Infant Presents Emergency Assignment Help: How to Answer This Question

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A 4-day-old infant presents to the emergency department. Parents state that the infant has been breathing fast, sweating, and feeding poorly since discharge from the hospital following a normal vaginal delivery. Upon assessment, vital signs are obtained with the following results: • Temperature (axillary): 36.7°C • Heart rate: 160 beats per minute with a murmur • Respiratory rate: 70 breaths per minute • SpO2: 95% on room air. • Breath sounds: Clear to auscultation • Chest radiograph, which shows cardiomegaly and increased vascular markings 1. In order to assess this patient, what should the respiratory therapist do first? a. Recommend obtaining electrolytes b. Perform a physical assessment c. Recommend obtaining a complete blood count d. Recommend an ECG 2. Based on the examination findings, which two steps should the respiratory therapist recommend? i. Echocardiogram ii. Blood pressure measurements in all four extremities iii. Pre- and postductal oxygen saturation iv. Palpating upper and lower extremity pulses a. i and iii b. ii and iv c. i and ii d. iii and iv 3. The diagnosis of patent ductus arteriosus is made by echocardiogram. Which of the following are the treatment options? a. Pericardial patch b. Surgical ligation c. Administration of beta blockers d. Inhalation of nitric oxide Case Study 2 A 10-day-old infant presents to the emergency department. Parents state that the infant has been very pale, irritable, poorly feeding, tachypneic for the last week, and lethargic for the last 24 hours. Upon assessment, vital signs are obtained with the following results: • Temperature (axillary): 36.7°C • Heart rate: 160 beats per minute • Respiratory rate: 65 breaths per minute • Blood pressure: 110/65 mm Hg • SpO2: 95% on room air • Breath sounds: Clear to auscultation Physical examination findings include strong pulses and hypertension in the upper extremities, diminished pedal pulses, and a blood pressure gradient, with low or unreadable blood pressures in the lower extremities. A systolic murmur is present at the upper left sternal border. An apical systolic ejection “click” is present. The physician orders an ECG. The results of the diagnostic tests are as follows: • Chest X-ray shows a normal or enlarged heart. • ECG shows right ventricular hypertrophy. • ECHO shows a narrowing in the aorta. A diagnosis of severe coarctation is made, and the infant is admitted to the intensive care unit. 1. In order to assess this patient, what should the clinician obtain? a. Electrolytes b. Physical assessment c. Complete blood count d. MRI of the chest 3. What interventions and/or additional testing should the clinician now consider? i. Cardiac catheterization ii. Echocardiogram iii. Doppler study of the legs iv. Chest radiograph a. i and iv b. ii and iii c. i and ii d. iii and iv 4. Upon admission to the cardiac intensive care unit, what is the first medical intervention that should be performed? a. Initiation of inhaled nitric oxide b. Administration of a fluid bolus c. Infusion of prostaglandin E d. Intubation and mechanical ventilation 5. Corrective actions for coarctation of the aorta include surgery to remove the narrowed area, balloon dilation during cardiac catheterization, and which of the following? i. A patch aortoplasty ii. Ligation of the ductus arteriosus iii. Graft to bypass the coarctation iv. Performing a Fontan procedure a. i and ii b. ii and iv c. i and iii d. iii and iv

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