Congenital Heart Defect
NextGen SKINNY Reasoning
Johnny Patterson, 5 months old
NCLEX Client Need Categories Covered in
Case Study NCSBN Clinical
Judgment Model Covered in
Case Study
Safe and Effective Care Environment Step 1: Recognize Cues
• Management of Care Ste...
congenital heart defect nextgen skinny reasoning johnny patterson
5 months old nclex client need categories covered in case study ncsbn clinical judgment model covered in case study safe an
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Congenital Heart Defect NextGen SKINNY Reasoning
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Congenital Heart Defect
NextGen SKINNY Reasoning
Johnny Patterson, 5 months old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
Gas exchange
Nutrition
Elimination
NCLEX Client Need Categories Covered in NCSBN Clinical Covered in
Case Study Judgment Model Case Study
Safe and Effective Care Environment Step 1: Recognize Cues ✓
• Management of Care ✓ Step 2: Analyze Cues ✓
• Safety and Infection Control Step 3: Prioritize Hypotheses ✓
Health Promotion and Maintenance ✓ Step 4: Generate Solutions ✓
Psychosocial Integrity ✓ Step 5: Take Action ✓
Physiological Integrity Step 6: Evaluate Outcomes ✓
✓
• Basic Care and Comfort
✓
• Pharmacological and
Parenteral Therapies
✓
• Reduction of Risk Potential
✓
• Physiological Adaptation
This study source was downloaded by 100000808565474 from CourseHero.com on 06-27-2021 17:01:43 GMT -05:00
Part I: History of Present Illness
Johnny Patterson was born at 38 weeks gestation and diagnosed with Trisomy 21 (Down
Syndrome). At his one-week well checkup at the pediatrician’s office, a prominent heart
murmur was auscultated. An echocardiogram revealed a large ventricular septal defect
immediately below the aorta. A referral was made to a cardiologist who suggested no
immediate interventions because Johnny did not appear to be in any distress.
Three weeks later at his second cardiologist appointment, his parents report that Johnny
seems to be sleeping more. He seems to have times when he breathes faster than usual and
becomes sweaty when he breastfeeds. His weight is 4 kg. At his last visit three weeks ago he
weighed 4.4 kg. The cardiologist prescribed 12 mcg digoxin every 12 hours (0.05mg/ml
solution is received from the pharmacy) and 8 mg furosemide every day (10mg/ml oral solution
is received from pharmacy).
What data from the histories are RELEVANT and must be NOTICED as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential)
RELEVANT Data: Clinical Significance:
1. Trisomy 21 diagnosed 1. At great risk of Tetralogy of Fallot
2. Prominent heart murmur 2. At great risk of Tetralogy of Fallot
3. large ventricular septal defect 3. Congenital heart defect
4. sleep more and breath faster than normal 4. Signs of heart failure
5. lost weight 0.4kg in 3 weeks 5. Failure to thrive, not getting enough nutrients
Johnny’s 5-month visit:
Johnny has been seen monthly by the cardiologist. Appointments at three
and four months were unremarkable. At his five-month visit, his dosage of
digoxin was increased to 22 mcg two times a day and furosemide
increased also to 14.4 mg because his weight increased to 7.2 kg. Is this a
safe dose for both medications?
What data is RELEVANT and must be NOTICED as clinically significant by the nurse?
(NCSBN: Step 1 Recognize cues/NCLEX: Reduction of Risk Potential)
RELEVANT Data: Clinical Significance:
1. johnny now weights 7.2 kg. no tissue noted by provider and Mom expressed no concerns.
2. Digoxin dose increased to 22 mcg BID and furosemide dose increased to 11.4 mg q 24 hours.
1. Normal weight
2. Digoxin dose: 43.2 mcg to 72 mcg daily
This study source was downloaded by 100000808565474 from CourseHero.com on 06-27-2021 17:01:43 GMT -05:00
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