Ryan is an 11 month old infant who was born with Down’s syndrome and lives with his parents in a middle class neighborhood. Ryan weighted 3.2 kg (7 lb) at birth and a heart murmur was heard. Ryan was breast fed for 4 months. His mother says that at the

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Ryan is an 11 month old infant who was born with Down’s syndrome and lives with his parents in a middle class neighborhood. Ryan weighted 3.2 kg (7 lb) at birth and a heart murmur was heard. Ryan was breast fed for 4 months. His mother says that at the time, he became “disinterested” in the breastfeeding, but when she was able to get him to nurse, he would fall asleep after having nursed for only 5 minutes. Because he was not gaining weight appropriately, his nurse practitioner prescribed infant formula with iron and suggested that his mother begin feeding Ryan rice cereal twice a day. At 4 months of age Ryan was diagnosed with an atrial septal defect that has been monitored since the diagnosis. Ryan sits unsupported but, according to his mother, does not crawl or attempt to stand because “he gets out of breath when he tries to crawl so we bought a walker that he moves around in”. Since he was 5 months old, Ryan has been receiving digoxin 200 micrograms and Furosemide 10 mg every day.

Ryan’s parents bring Ryan in to the clinic because he has been lethargic and has had diarrhea for the past 24 hours. When the nurse practitioner assesses Ryan, he weighs 7 kg (15.4 lb) and his vital signs are:

Temperature: 36.5 C (97.7 F)

Pulse: 80 beats/minute

Respirations: 35 breaths/minute

His laboratory results are:

Potassium level: 2.9 mmol/L

Digoxin level 2.5 ng/mL (Broyles, 2006).

What are the physical exam findings? this is very important part of the answer. summarize and answer plus other questions. please only for a writer the is understand health care, this is a cardiac patient. need in 6 hours

Three references no from 2004 -2014 only.

Differential diagnosis,

2. Pathophysiology,

3. Epidemiology,

4. Physical exam findings,