Which of the following are expected assessment findings in a child with congestive heart failure (CHF)?

Choice A rationale Diaphoresis (sweating) during feeding in an infant is a key sign of increased sympathetic nervous system activity and extreme work of breathing due to pulmonary venous congestion. The significant physical effort required for sucking and swallowing rapidly increases oxygen consumption, triggering a stress response and signaling profound respiratory distress and cardiac compromise in congestive heart failure (CHF). Choice B rationale Bounding peripheral pulses are typically indicative of conditions with a wide pulse pressure (high systolic, low diastolic), such as a patent ductus arteriosus (PDA) or severe aortic regurgitation, or hyperdynamic states like fever or sepsis. Congestive heart failure (CHF) due to poor contractility generally results in diminished or thready pulses due to low cardiac output and peripheral vasoconstriction. Choice C rationale Weight loss or, more commonly, failure to thrive, is an expected finding due to the combination of poor caloric intake (infants fatigue easily during feeding) and the dramatically increased metabolic rate associated with the persistently high work of breathing and cardiac effort in congestive heart failure (CHF). However, fluid retention can sometimes mask this. Choice D rationale Tachycardia (increased heart rate, normal range varies by age) is the primary physiological compensatory mechanism in congestive heart failure (CHF) to maintain cardiac output (Cardiac Output = Stroke Volume×Heart Rate) when the stroke volume is reduced due to myocardial dysfunction or volume overload. It is an almost universally expected finding. Choice E rationale Hepatomegaly (enlarged liver) is a consequence of systemic venous congestion due to failure of the right side of the heart to effectively pump blood forward. The resulting increase in systemic central venous pressure causes the blood to back up into the inferior vena cava and subsequently into the hepatic veins, causing passive liver congestion.