The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include? (Select all that apply.)

The correct answer is choice D. "Currant jelly" stools.

Choice A rationale:

Loose, foul-smelling stools are not characteristic of intussusception. Intussusception is a condition in which a part of the intestine invaginates into another part, causing obstruction. This obstruction often leads to "currant jelly" stools, which are composed of mucus, blood, and sloughed intestinal tissue. Loose stools might be associated with other gastrointestinal issues but are not a hallmark of intussusception.

Choice B rationale:

Ribbon-like stools are characteristic of intussusception. When a section of the intestine telescopes into another section, it can cause the stool to be squeezed into a ribbon-like shape as it passes through the narrowed portion. This description aligns with the pathophysiology of intussusception.

Choice C rationale:

Hard stools positive for guaiac indicate the presence of blood in the stool, but this finding is not specific to intussusception. Guaiac testing detects occult blood, which could be present in various gastrointestinal conditions, including bleeding ulcers or diverticulitis, and not exclusively in intussusception.

Choice D rationale:

"Currant jelly" stools are characteristic of intussusception. As mentioned earlier, these stools are the result of the obstruction and subsequent damage to the intestinal lining, leading to the presence of blood, mucus, and sloughed tissue. This description is a classic sign of intussusception and should raise suspicion for this condition.

The correct answers are choices A, B, and D.

Choice A rationale:

Decreased urinary output can be a sign of heart failure, especially in infants. In heart failure, the heart's ability to pump effectively can lead to decreased blood flow to the kidneys, resulting in decreased urine production.

Choice B rationale:

Sweating (inappropriate) is a symptom of heart failure in infants. Infants with heart failure might sweat excessively, especially while feeding or crying, due to the effort required by the heart to pump blood effectively.

Choice C rationale:

Warm flushed extremities are not typically associated with heart failure in infants. In heart failure, extremities might actually become cool and pale due to poor circulation.

Choice D rationale:

Anorexia, or a lack of appetite, is a common sign in infants with heart failure. The increased effort required for feeding due to compromised cardiac function can lead to poor feeding and decreased appetite.

Choice E rationale:

Weight loss can occur in infants with heart failure due to inadequate caloric intake, difficulty with feeding, and increased metabolic demands associated with heart failure. However, it's not as specific a sign as decreased urinary output, sweating, and anorexia.