FNP2 - Module 4 Discussion - Cardiovascular
1. What are your top four (4) differential diagnoses?
**Congestive Heart Failure - The patient presents with diaphoresis with feedings, increased sleepiness,
mild subcostal and intercostal retractions, and a delayed capillary refill of 4-5 seconds. All symptoms
suggestive of CHF. X-ray showed moderate cardiomegaly with a moderate degree of pulmonary edema
that are all suggestive of CHF. The patient also presents with a palpable liver edge as well as an S4 gallop
heard at the cardiac apex.
Ventricular Septal Defect - The patient presents with poor feeding, lethargy, dyspnea, and diaphoresis
when feeding. A Grade II/VI holosystolic murmur at the mid lower left sternal border with radiation to
the cardiac apex was heard upon auscultation. The patient also presents with signs and symptoms of
Congestive Heart Failure that may be caused by VSD. This diagnosis needs to be addressed as it often
needs surgical repair for best treatment.
Patent Ductus Arteriosus - The patient presents with CHF symptoms including dyspnea, tachycardia, and
diaphoresis which can indicate a large PDA. A continuous murmur is typically heard in patients with a
PDA. This can be a very serious heart defect and needs to be evaluated.
Coarctation of the Aorta - A narrowing of the descending aorta that leads to symptoms of CHF.
Symptoms include dyspnea, poor feeding, and diaphoresis during feeds. Although, these congenital heart
defects are often seen at birth and diagnosed shortly after delivery. It cannot be ruled out until further
testing is done.
2. Identify your primary diagnosis & explain your rationale - findings that lead you to this
diagnosis.
My primary diagnosis is Congestive Heart Failure related to possible congenital heart defect
(VSD). This diagnosis is evidenced by the patient’s presenting symptoms including tachypnea, poor
feeding, sweating with feeds, lethargy, and tachycardia. Other symptoms related to CHF include a
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, palpable liver edge, S4 sound heard upon auscultation, delayed capillary refill of 4-5 seconds, and
cardiomegaly and pulmonary edema shown on the X-ray. CHF indicates that the heart is not pumping
blood properly to the systemic circulation. This makes it difficult for the infant to thrive. There are several
causes of CHF in infants. A common factor is congenital heart defects. The patient also presents with a
holosystolic murmur that may be indicative of a congenital heart defect like VSD that can be causing the
CHF. Although it is important to evaluate the patient for heart defects, we must first address the patient’s
current symptoms of CHF. Key indications of VSD in the infant include a loud holosystolic murmur that
is present several weeks after birth. These symptoms often appear with infants three to four weeks of life
with moderate to large VSD (Fulton & Saleeb, 2024).
3. What labs and diagnostic tests would you want to order - give rationale for each.
There are several initial tests that will be ordered for infants presenting with heart failure
symptoms. The first exam ordered will be an electrocardiogram (ECG). An ECG will identify the
presence of congenital heart defects as well as identify the location of the defect and estimate the size of
the shunt (Fulton & Saleeb, 2024). It will also be used to assess the perfusion of heart such as ejection
fraction for the infant. A 12 Lead EKG will be ordered as well as this is a noninvasive test to assess the
infant's heart rhythm as the patient presents with some tachycardia. I would also want to order a CBC and
CMP to assess for a potential infection or other causes of dyspnea such as anemia or pneumonia. These
will also determine if the patient is a diabetic that can be a risk factor for CHF. Pulse oximetry should be
monitored closely in this patient due to their dyspnea and respiratory distress. A B-type natriuretic
peptide (BNP) and N-terminal fragment can be ordered to help discriminate between cardiac disease
and pulmonary disease (Singh & Singh, 2025). Lastly, a cardiac catheterization can be done as well to
help identify diagnosis. It will also help by measuring the pressure and oxygen inside the chambers of the
heart to determine if there is any type of shunt (NHLBI, 2022). Although, I would hold off on the cardiac
catheterization unless necessary due to the results of the other tests. This is an invasive test and can be
quite stressful for the infant and family.
This study source was downloaded by 100000898062787 from CourseHero.com on 10-01-2025 00:01:05 GMT -05:00
https://www.coursehero.com/file/251701065/FNP2-Module4Discussion-Cardiovascularpdf/
1. What are your top four (4) differential diagnoses?
**Congestive Heart Failure - The patient presents with diaphoresis with feedings, increased sleepiness,
mild subcostal and intercostal retractions, and a delayed capillary refill of 4-5 seconds. All symptoms
suggestive of CHF. X-ray showed moderate cardiomegaly with a moderate degree of pulmonary edema
that are all suggestive of CHF. The patient also presents with a palpable liver edge as well as an S4 gallop
heard at the cardiac apex.
Ventricular Septal Defect - The patient presents with poor feeding, lethargy, dyspnea, and diaphoresis
when feeding. A Grade II/VI holosystolic murmur at the mid lower left sternal border with radiation to
the cardiac apex was heard upon auscultation. The patient also presents with signs and symptoms of
Congestive Heart Failure that may be caused by VSD. This diagnosis needs to be addressed as it often
needs surgical repair for best treatment.
Patent Ductus Arteriosus - The patient presents with CHF symptoms including dyspnea, tachycardia, and
diaphoresis which can indicate a large PDA. A continuous murmur is typically heard in patients with a
PDA. This can be a very serious heart defect and needs to be evaluated.
Coarctation of the Aorta - A narrowing of the descending aorta that leads to symptoms of CHF.
Symptoms include dyspnea, poor feeding, and diaphoresis during feeds. Although, these congenital heart
defects are often seen at birth and diagnosed shortly after delivery. It cannot be ruled out until further
testing is done.
2. Identify your primary diagnosis & explain your rationale - findings that lead you to this
diagnosis.
My primary diagnosis is Congestive Heart Failure related to possible congenital heart defect
(VSD). This diagnosis is evidenced by the patient’s presenting symptoms including tachypnea, poor
feeding, sweating with feeds, lethargy, and tachycardia. Other symptoms related to CHF include a
This study source was downloaded by 100000898062787 from CourseHero.com on 10-01-2025 00:01:05 GMT -05:00
https://www.coursehero.com/file/251701065/FNP2-Module4Discussion-Cardiovascularpdf/
, palpable liver edge, S4 sound heard upon auscultation, delayed capillary refill of 4-5 seconds, and
cardiomegaly and pulmonary edema shown on the X-ray. CHF indicates that the heart is not pumping
blood properly to the systemic circulation. This makes it difficult for the infant to thrive. There are several
causes of CHF in infants. A common factor is congenital heart defects. The patient also presents with a
holosystolic murmur that may be indicative of a congenital heart defect like VSD that can be causing the
CHF. Although it is important to evaluate the patient for heart defects, we must first address the patient’s
current symptoms of CHF. Key indications of VSD in the infant include a loud holosystolic murmur that
is present several weeks after birth. These symptoms often appear with infants three to four weeks of life
with moderate to large VSD (Fulton & Saleeb, 2024).
3. What labs and diagnostic tests would you want to order - give rationale for each.
There are several initial tests that will be ordered for infants presenting with heart failure
symptoms. The first exam ordered will be an electrocardiogram (ECG). An ECG will identify the
presence of congenital heart defects as well as identify the location of the defect and estimate the size of
the shunt (Fulton & Saleeb, 2024). It will also be used to assess the perfusion of heart such as ejection
fraction for the infant. A 12 Lead EKG will be ordered as well as this is a noninvasive test to assess the
infant's heart rhythm as the patient presents with some tachycardia. I would also want to order a CBC and
CMP to assess for a potential infection or other causes of dyspnea such as anemia or pneumonia. These
will also determine if the patient is a diabetic that can be a risk factor for CHF. Pulse oximetry should be
monitored closely in this patient due to their dyspnea and respiratory distress. A B-type natriuretic
peptide (BNP) and N-terminal fragment can be ordered to help discriminate between cardiac disease
and pulmonary disease (Singh & Singh, 2025). Lastly, a cardiac catheterization can be done as well to
help identify diagnosis. It will also help by measuring the pressure and oxygen inside the chambers of the
heart to determine if there is any type of shunt (NHLBI, 2022). Although, I would hold off on the cardiac
catheterization unless necessary due to the results of the other tests. This is an invasive test and can be
quite stressful for the infant and family.
This study source was downloaded by 100000898062787 from CourseHero.com on 10-01-2025 00:01:05 GMT -05:00
https://www.coursehero.com/file/251701065/FNP2-Module4Discussion-Cardiovascularpdf/
