Case study#9 – Explain you answer
A father is in the cardiac intensive care unit holdingthe hand of his 1-week-old daughter. After discharge, the motherand father noted that the baby had rapid breathing and was a pooreater. Her color was mottled with crying and she seemed to sweatwhen distressed. They took the baby back to the pediatrician’soffice for a weight check and were immediately transported to alocal children’s hospital for cardiac evaluation. The parentsbelieve they are responsible because the mother did not receivemedical care during her pregnancy. This baby is their third child,and they did not have medical insurance after the father lost hisjob. Worried about how they are going to pay the medical bills,they met with financial counselors who are assisting them withinformation and filing paperwork. Because both parents arehigh-school dropouts, neither reads well and they struggle tounderstand their daughter’s diagnosis of TOF.
Consisting of four defects, TOF is a congenital cardiacdefect that:
1. Requires increasing cardiac workload and theefficiency of heart function.
2. Allows desaturated blood to enter the systemic systemwithout passing through the lungs.
3. Causes shunting from the left side of the heart tothe right side with outflow obstruction.
4. Increases pulmonary blood flow, allowing shunting ofblood and leading to pulmonary hypertension.
While the father is with the newborn, the mother is inthe emergency department with their little boy. The grandmotherwatched the boy while his mother and father were at the hospitalfor his sister’s birth. The mother of the newborn told her motherthat her son has had a fever and red eyes for 4 days. As of thismorning, he refuses to open his mouth to eat or drink. With a faintrash and puffy fingers, the little boy is irritable and refuses toleave his mother’s lap. The emergency department physician admitsthe child with a diagnosis of a viral illness. The next morning,the boy’ hands and feet begin to peel, and the infectious diseaseteam is consulted. It is determined that he has Kawasakidisease.
The clinical course of this disease progresses in threestages. During the acute phase, the child is treated withintravenous immunoglobulin and:
1. Aspirin to reduce thrombosis formation that may occurwithin coronary artery aneurysms
2. Ibuprofen to reduce inflammation of the vascularsystem
3. Dialysis to remove the toxins resulting fromconcurrent renal failure
4. Plasma infusions to decrease thepolycythemia
