1. Hello I need some help on this question, here are some of the complications I am needing to find the initial action then possible problem.
    S/S tachycardiac,palpable liver above RCM,weakining pulses,delayed cap. refill, poor skin turgor,HCT 48.
    Would you give a fluid bolus,CXR,ECHO,Transfusion first?
    What do the S/S represent Fluid overload,PDA, Sepsis,Dehydration?
    I was gonna put give bolus first but not sure on the diagnosis dehydration? Thanks for any suggestions!!
  2. Visit premern profile page

    About premern

    Joined: Mar '03; Posts: 22
    R.N. Baby Nurse
    Specialty: NICU, Newborn Nursery, L&D


  3. by   lily0004us
    Last edit by lily0004us on Aug 24, '03
  4. by   Tiki_Torch
    I'm thinking congestive heart failure, coarctation of the aorta, hypoplastic left heart syndrome, sepsis, metabolic disease or asphyxia.

    Congestive heart failure could easily cause the hepatomegaly from the extra venous pressure. The decreased pulses, and tachypnea can also be caused by congestive heart failure, because since babies hearts don't have as much ability to increase stroke volume, they compensate by increasing heart rate. Tachypnea is the first sign of pulmonary edema but as it progresses, respiratory symptoms occur. The poor cardiac output could cause the peripheral pulses to be weak and delayed capillary refill because the body is sending its volume to the vital tissues. If there is a coarctation then only the lower half of the body pulses would be weak and the blood pressures would be like 10% lower than the upper ones. If there is a fluid overload puffing up the heart's size, you could maybe see that on xray. An xray could also show a small heart (hypoplastic left heart) and if there are any other heart defects the doctors can sometimes tell by looking at the pulmonary vascularity on xray. An echocardiogram can give information about heart size and anatomy, pressures and gradients and cardiac function. The hct is a bit low but not that low.

    I'm rambling... sorry....

    I suppose there is no murmur heard or no respiratory symptoms... no edema?

    Of your options, I'd like to see an xray done first because it would show a large, small or normal size heart and possibly some signs of heart defect. Then an echo to see more fluid and anatomy related details. I'd be sitting on ready to give a fluid bolus in case the doctor thinks the baby is hypovolemic but I really think the kid has either congestive heart failure due to either volume overload, pressure overload, or a cardiac problem. I would put the transfusion as last on my list.

    Please, please let us know the correct answers when you find out! I'm dying to know!!!

  5. by   premern
    Thanks I will let ya know!!