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NUR 213 Ventral Septal Defect

NUR 213 Ventral Septal Defect. Unfolding Case Study Developed by Benita Beard, MSN, RN Brenda Stepp , MSN, RN. Outcomes for Case Study. Determine current best practice for nursing and collaborative care strategies in the treatment of individuals with ventral septal defect.

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NUR 213 Ventral Septal Defect

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  1. NUR 213Ventral Septal Defect Unfolding Case Study Developed by Benita Beard, MSN, RN Brenda Stepp, MSN, RN

  2. Outcomes for Case Study • 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.

  3. Outcomes for Case Study • 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.

  4. What if ? • Baby Girl H was admitted to the Well-Baby Nursery at 0742. • Admission Data: Temp: 97.2 ®; Heart Rate:144; Respiratory Rate: 42

  5. What else do you want to know? • 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, 1st stage 12 hours, 45 minutes 2nd stage; no episiotomy or lacerations; Stadol 1 mg administered 2 hours prior to delivery • Other 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

  6. What else do you want to know? • Weight was 6 lb 2 oz: 18 inches • Apgar 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 admission • Routine meds administered

  7. Discharge Data • 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 check

  8. 2 Month Check-Up • 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

  9. What education/follow-up is indicated based on these assessment findings? • 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.

  10. Follow-up • Weight check in 2 weeks • Feedings every two to three hours • Other diagnostics that might be indicated?

  11. 2 week follow-up visit • 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%

  12. Diagnostics • Ultrasound of heart reveals large Ventral Septal Defect • Labs: Hct 42, HGB 17 • Plan is to send to pediatric referral center for Cardiac Catheterization

  13. Care of the Child Undergoing a Cardiac Catheterization • Pre-Procedural management • Post-Procedural management

  14. Follow-Up Visit with Cardiologist • 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

  15. Plan of Care for the Child with Heart Failure • Nutritional Management • Medical Management • Other 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

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