Weight gain is an early symptom of congestive heart failure due to accumulation of fluid. Important among these are renal retention of fluid, renin-angiotensin mediated vasoconstriction and sympathetic overactivity. Excessive fluid retention increases the cardiac output by increasing the end diastolic volume (preload), but also results in symptoms of pulmonary and systemic congestion.

Option B: Vasoconstriction (increase in afterload) tends to maintain flow to vital organs, but it is disproportionately elevated in patients with CHF and increases myocardial work. Similarly, sympathetic overactivity results in increase in contractility, which also increases myocardial requirements. An understanding of the interplay of the four principal determinants of cardiac output – preload, afterload, contractility and heart rate is essential in optimising the therapy of CHF. It is clinically useful to consider CHF in different age groups separately.
Option C: In the past, the most sensitive and specific variables for the presence of CHF (p<0.0001) were, a history of less than 3.5 oz/feed, respiratory rate greater than 50/min, an abnormal respiratory pattern, diastolic filling sounds, and hepatomegaly. Moderate to severe CHF was considered to be present when patients took less than 3 oz/feed or greater than 40 min/feed, had an abnormal respiratory pattern with a resting respiratory rate greater than 60/min, and had a diastolic filling sound and moderate hepatomegaly.
Option D: Tachycardia >150/min is common, and heart rates >180/min are abnormal even in the setting of respiratory distress and suggests CHF. Severe CHF was accompanied by a heart rate greater than 170/min, decreased perfusion, and severe hepatomegaly. Thus, the grading of the severity of CHF in infants should include an accurate description of these historical and clinical variables.

None.

Acetaminophen in even moderately large doses can cause serious liver damage that may result in death. Immediate evaluation of liver function is indicated with consideration of N-acetylcysteine administration as an antidote. Acetaminophen is rapidly absorbed from the gastrointestinal (GI) tract and reaches therapeutic levels in 30 minutes to 2 hours. Overdose levels peak at 4 hours unless other factors could delay gastric emptying, such as a co-ingestion of an agent that slows gastric motility, or if the acetaminophen is in an extended-release form.

Option A: Tinnitus is associated with aspirin overdose, not acetaminophen. Acetaminophen has an elimination half-life of 2 hours, but can be as long as 17 hours in patients with hepatic dysfunction. It is metabolized by the liver, where it is conjugated to nontoxic, water-soluble metabolites that are excreted in the urine.
Option B: In the third stage (72 hours to 96 hours), liver dysfunction is significant with renal failure, coagulopathies, metabolic acidosis, and encephalopathy. Gastrointestinal (GI) symptoms reappear, and death is most common at this stage. The fourth stage (4 days to 3 weeks) is marked by recovery.
Option C: Diarrhea and hypertension are not associated with acetaminophen. The diagnosis of acetaminophen toxicity is based on serum levels of the drug, even if there are no symptoms. Other laboratory studies needed include liver function tests (LFTs) and coagulation profile (PT/INR). If the ingestion is severe, LFTs can rise within 8 to 12 hours of ingestion. Normally LFTS remain elevated in the second stage at 18 to 72 hours.

Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Respiratory depression is among the more serious adverse reactions with opiate use that is especially important to monitor in the postoperative patient population.

Option A: Among the more common unwanted effects of morphine use is constipation. This effect occurs via stimulation of mu-opioid receptors on the myenteric plexus, which in turn inhibits gastric emptying and reduces peristalsis. Other common side effects include central nervous system depression, nausea, vomiting, and urinary retention.
Option C: Morphine can also affect the cardiovascular system and reportedly can cause flushing, bradycardia, hypotension, and syncope. It is also important to note that patients can experience pruritus, urticaria, edema, and other skin rashes.
Option D: Morphine sulfate does not significantly affect body temperature. Other reported side effects include lightheadedness, sedation, and dizziness. Patients often report nausea and vomiting, which is why in many emergency departments, morphine administration is with an antiemetic such as ondansetron.

Following triage, an x-ray should be performed to rule out fracture. Review follow-up and serial X-rays. Provides visual evidence of proper alignment or beginning callus formation and healing process to determine the level of activity and need for changes in or additional therapy.

Option A: Ice, not heat, should be applied to a recent sports injury. Apply cold or ice pack first 24–72 hr and as necessary. Reduces edema and hematoma formation, decreases pain sensation. Note: Length of application depends on degree of patient comfort and as long as the skin is carefully protected.
Option B: An elastic bandage may be applied. Maintain immobilization of affected part by means of bed rest, cast, splint, traction. Relieves pain and prevents bone displacement and extension of tissue injury. Elevate and support injured extremity. Promotes venous return, decreases edema, and may reduce pain.
Option D: Pain medication can be given once fracture has been excluded. Medicate before care activities. Let the patient know it is important to request medication before pain becomes severe. Promotes muscle relaxation and enhances participation.