Passage / Scenario

Nurse's Notes: The infant presents with tachypnea, moderate retractions, and nasal flaring. Auscultation reveals crackles in all lung fields, with no nasal drainage. The infant has a dry cough that occurs periodically. The skin appears pale, the scalp is diaphoretic, and the lower extremities are cool to the touch. The infant is tachycardic with a regular rhythm, and no murmur is heard. Peripheral pulses are full and bounding in the upper extremities but weak in the bilateral pedal pulses. Mucous membranes are slightly dry and pink, with slightly decreased skin turgor. Capillary refill time is 3 seconds. Periorbital edema and non-pitting edema of the feet are noted. The anterior fontanel is soft and slightly depressed. The diaper remains dry. The abdomen is soft, full, and round, with active bowel sounds; Medical History: The infant was born at 38 weeks gestation via vaginal delivery with no complications. The infant has had no previous hospitalizations or surgeries. The infant has been exclusively breastfed and has no known allergies. The mother reports that the infant has been feeding poorly for the past two days and has had decreased urine output. There is no family history of congenital heart disease or respiratory conditions; Diagnostic Results: Chest X-ray: Mild left ventricular hypertrophy noted. Increased pulmonary vascular markings in all lobes; Complete Blood Count (CBC): White Blood Cells (WBC): 12,000/mm³ (4,500-11,000/mm³), Hemoglobin (Hgb): 11 g/dL (11-14 g/dL), Hematocrit (Hct): 33% (33-39%), Platelets: 250,000/mm³ (150,000-450,000/mm³); Electrolytes: Sodium (Na): 138 mEq/L (135-145 mEq/L), Potassium (K): 4.2 mEq/L (3.5-5.0 mEq/L), Chloride (Cl): 102 mEq/L (98-106 mEq/L), Bicarbonate (HCO3): 22 mEq/L (22-28 mEq/L); Vital Signs: Temperature: 37.7°C (99.9°F), Heart rate: 174/min while sleeping, Respiratory rate: 72/min while sleeping, Blood pressure in right upper extremity: 60/39 mm Hg, Oxygen saturation: 90%; Physical Examination Results: The infant is alert but irritable. The skin is pale with a diaphoretic scalp and cool lower extremities. The infant exhibits tachypnea with moderate retractions and nasal flaring. Crackles are heard in all lung fields upon auscultation. The heart rate is tachycardic with a regular rhythm, and no murmur is detected. Peripheral pulses are full and bounding in the upper extremities but weak in the bilateral pedal pulses. The mucous membranes are slightly dry and pink, with slightly decreased skin turgor. Capillary refill time is 3 seconds. Periorbital edema and non-pitting edema of the feet are noted. The anterior fontanel is soft and slightly depressed. The abdomen is soft, full, and round, with active bowel sounds; A nurse is caring for a 6-week-old infant in the pediatric unit.