Pediatric Nursing Q 15

Correct Answer: B. Absent or diminished femoral pulses

Absent or diminished femoral pulse is a classic characteristic of coarctation of the aorta. In patients with neonatal coarctation evolving while the patent ductus arteriosus is closing, the lower extremity saturation can be low as perfusion to the lower body can be maintained by ductal patency. In the era of lower extremity pulse oximetry screening in newborns, a neonate could often pass with an acceptable saturation as it is less common for the ductus to contribute significantly unless other left heart structures are hypoplastic.

Option A: Tet spells require a rapid and aggressive approach including positioning (knee-chest) to increase systemic vascular resistance, oxygen therapy to cause pulmonary vasodilation and systemic vasoconstriction, intravenous fluid bolus to improve the right ventricle filling and pulmonary flow; morphine, intravenous beta-blockers to help improve the right ventricle outflow obstruction by relaxing the muscle, and intravenous phenylephrine to increase systemic afterload.

Option C: Severe cyanosis at birth is seen in such defects as transposition of the great vessels. The degree of cyanosis is dependent on the amount of mixing between the two parallel circuits. Factors affecting intracardiac mixing include the size and presence of an ASD or VSD. Cyanosis is not affected by exertion or supplemental oxygen.

Option D: Tet episodes are characteristic of Tetralogy of Fallot. “Tet spells” or hypercyanotic episodes present during infancy or toddler age and decrease after 4 to 5 years of age. Dehydration or agitation commonly precipitate tet spells, and if patients do not receive prompt and adequate treatment, they can develop severe cyanosis and hypoxia that, subsequently, can cause syncope and even death.