and 1800Enalapril 0.3mg per NG twice per day at 0600 and 1800Metoclopramide 1mg per NG four times per day before mealsPantoprazole 15mg per NG once per dayIV saline lockFormula: 24 calorie/30mL 120mL every 3 hoursMay PO feed and tube feed remainder of feedingSchedule echocardiogram and Chest x-ray as soon as possibleCBC, Electrolytes and Digoxin LevelOxygen prn for respiratory distress BabySIM® Program for Nursing Curiculum Integration (PNCI™)
Q u e s t i o n s t o P r e p a r e f o r t h e S i m u l a t e d C l i n i c a l E x p e r i e n c e
R e f e r e n c e s
1. Describe congenital heart defects with focus on atrio-ventricular canal and ventricular Dooley, K. J. and Bishop, L. (2002). Medical management of the cardiac infant and child after surgical discharge. Critical Care Nursing Quarterly, 25(3), 98-1004.
2. Describe Trisomy 21 (Down syndrome).
Duran, C.R., Oman, K.S., Abel, J.J., Koziel, V.M., and Szymanski, D. (2007). 3. What is the indication, usual dosage, and side effects/nursing implications for the following Attitudes toward and beliefs about family presence: A survey of healthcare providers, patients’ families, and patients. American Journal of Critical Care, Hockenberry, M. J., Wilson, D., Winkelstein, M. L., and Kline, N. E. (2003). Wong’s nursing care of infants and children (7th ed.). St. Louis: Mosby.
Joanna Briggs Institute for Evidence Based Nursing and Midwifery. (2005). Best practice: Vital signs, 3(3). Retrieved May 30, 2005 from http://www.joannabriggs.
edu.au/best_practice/bp8.php 4. What are the signs/symptoms and treatment for a child in respiratory distress? McGee, S. (2007). Evidence-based physical diagnosis (2nd ed.). Philadelphia: 5. Formulate a nutritional plan for an infant with Down syndrome, cardiovascular disease, and How much formula/calories does a healthy infant need compared to a child with these Springhouse. (2007). Best practices: A guide to excellence in nursing care. (2nd How many calories are in standard infant formula? ) Congenital Cardiac Abnor™
How is standard infant formula mixed (from powder)? Taketomo, C. K., Hodding, J. H., and Kraus, D. M. (2003). Lexi-Comp’s pediatric Why would fortifi ed formula be indicated in a child with these disorders? dosage handbook (10th ed.). Hudson, OH: Lexi-Comp.
How is fortifi ed formula mixed (from powder) to obtain 22kcal/30mL and 24kcal/30mL formula?When can solid foods be introduced to infants? 6. What supportive emotional measures can the nurse provide a hospitalized pediatric patient 2007 METI, Sarasota, FL; Authors: Diane Anderson, M. Michelle Piper Dallas; Dawn Hughes, Mount Carmel College of Nursing. v Learner 2
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