What is the greatest priority in the therapeutic management of a child with congestive heart failure due to pulmonary stenosis?

• A. Educating the family about signs of infection
• B. Administering enoxaparin to improve left ventricular contractility
• C. Assessing heart rate and blood pressure every 2 hours
• D. Administering furosemide to decrease systemic venous congestion

Answer: (D)

The main idea here is that the most urgent goal in pediatric congestive heart failure from a lesion like pulmonary stenosis is to relieve fluid overload and venous congestion to improve overall circulation. A loop diuretic such as furosemide directly accomplishes this by increasing urine output, which lowers preload and reduces systemic venous pressure. By pulling fluid off the body, furosemide helps decrease edema and hepatomegaly, which in turn can improve feeding, breathing, and overall comfort for the child.

Other options don’t address this immediate need. An anticoagulant like enoxaparin doesn’t improve heart contractility or reduce venous congestion, so it isn’t a primary therapy for this situation. Education about signs of infection is important for ongoing care but isn’t the immediate therapeutic priority in managing active heart failure. Frequent vital sign checks are essential for monitoring, but they are part of assessment rather than a treatment to relieve the symptoms of congestive failure.

So, administering furosemide to decrease systemic venous congestion is the best choice to rapidly improve the child’s symptom burden and stabilize condition.