A.T. , a 2 day old, was
A.T. , a 2 day old, was transferred to Riley Hospital. Chief complaint: ↑ RR and HR; ↑ pallor and diaphoresis with feeding; ↑ coughing, seems to get short of breath and easily tired with feeding – takes 60 minutes to consume 2 ounces of formula; ↓ number of wet diapers Physical exam: Length 50 cm (35th percentile); Weight 2670 grams (5th percentile) Vital Signs: HR 164 (normal 100-140); RR 68 (normal 30-60); BP 82/34 General: Irritable, ↑ napping, weak cry, hard to comfort, prefers elevated HOB position HEENT: Unremarkable, except facial stigmata of Down’s Syndrome Neck: Unremarkable, no JVD Lungs: Equal excursion and breath sounds bilaterally, fine crackles over lower lobes bilaterally, intercostal retractions with nasal flaring, nonproductive cough, O2 requirement ½ L NC Heart: Slightly hyperactive precordium, no arrhythmia, grade II/VI holosystolic murmur at lower LSB, grade III/VI systolic murmur at upper LMCL Peripheral vascular: skin – pale, cool and clammy (even when dressed only in a diaper), capillary refill less than 2 seconds, pulses +2 and equal bilaterally, no edema Abdomen: Soft, non-tender, non-distended, liver palpable @ 4 cm below RCM, bowel sounds x4 Extremities: MAE x4, but holds extremities in extension posture Neuro: Unremarkable for expected newborn reflexes Admission Diagnostics: EKG – normal sinus rhythm CXR – mild cardiomegaly with mildly increased pulmonary vascularity Echo – Large VSD; Image transcription text An order is received to administer: Furosemide 1mg/kg IV STAT. The patient weighs 2670 grams. The following medications are availab… Show more On day 3 of admission, A.T. goes to the OR for a PA Banding. The parents ask about diet restrictions due to heart failure in an infant. The team suggests feeding A.T. Similac with Fe 27 cal/oz, at least 3 ounces every 3 hours. Explain the diet recommendations for an infant in heart failure. Provide the recommendation and rationale.
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