Ventral Septal Defect

Ventral Septal Defect SKINNY Reasoning Case Study History of Present Problem Mandy Gray is a two-month-old infant born with a large ventricular septal defect (VSD) that was diagnosed by her pediatrician during her two-week infant check-up. The parents called her pediatric cardiology clinic because Mandy was breathing faster and showed signs of increased work of breathing. Her mother states that she is having difficulty nursing because she tires easily and then becomes fussy and cries because she is hungry. Her height and weight are below the 25th percentile (wt: 4.5 kg. ht: 54 cm). Her Mom reports that Mandy’s weight has increased by 8 ounces (240 g) in the last 24 hours. Her pediatric cardiologist is concerned about worsening heart failure and Mancy will be admitted with a diagnosis of acute heart failure. Personal/Social History Mandy is the first child of Jim and Jessica who were married two years ago. They were both raised in the Catholic faith but are not active in the church. Both parents seem anxious about their infant daughter but express hopefulness about the surgery to correct the problem. The surgery is scheduled in four months. Her mother is an RN who works in a dermatology clinic. Since Mandy’s birth, her mother has stayed home to care for Mandy because she is too medically fragile to be cared for in a daycare setting. Both of Jim’s parents are deceased, and Jessica’s parents live in another state. Vital Signs Current VS: FLACC Behavioral Pain Assessment Scale: T: 99.4 F/37.5 C (temporal) Face: 1 P: 210/min (regular) Legs: 0 R: 74/min Activity: 0 BP: 70/45 MAP: 50 Cry: 1 O2 sat: 90% on RA Consolability: 0 Current Assessment Current Assessment: GENERAL APPEARANCE: Pale in color, quiet while in mother’s arms. Working moderately hard to breathe and appears tired with eyes closing but startles awake with loud sounds or voice RESP: Fine crackles at bases bilaterally. Grunting noted with expirations and mild to moderate sub-costal retractions and slight nasal flaring CARDIAC: Pallor noted at face and trunk; capillary refill is greater than 2 seconds. Grade 3/6 holosystolic murmur heard at 3rd, 4th, 5th intercostal space at the left sternal border. Apical heart rate is rapid and peripheral pulses are equal, weak but palpable, lower extremities 1+ pitting edema NEURO: Awake but appears tired. Responds to mother and father appropriately with an occasional smile. GI: Abdomen rounded, soft and non-tender, hepatosplenomegaly present, bowel sounds audible GU: Per Mom, has only had one wet diaper today SKIN: Skin integrity intact, skin turgor elastic Radiology Reports Radiology: Chest X-Ray Results: Clinical Significance: Cardiac silhouette slightly enlarged. No infiltrates present.