, 5 CHD HESI RN CASE STUDY PEDI CONGENITAL HEART DISEASE
1. Client Teaching
Timmy has been improving daily and is due to be discharged. The nurse is
completing the discharge teaching.
2. 32.ID: 17498063543
Which statement by Joan indicates that the teaching has been effective?
A. "We will be taking Timmy to church every Sunday to thank God that he
is all right."
Timmy's parents should avoid taking him around large crowds for 4 to 6 weeks
after his surgery.
B. "We are going to treat Timmy very special to make sure nothing
happens to him."
Joan and Thomas should treat Timmy as normally as possible and realize that
anything can happen to him no matter how good they are as parents.
C. "We must resume Timmy's regular meal, sleep, and play times as soon
as we get home." Correct
Joan and Thomas should resume a normal schedule as soon as possible.
D. "We understand that we should not have any more children, so Timmy
will be an only child."
While there is no way to ensure that another child born to Thomas and Joan will
not have a VSD, having a child with this defect is not a contraindication to having
more children.
Awarded 1.0 points out of 1.0 possible points.
3. 33.ID: 17498063549
Which statement by Joan indicates that the teaching has been effective? (Select all
that apply.)
A. "We will be taking Timmy to church every Sunday to thank God that he
is all right."
Timmy's parents should avoid taking him around large crowds for 4 to 6 weeks
after his surgery.
B. "We will use creams or lotions on the surgical incision to prevent
scarring."
Creams and lotions should not be used until the incision is completely healed.
C. "We must resume Timmy's regular meal, sleep, and play times as soon
as we get home." Correct
Thomas should resume a normal schedule as soon as possible.
D. "We understand that we should not have any more children, so Timmy
will be an only child."
While there is no way to ensure that another child born to Thomas and Joan will
not have a VSD, having a child with this defect is not a contraindication to having
more children.
E. "Pat the incision dry, but do not rub it until it is completely
healed." Correct
Rubbing the incision may cause the wound to gape open or become irritated.
, 1. Postoperative CareTimmy's surgery is successful, and Joan and Thomas are
allowed to visit him in the intensive care unit. The nurse is completing Timmy's shift
assessment. His weight is 22 lbs (9.98 kg) and his length is 28 inches (71.1 cm).
Timmy's laboratory results are:
o Hematocrit: 38%
o Hemoglobin: 7 g/dL
o White blood cell count: 11.5 cells/mm3
o Glucose: 90 mg/dL
2. 29.ID: 17498063562
Which additional assessment data warrants immediate intervention by the nurse?
(Select all that apply.)
o Apical pulse rate of 88/minute. Correct
An apical pulse of 88 is low for a 1-year-old infant.
o Hemoglobin 7 g/dL. Correct
This is an abnormally low hemoglobin and indicates hemorrhage. The nurse
should notify the surgeon immediately.
o Peripheral pulses 2+ bilaterally.
Bilateral 2+ peripheral pulses are normal. Diminished pulses would require
immediate intervention.
o Serum potassium level 2.6 mEq/l. Correct
Normal serum potassium level in an infant is 3.5-5 mEq/l. This level reflects a
potentially life-threatening complication.
o Urine output of 10 mL in the last hour.
Normal urine output for infants is 1 mL/kg/hr. Timmy weighs 10 kg, so this output
is adequate.
Awarded 1.0 points out of 1.0 possible points.
B. Timmy is stabilized, but the nurse recognizes that he remains a high risk for fluid and
electrolyte imbalance.
C. 30.ID: 17498063566
Which intervention is important to include in Timmy's plan of care to address this
concern in the immediate postoperative period?
o Monitor urine output every shift.
The I&O should be monitored hourly, not every shift.
o Monitor the infant's glucose level. Correct
Glucose, a critical factor in maintaining cardiac contractility, is impacted by shifts
in fluids and electrolytes.
o Administer pain medication PRN.
This is an appropriate intervention, but it does not address fluid and electrolyte
balance.
o Administer IV antibiotics prophylactically.
This is an appropriate intervention to prevent infection, but it does not address
fluid and electrolyte balance.
Awarded 1.0 points out of 1.0 possible points.
D. Timmy's parents are concerned that Timmy may be in pain. He has prescriptions for
a continuous IV analgesic infusion and a PRN pain medication bolus.
E. 31.ID: 17498063559
1. Client Teaching
Timmy has been improving daily and is due to be discharged. The nurse is
completing the discharge teaching.
2. 32.ID: 17498063543
Which statement by Joan indicates that the teaching has been effective?
A. "We will be taking Timmy to church every Sunday to thank God that he
is all right."
Timmy's parents should avoid taking him around large crowds for 4 to 6 weeks
after his surgery.
B. "We are going to treat Timmy very special to make sure nothing
happens to him."
Joan and Thomas should treat Timmy as normally as possible and realize that
anything can happen to him no matter how good they are as parents.
C. "We must resume Timmy's regular meal, sleep, and play times as soon
as we get home." Correct
Joan and Thomas should resume a normal schedule as soon as possible.
D. "We understand that we should not have any more children, so Timmy
will be an only child."
While there is no way to ensure that another child born to Thomas and Joan will
not have a VSD, having a child with this defect is not a contraindication to having
more children.
Awarded 1.0 points out of 1.0 possible points.
3. 33.ID: 17498063549
Which statement by Joan indicates that the teaching has been effective? (Select all
that apply.)
A. "We will be taking Timmy to church every Sunday to thank God that he
is all right."
Timmy's parents should avoid taking him around large crowds for 4 to 6 weeks
after his surgery.
B. "We will use creams or lotions on the surgical incision to prevent
scarring."
Creams and lotions should not be used until the incision is completely healed.
C. "We must resume Timmy's regular meal, sleep, and play times as soon
as we get home." Correct
Thomas should resume a normal schedule as soon as possible.
D. "We understand that we should not have any more children, so Timmy
will be an only child."
While there is no way to ensure that another child born to Thomas and Joan will
not have a VSD, having a child with this defect is not a contraindication to having
more children.
E. "Pat the incision dry, but do not rub it until it is completely
healed." Correct
Rubbing the incision may cause the wound to gape open or become irritated.
, 1. Postoperative CareTimmy's surgery is successful, and Joan and Thomas are
allowed to visit him in the intensive care unit. The nurse is completing Timmy's shift
assessment. His weight is 22 lbs (9.98 kg) and his length is 28 inches (71.1 cm).
Timmy's laboratory results are:
o Hematocrit: 38%
o Hemoglobin: 7 g/dL
o White blood cell count: 11.5 cells/mm3
o Glucose: 90 mg/dL
2. 29.ID: 17498063562
Which additional assessment data warrants immediate intervention by the nurse?
(Select all that apply.)
o Apical pulse rate of 88/minute. Correct
An apical pulse of 88 is low for a 1-year-old infant.
o Hemoglobin 7 g/dL. Correct
This is an abnormally low hemoglobin and indicates hemorrhage. The nurse
should notify the surgeon immediately.
o Peripheral pulses 2+ bilaterally.
Bilateral 2+ peripheral pulses are normal. Diminished pulses would require
immediate intervention.
o Serum potassium level 2.6 mEq/l. Correct
Normal serum potassium level in an infant is 3.5-5 mEq/l. This level reflects a
potentially life-threatening complication.
o Urine output of 10 mL in the last hour.
Normal urine output for infants is 1 mL/kg/hr. Timmy weighs 10 kg, so this output
is adequate.
Awarded 1.0 points out of 1.0 possible points.
B. Timmy is stabilized, but the nurse recognizes that he remains a high risk for fluid and
electrolyte imbalance.
C. 30.ID: 17498063566
Which intervention is important to include in Timmy's plan of care to address this
concern in the immediate postoperative period?
o Monitor urine output every shift.
The I&O should be monitored hourly, not every shift.
o Monitor the infant's glucose level. Correct
Glucose, a critical factor in maintaining cardiac contractility, is impacted by shifts
in fluids and electrolytes.
o Administer pain medication PRN.
This is an appropriate intervention, but it does not address fluid and electrolyte
balance.
o Administer IV antibiotics prophylactically.
This is an appropriate intervention to prevent infection, but it does not address
fluid and electrolyte balance.
Awarded 1.0 points out of 1.0 possible points.
D. Timmy's parents are concerned that Timmy may be in pain. He has prescriptions for
a continuous IV analgesic infusion and a PRN pain medication bolus.
E. 31.ID: 17498063559
