Copyright © 2018 Keith Rischer, d/b/a KeithRN. All Rights reserved.

Ventral Septal Defect

UNFOLDING Reasoning

Mandy Gray, 2 months old

Primary Concept

Perfusion

Interrelated Concepts (In order of emphasis)

• Gas Exchange

• Clinical Judgment

• Patient Education

• Communication

NCLEX Client Need Categories Percentage of Items from Each

Category/Subcategory

Covered in

Case Study

Safe and Effective Care Environment

✓ Management of Care 17-23% ✓

✓ Safety and Infection Control 9-15%

Health Promotion and Maintenance 6-12% ✓

Psychosocial Integrity 6-12% ✓

Physiological Integrity

✓ Basic Care and Comfort 6-12% ✓

✓ Pharmacological and Parenteral Therapies 12-18% ✓

✓ Reduction of Risk Potential 9-15% ✓

✓ Physiological Adaptation 11-17% ✓

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Copyright © 2018 Keith Rischer, d/b/a KeithRN. All Rights reserved.

History of Present Problem:

Mandy Gray is a two-month-old infant born with a large ventricular septal defect (VSD) that was diagnosed by

her pediatrician during her two-week infant check-up. The parents called her pediatric cardiology clinic

because Mandy was breathing faster and showed signs of increased work of breathing. Her mother states that

she is having difficulty nursing because she tires easily and then becomes fussy and cries because she is

hungry. Her height and weight are below the 25th percentile (wt: 4.5 kg. ht: 54 cm). Her Mom reports that

Mandy’s weight has increased by 8 ounces (240 g) in the last 24 hours. Her pediatric cardiologist is concerned

about worsening heart failure and Mancy will be admitted with a diagnosis of acute heart failure.

Personal/Social History:

Mandy is the first child of Jim and Jessica who were married two years ago. They were both raised in the

Catholic faith but are not active in the church. Both parents seem anxious about their infant daughter but

express hopefulness about the surgery to correct the problem. The surgery is scheduled in four months. Her

mother is an RN who works in a dermatology clinic. Since Mandy’s birth, her mother has stayed home to care

for Mandy because she is too medically fragile to be cared for in a daycare setting. Both of Jim’s parents are

deceased, and Jessica’s parents live in another state.

What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?

(Reduction of Risk Potential)

RELEVANT Data from Present Problem: Clinical Significance:

RELEVANT Data from Social History: Clinical Significance:

Patient Care Begins:

What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?

(Reduction of Risk Potential/Health Promotion and Maintenance)

RELEVANT VS Data: Clinical Significance:

Current VS: FLACC Behavioral Pain Assessment Scale:

T: 99.4 F/37.5 C (temporal) Face: 1

P: 210/min (regular) Legs: 0

R: 74/min Activity: 0

BP: 70/45 MAP: 50 Cry: 1

O2 sat: 90% on RA Consolability: 0

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