CCRN Critical Care Nursing

Category - Pediatrics

Which of the following nursing diagnosis would the nurse identify as the priority for a 4-month-old infant with heart failure and congenital heart disease:
  1. risk for infection
  2. impaired mobility
  3. activity intolerance
  4. ineffective health maintenance
Explanation
Answer: C - An infant with congenital heart disease and congestive heart failure tires very easily, leading to a priority nursing diagnosis of Activity Intolerance. Nursing care needs to focus on allowing the infant to have frequent rest periods. Infants with congenital heart disease and congestive heart failure are not necessarily at risk for more infections than other infants. Impaired Mobility usually is not a problem because an infant with congenital heart disease usually exhibits normal physical mobility. Ineffective Health Maintenance usually is not a problem because these infants still need regular and routine health check-ups
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