The nurse is performing a physical assessment on a newborn. The nurse assessed 3+ brachial pulses, cold and pale feet, decreased capillary refill time in the feet, and warm and pink hands.
Which cardiac disease process do these assessment findings support?
The nurse is performing a physical assessment on a newborn. The nurse assessed 3+ brachial pulses, cold and pale feet, decreased capillary refill time in the feet, and warm and pink hands.
Which cardiac disease process do these assessment findings support?
A. Tetralogy of Fallot (TOF)
[30%]
B. Hypoplastic left heart syndrome
[9%]
C. Coarctation of the aorta (COA)
[49%]
D. Transposition of the great arteries
[12%]
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Newborn
Client Need
Test Plan
Physiological Adaptation
Related Topic
Pathophysiology
Item Type
Item Type
Analysis
Explanation
Choice C is correct. Coarctation of the aorta is a narrowing of the aorta near the ductus arteriosus. Because of this narrowing, there is increased blood flow to the upper extremities and decreased blood flow to the lower extremities. That causes the symptoms described in the question: bounding upper pulses, faint lower pulses, and overall better perfusion to the upper extremities.
Choice A is incorrect. In tetralogy of Fallot, four defects are combined - an overriding aorta, pulmonary stenosis, hypertrophy of the right ventricle, and a VSD. At birth, the nurse would appreciate a murmur and mild to severe cyanosis, depending on the case. The described symptoms do not fit the tetralogy of Fallot.
Choice B is incorrect. In hypoplastic left heart syndrome, the left side of the heart is underdeveloped. The nurse would note cyanosis and murmur at birth, but the described symptoms do not fit hypoplastic left heart syndrome.
Choice D is incorrect. In the transposition of the great arteries, the pulmonary artery leaves the left ventricle, and the aorta leaves the right ventricle. These infants are severely cyanotic at birth and need surgery early in life, but the described symptoms do not fit the transposition of the great arteries.
Related Videos
2 Key Topics
Coarctation of the Aorta (CoA)
31.7 Obstructive Congenital Heart Defects
Additional Info
✓ Coarctation of the aorta accounts for approximately 5-8% of all congenital heart defects. It is one of the most common congenital cardiovascular anomalies and occurs in approximately 1 in 2,500 live births.
✓ Maintain close monitoring of the infant's vital signs, including blood pressure, heart rate, and oxygen saturation. Regular assessment of peripheral pulses, capillary refill, skin color, and temperature is essential to detect changes in perfusion and oxygenation status.
✓ Assist with feeding as needed, as infants with COA may experience feeding difficulties due to poor cardiac output and respiratory compromise. Monitor intake and output closely, and collaborate with the healthcare team to adjust feeding regimens to meet the infant's nutritional needs.
