Which assessment findings would alert the nurse to an infant or child in heart failure? (Select All that Apply)

Choice A rationale Tachypnea, an abnormally rapid rate of breathing, is a physiological compensatory mechanism in heart failure. The compromised cardiac output leads to inadequate systemic oxygen delivery, triggering sympathetic nervous system activation. This increases respiratory rate to enhance oxygen intake and carbon dioxide expulsion, aiming to improve tissue perfusion and compensate for pulmonary venous congestion. The normal respiratory rate for infants is 30-60 breaths/min and for children 20-30 breaths/min. Choice B rationale Increased comfort laying down is not characteristic of heart failure; in fact, orthopnea, or difficulty breathing when lying flat, is a common symptom. When supine, venous return to the heart increases, exacerbating pulmonary congestion and dyspnea in a failing heart that cannot efficiently pump the increased blood volume, hence individuals prefer an upright position. Choice C rationale Increased urine output is not a typical finding in heart failure. The reduced cardiac output in heart failure leads to decreased renal perfusion. This activates the renin-angiotensin-aldosterone system and increases antidiuretic hormone release, promoting sodium and water retention to maintain circulating blood volume, thereby decreasing urine output. Normal urine output for infants is 2-3 mL/kg/hr and for children 1-2 mL/kg/hr. Choice D rationale Periorbital edema, swelling around the eyes, is a manifestation of fluid retention in heart failure. The impaired cardiac function results in increased hydrostatic pressure in the capillaries and reduced renal excretion of sodium and water. This leads to extravasation of fluid into the interstitial spaces, particularly in areas of low tissue pressure like the periorbital region. Choice E rationale Poor feeding in infants and children with heart failure results from several physiological factors. Increased metabolic demands due to the heightened work of breathing and tachycardia, coupled with generalized fatigue and dyspnea during feeding, make it difficult for the child to consume adequate nutrition. Reduced gastrointestinal perfusion can also lead to early satiety and nausea.