Chapter 27, The Child with Cardiovascular Dysfunction

A 10-year-old with rheumatic fever is seen in the primary clinic. The parent reports the child had a sore throat and fever 3 weeks ago, but did not come to the office to be seen. What lab test in the patient's should the nurse check for that is most indicative for acute rheumatic fever?

Antistreptolysin O (ASO or ASLO) titer

A 2 week old (born at 36 weeks gestation) with patent ductus arteriosus (PDA) is admitted for initial placement of a nasogastric tube to begin NG feeds due to FTT related to this congenital defect. The child's cardiac status is stable. The nurse needs to administer Indomethacin to this infant. What is the implication for this medication? How does it help this infant?

Indomethacin which is a prostaglandin inhibitor can close the PDA in premature infants and some newborns.

A 10-year-old with rheumatic fever is seen in the primary clinic. The parent reports the child had a sore throat and fever 3 weeks ago, but did not come to the office to be seen. The parent asks the nurse what caused the acute rheumatic fever. How should the nurse respond?

It is most likely caused by an untreated group A strep (GAS) infection

A 2 week old (born at 36 weeks gestation) with patent ductus arteriosus (PDA) is admitted for initial placement of a nasogastric tube to begin NG feeds due to FTT related to this congenital defect. The child's cardiac status is stable. When obtaining the apical heart rate, the nurse hears a loud murmur. Is this to be expected?

Yes, there is a characteristic machinery-like sounding murmur.

Which heart defect causes narrowing of the aortic valve? 1 Aortic stenosis 2 Atrial septal defect 3 Coarctation of the aorta 4 Patent ductus arteriosus

1 Aortic stenosis causes narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Atrial septal defect is an abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. Coarctation of the aorta is an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close during the first few weeks of life.

Which term describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia? 1 Clubbing 2 Polycythemia 3 Hypercyanotic spells 4 Raynaud phenomenon

1 Clubbing is a thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia and polycythemia. Polycythemia is an increased number of red blood cells. Hypercyanotic, or "blue," spells are often seen in infants with tetralogy of Fallot; the affected infant becomes acutely cyanotic and hyperpneic. Raynaud phenomenon is an autoimmune disease.

The nurse is caring for a child with Kawasaki disease (KD). Which intervention performed at the time of diagnosis does the nurse refer to for evaluating long-term complications? 1 Echocardiogram 2 Intake and output record 3 Complete blood count 4 Erythrocyte sedimentation rate

1 Echocardiograms are used to monitor myocardial and coronary artery status. A baseline echocardiogram should be obtained at the time of diagnosis for comparison with future studies. Long-term complications of KD include the development of coronary artery aneurysms and disrupting blood flow. In the convalescent phase, intake, output, and daily weight all return to normal. The convalescent phase is complete when all blood values such as complete blood count and erythrocyte sedimentation rate are normal. This is 6 to 8 weeks after the onset of the disease.

The patient with heart failure receives furosemide intravenously. Which intervention is appropriate? 1 Record output as soon as the drug is given. 2 Do not give foods high in potassium. 3 Observe for signs of hypertension. 4 Observe for skin rash and drowsiness.

1 Furosemide is a diuretic used in heart failure. It blocks the reabsorption of sodium and water in the proximal renal tubule. Output should be recorded as soon as the medication is administered, and the child must be monitored for dehydration. Furosemide causes excretion of chloride and potassium. Therefore, the child must be encouraged to have foods high in potassium or given potassium supplements. One of the side effects of furosemide is postural hypotension. Skin rash and drowsiness are side effects seen in children who receive spironolactone.

Which is an early sign of congestive heart failure? 1 Tachypnea 2 Bradycardia 3 Inability to sweat 4 Increased urine output

1 Tachypnea is one of the early signs of congestive heart failure that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure. The child with congestive heart failure may be diaphoretic and exhibit decreased urine output.

What does the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)? 1 Institute prophylactic antibiotic therapy. 2 Treat with short-term oral drug therapy. 3 Treat a cold with over-the-counter drugs. 4 Take blood culture before dental work.

1 The parents must take adequate measures to prevent infection. The child must be administered prophylactic antibiotic therapy 1 hour before certain procedures, such as dental work. Treatment of IE requires long-term parenteral drug therapy. Intravenous antibiotics may be administered at home with nursing supervision. Any unexplained fever, weight loss, lethargy, malaise, or anorexia must be reported to the health care provider. Such symptoms should not be self-diagnosed as a cold or flu, nor should they be treated with over-the-counter drugs. Early diagnosis and treatment are important in preventing further cardiac damage, embolic complications, and growth of resistant organisms. Blood cultures must be taken periodically to evaluate the response to antibiotic therapy.

Which clinical manifestations of heart failure in an infant occur due to pulmonary congestion rather than impaired myocardial function? Select all that apply. 1 Cyanosis 2 Tachypnea 3 Tachycardia 4 Gallop rhythm 5 Costal retractions

1,2,5 In an infant with heart failure, cyanosis, tachypnea, and costal retractions occur due to pulmonary congestion. Cyanosis occurs due to impaired gas exchange because oxygen does not reach the alveoli for gas exchange in adequate amounts due to fast breathing rates. The fast breathing, or tachypnea, is in response to the decreased ability of the lungs to expand. During attempts to ventilate the noncompliant lungs, the pliable chest wall of the infant is drawn inward, resulting in costal retractions. Tachycardia and a gallop rhythm are the result of impaired myocardial function rather than pulmonary congestion. Tachycardia is a direct result of sympathetic stimulation of the myocardium. Gallop rhythm refers to the extra heart sounds S 3and S 4that occur due to ventricular dilation and excess preload.

After a patient returns from cardiac catheterization, the nurse assesses that the pulse distal to the catheter insertion site is weaker. Which is the nurse's best action? 1 Elevate the affected extremity. 2 Record the data on the nurse's notes. 3 Notify the physician of the observation. 4 Apply warm compresses to the insertion site.

2 Because a weaker pulse is an expected finding, the nurse should document this and continue to monitor it. The pulse distal to the catheter insertion site may be weaker for the first few hours after catheterization. Elevation is not necessary; the extremity is kept straight. It should gradually increase in strength. The insertion site is kept dry.

In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures? 1 Electrophysiology 2 Echocardiography 3 Electrocardiography 4 Cardiac catheterization

2 Echocardiography involves the use of high-frequency sound waves. The child undergoing this procedure must lie completely still. With improvements in technology a diagnosis can sometimes be made without cardiac catheterization. Electrocardiography is an electrical tracing of the depolarization of myocardial cells. Cardiac catheterization is an invasive procedure in which a catheter is threaded into the heart, a contrast medium is injected, and the heart and its vessels are visualized. Electrophysiology is an invasive procedure in which catheters with electrodes record the impulses of the heart directly from the conduction system.

The nurse, preparing to give digoxin to a 9-month-old infant, checks the dosage and sees that 4 mL of the drug is to be administered. Which action by the nurse is correct? 1 Mix the dose with juice to disguise its taste. 2 Refrain from drawing up the dose because there is an error in the dosage. 3 Check the heart rate and administer the dose by letting the infant suck it through a nipple. 4 Check the heart rate and administer the dose by placing it at the back and side of the mouth.

2 igoxin is often prescribed in micrograms. Rarely is more than 1 mL administered to an infant. As a potentially dangerous drug, digoxin has precise administration guidelines. Some institutions require that digoxin dosages be checked by another professional before administration. The nurse has drawn up too much medication and should not give it to the child. Administering the dose through a nipple is the correct procedure, but too much medication has been prepared, so it should not be given to the child. Administering the dose by placing it at the back and side of the mouth is the correct procedure, but too much medication has been prepared, so it should not be given to the child.

After cardiac catheterization of a child, which assessment finding is most concerning to the nurse? 1 The pulse distal to the catheterization site is weak. 2 The affected extremity feels cool when touched. 3 The child has resumed oral intake with clear liquids. 4 The child is in bed with the affected extremity held straight

2 If the affected extremity feels cool when touched, arterial obstruction may be present. The health care provider must be notified immediately. A weak pulse distal to the site for the first few hours after catheterization is not a cause for concern. However, the pulse should gradually increase in strength. The child's usual diet can be resumed as soon as tolerated, beginning with sips of clear liquids and advancing as the condition allows. The child must take in enough fluids to ensure adequate hydration. Blood loss, nothing by mouth (NPO) status, and diuretic actions of dyes used during the procedure increase the risk for hypovolemia and dehydration. The child must be kept in bed, with the affected extremity maintained straight for several hours, to promote healing of the cannulated vessel.

What teaching should the nurse give to the principal caregiver of a child about the administration of digoxin? Select all that apply. 1 Mix the drug with some food or fluids. 2 Administer the drug every 12 hours. 3 Report frequent vomiting or poor feeding. 4 Give a second dose if the child vomits. 5 Give water after administering the drug.

2,3, 5 Maintenance doses of digoxin (Lanoxin) are given every 12 hours, such as at 8 AM and 8 PM. Digoxin can be dangerous because it has a narrow margin of safety between therapeutic, toxic, and lethal doses. Frequent vomiting, poor feeding, or a slow heart rate can be signs of toxicity. The health care provider must be notified if any of these signs are observed in the child. The child must be given water after administering the drug and encouraged to brush the teeth to prevent tooth decay. The drug must not be mixed with food or fluids, because the child will receive an inaccurate dosage if the child refuses to have the food and other fluids. If the child vomits after a dose, a second dose should not be given, because this may lead to an overdose.

What preprocedural interventions does the nurse implement for a child who is prescribed a cardiac catheterization? Select all that apply. 1 Assess the quality of the apical pulse. 2 Assess for any symptoms of infection. 3 Obtain history for any allergic reactions. 4 Obtain an accurate height measurement of the child. 5 Ensure nothing by mouth (NPO) 3 hours before procedure.

2,3,4 procedure may be cancelled in case of severe diaper rash if femoral access is required. A history of allergies is important to obtain, because some of the contrast agents are iodine-based. The nurse must obtain an accurate height measurement of the child to ensure correct catheter selection. Assessment of pedal pulses is important after catheterization. The nurse should therefore assess the presence and quality of pedal pulses before the procedure. The nurse must ensure that the child is NPO for 4 to 6 hours or more before the procedure.

Which medications are diuretics used in the management of heart failure? Select all that apply. 1 Digoxin 2 Furosemide 3 Chlorothiazide 4 Potassium supplements 5 Spironolactone

2,3,5 Diuretics used in the management of heart failure include furosemide (Lasix), chlorothiazide (Diuril), and spironolactone (Aldactone). Digoxin (Lanoxin) is not a diuretic. Potassium supplements are not diuretics; instead, they replace potassium lost as a result of taking potassium-depleting diuretics.

What are the differences between dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy? Select all that apply. 1 Dilated cardiomyopathy is rarely seen in the pediatric age group. 2 Hypertrophic cardiomyopathy is seen due to a mutation in the genes. 3 Restrictive cardiomyopathy is often seen in infants of diabetic mothers. 4 Restrictive cardiomyopathy is the most common cardiomyopathy in children. 5 Dilated cardiomyopathy causes greatly decreased contractility of the heart muscles. 6 Hypertrophic cardiomyopathy involves an increase in muscle mass without an increase in cavity size.

2,5,6 Hypertrophic cardiomyopathy may occur due to a mutation in the genes that encode proteins of the cardiac sarcomere. In dilated cardiomyopathy, there is ventricular dilation and a greatly reduced contractility. In hypertrophic cardiomyopathy, there is an increase in heart muscle mass without an increase in the cavity size. Restrictive cardiomyopathy is rare in children. Hypertrophic cardiomyopathy is often seen in the infants of diabetic mothers. The most common cardiomyopathy in children is dilated cardiomyopathy.

What is a priority patient outcome for a child with congestive heart failure? 1 The child will have a rapid heart rate. 2 The child will have skin that is cool to touch. 3 The child will not have distended neck veins. 4 The child will sleep with the head down and feet elevated.

3 A lack of distended neck veins is an appropriate patient outcome for a child with congestive heart failure. The child should have a heart rate that is acceptable for age rather than rapid. The skin should be warm to touch rather than cool. The child should sleep with the head elevated rather than with the head down and the feet elevated.

A child receiving antihypertensive therapy presents with a cough and angioedema. Which drug does the health care provider need to discontinue? 1 Losartan 2 Atenolol 3 Captopril 4 Amlodipine

3 Captopril is an angiotensin converting enzyme (ACE) inhibitor. Side effects include a cough and angioedema. The health care provider needs to discontinue captopril if these side effects are noticed. Angiotensin receptor blockers such as losartan may cause an increase in potassium levels. Atenolol is a beta blocker. Such drugs may cause fatigue, a decrease in exercise tolerance, weakness, and cold extremities. They can possibly cause impotence too. Amlodipine is a calcium channel blocker that may cause peripheral edema and constipation.

Why do children with persistent hypoxemia have an increased likelihood of postoperative bleeding compared to normal children? 1 Due to an increase in their plasma volume 2 Due to an increase in their number of platelets 3 Due to an increase in their red blood cell count 4 Due to an increase in their pulmonary vascular resistance

3 Persistent hypoxemia stimulates the formation of red blood cells. This leads to polycythemia, or an increase in the total red blood cell count. This, in turn, leads to anemia if iron is not readily available to form more hemoglobin. The blood viscosity increases, and the platelets and other coagulation factors tend to be crowded out. This increases the likelihood of postoperative bleeding. The red blood cell count increases without a corresponding increase in the plasma volume. Hence, the blood viscosity increases. The number of platelets is not increased. Platelets and other coagulation factors may not be able to reach the site of injury because of the increased blood viscosity. Hypoxia causes an increase in pulmonary vascular resistance leading to a decrease in pulmonary blood flow. However, this does not increase the likelihood of postoperative bleeding.

Which is the primary therapy for secondary hypertension in children? 1 A low-salt diet 2 Weight reduction 3 Treatment of the cause 4 Improved exercise and fitness

3 Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension can be resolved. Weight reduction, a low-salt diet, and improved exercise and fitness are usually effective in managing essential hypertension.

The nurse is planning care for an infant with heart failure. Which intervention does the nurse include? 1 Forcing fluids appropriate to age 2 Monitoring respirations during active periods 3 Organizing activities to permit uninterrupted sleep 4 Giving larger feedings less often to conserve energy

3 The child needs to be well-rested before feeding. The child's needs should be met to minimize crying. The nurse must organize care to decrease energy expenditure. The child in congestive heart failure has an excess of fluid, so forcing fluids is contraindicated. Monitoring of vital signs is appropriate, but minimizing energy expenditure is a priority. The child often cannot tolerate larger feedings; small, frequent feedings should be given to the child in congestive heart failure.

What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect? 1 Prone 2 Supine 3 Knee-chest 4 Low Fowler

3 The squatting position, otherwise known as the knee-chest position, decreases the amount of blood returning to the heart and allows the child time to compensate. The prone and supine positions do not offer any advantages to the child with cardiac compromise. The low Fowler position would assist with respiratory issues but not with cardiac compensation.

The nurse is reviewing the laboratory results of a child with congenital heart disease. What finding indicates that the child is at risk for coronary artery disease? 1 Total cholesterol of 160 mg/dL 2 Low density lipoprotein of 96 mg/dL 3 High density lipoprotein of 38 mg/dL 4 Non-high density lipoprotein of 112 mg/dL

3 In children, the normal value of high density lipoprotein (HDL) is over 45 mg/dL. A value of 38 mg/dL is considered to be low and indicates that the child is at risk of coronary artery disease (CAD). An increase in the values of total cholesterol (TC), low density lipoprotein (LDL), and non-HDL cholesterol puts the child at a risk of CAD. The normal value of TC is less than 170 mg/dL, the normal value of LDL is less than 110 mg/dL, and normal value of non-HDL cholesterol is less than 120 mg/dL.

The infant with cyanotic disease becomes acutely hypercyanotic during an intravenous catheter insertion. Which intervention does the nurse employ first? 1 Prepare for endotracheal intubation. 2 Administer morphine subcutaneously. 3 Place the infant in a knee-chest position. 4 Provide bag-mask ventilation with 21% FiO2.

3 The infant with cyanotic heart disease who has an acute episode of hypoxemia during a painful procedure is having a hypercyanotic spell. The immediate intervention is to place the infant in a knee-chest position which increases systemic vascular resistance thereby diverting more blood through the pulmonary artery. Bag-mask ventilation may be necessary if placing the patient in knee-chest position doesn't work, but the infant should receive 100% FiO2 by face mask because oxygen is a pulmonary vasodilator. If knee-chest position and bag-mask ventilation are unsuccessful, subcutaneous morphine can be administered. Intubation may be indicated if the other interventions are unsuccessful.

A child with heart failure is being treated with both digoxin and captopril. Which complications are likely to be due to the use of digoxin rather than captopril? Select all that apply. 1 Fever 2 Cough 3 Vomiting 4 Bradycardia 5 Hypotension 6 Allergic reactions

3,4 Bradycardia and vomiting are signs of digoxin toxicity. Though vomiting may be due to other causes as well, the nurse should confer with the primary health care provider if a child on digoxin begins vomiting. Fever is an immune-based side effect seen with the administration of captopril. Cough and hypotension are the principal side effects of angiotensin converting enzyme (ACE) inhibitors, the group of drugs to which captopril belongs. Allergic reactions are immune-based side effects common with the administration of captopril.

What is the primary reason for a newborn with congenital heart disease to be kept well-hydrated? 1 To increase the urine output 2 To normalize the blood pressure 3 To allow proper feeding of the newborn 4 To reduce the risk of cerebrovascular accidents

4 A newborn with a congenital heart disease is often cyanotic. Cyanotic infants need to be kept well-hydrated. This is done primarily to keep the hematocrit and blood viscosity within the acceptable limits and to reduce the risk of cerebrovascular accidents. Proper hydration of the newborn can increase the urine output, but this is not the primary reason to keep them well-hydrated. Parents can be alerted to detect dehydration when the urine output of the newborn is reduced. Dehydration causes hypotension. Adequate hydration can help normalize the blood pressure, but this is not the primary reason. Proper hydration does not allow for proper feeding, rather, proper feeding allows for adequate hydration.

Surgical repair for patent ductus arteriosus (PDA) is performed to prevent which complication? 1 Pulmonary infection 2 Right-to-left shunting of blood 3 Decreased workload on the heart's left side 4 A worsening of pulmonary vascular congestion

4 A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary vascular congestion may occur. Increased pulmonary vascular congestion is the primary complication; pulmonary infection may occur, but it is not the priority complication. Patent ductus arteriosus involves left-to-right shunting of blood. The decreased workload on the left side of the heart is not a priority complication of a PDA.

What clinical manifestation does the nurse expect to find during the assessment of an infant with coarctation of the aorta? 1 Bounding femoral pulses 2 Low pressure in the arms 3 Weak pulses in the arms 4 Cooler lower extremities

4 An infant with coarctation of the aorta, an obstructive defect of the heart, has cooler lower extremities due to localized narrowing near the insertion of the ductus arteriosus. This leads to decreased pressure in the lower extremities and weak or absent femoral pulses. The narrowing also causes increased pressure in the head and upper extremities and bounding pulses in the arms.

Which congenital heart defect is described as the incomplete fusion of the endocardial cushions? 1 Atrial septal defect 2 Ventricular septal defect 3 Patent ductus arteriosus 4 Atrioventricular canal defect

4 Atrioventricular canal defect is the incomplete fusion of the endocardial cushions. Atrial septal defect is abnormal opening between the atria. Ventricular septal defect is an abnormal opening between right and left ventricles. Patent ductus arteriosus is the failure of the fetal ductus arteriosus to close within the first weeks of life.

The nurse is caring for a child with a bedside cardiac monitor for electrocardiogram (ECG). Which intervention by the nurse is appropriate? 1 Change electrodes on the patient every 12 hours. 2 Assess the cardiac monitor frequently for heart sounds. 3 Ensure that the black electrode is placed on the right leg. 4 Ensure that the white electrode is on the right of the chest.

4 Electrodes for cardiac monitoring are often color coded. White electrodes are placed on the right side of the chest, above the level of the heart. The black electrode is placed on the left chest above the level of the heart, not the right leg. Electrodes should be changed every 1 or 2 days because they irritate the skin. Bedside monitors assist in patient care. However, the nurse should assess the patient and not the cardiac monitor for auscultation of heart sounds. The ground electrode is green or red and is placed on the abdomen.

In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart? 1 Echocardiography 2 Electrophysiology 3 Electrocardiography 4 Cardiac catheterization

4 In cardiac catheterization, radiopaque catheters are placed in a peripheral blood vessel and advanced into the heart as a means of measuring pressures and oxygen levels in heart chambers and visualizing heart structures and blood flow patterns. Electrocardiography involves leads placed on the patient's chest do detect how electrical signals pass through the heart. Echocardiography uses high-frequency sound waves to create a picture of the structures of the heart. Electrophysiology uses catheters within the heart to diagnose dysrhythmias.

How should the nurse administer a digitalizing dosage to a child prescribed digoxin? 1 Administer divided doses orally over 12 hours. 2 Administer the medication orally twice a day. 3 Administer the medication orally once a day. 4 Administer divided doses intravenously over 24 hours.

4 In children, digoxin (Lanoxin) is used almost exclusively because of its more rapid onset. A digitalizing dosage is administered in divided doses over 24 hours, orally or intravenously, to produce optimal cardiac effects. A maintenance dosage is administered orally twice a day to improve myocardial efficiency. The beneficial effects of this treatment are increased cardiac output, decreased heart size, decreased venous pressure, and relief of edema.

Which clinical manifestations result from pulmonary congestion in children with congestive heart failure? 1 Weight gain, cough, cyanosis 2 Fatigue, tachypnea, orthopnea 3 Restlessness, cyanosis, wheezing 4 Tachypnea, exercise intolerance, cyanosis

4 Tachypnea, exercise intolerance, and cyanosis, along with orthopnea, wheezing, and cough, are clinical manifestations of pulmonary congestion in children with congestive heart failure. Fatigue and restlessness are the result of impaired myocardial function, and weight gain is caused by systemic venous congestion.

Which is considered a mixed cardiac defect? 1 Pulmonic stenosis 2 Atrial septal defect 3 Patent ductus arteriosus 4 Transposition of the great arteries

4 Transposition of the great arteries permits mixing of oxygenated and unoxygenated blood in the heart. Pulmonic stenosis is classified as an obstructive defect. Atrial septal defect is classified as a defect with increased pulmonary blood flow. Patent ductus arteriosus is classified as a defect with increased pulmonary blood flow.

A child with heart failure has been prescribed digoxin and enalapril. How does the action of digoxin differ from that of enalapril? 1 It reduces blood pressure due to vasodilation. 2 It reduces pulmonary and systemic vascular resistance. 3 It reduces cardiac preload by preventing volume expansion. 4 It reduces cardiac afterload by improving contractility of the heart.

4 Both digoxin and angiotensin converting enzyme inhibitors (ACE inhibitors) such as enalapril enhance the myocardial function in heart failure. Digoxin does this by improving the contractility of the heart. Enalapril blocks the formation of angiotensin II, which results in vasodilation. This results in a decrease in blood pressure and a decrease in pulmonary and systemic resistance. ACE inhibitors reduce the secretion of aldosterone, which reduces preload by preventing volume expansion from fluid retention.

The nurse is assessing the chest tube drainage of a 20 kg child in the postoperative period after cardiac surgery. Which drainage, if present in the patient, would prompt the nurse to contact the provider immediately? 1 Drainage volume of 80 mL in 1 hour. 2 Serous drainage after 12 hours postsurgery. 3 Bright red drainage immediately after surgery. 4 Drainage greater than 12 mL/hr for more than 3 hours

4 Chest tube drainage greater than 3 mL/kg/hr for more than 3 consecutive hours may indicate postoperative hemorrhage. Cardiac tamponade can develop rapidly and is life threatening. Drainage volume of 5 to 10 mL/kg in any 1 hour is excessive and must be reported to the primary health care provider. The largest volume of drainage occurs in the first 12 to 24 hours. It is normal to have bright red drainage immediately after surgery that changes to serous drainage with healing.

A 5-month-old infant with Down Syndrome and a ventricular septal defect (VSD) is admitted for surgical repair of this congenital defect. The nurse works on the surgical unit; however, the nurse has not cared for a patient with a cardiac defect. What is a VSD?

Abnormal opening between the right and left ventricle

A 10-year-old with rheumatic fever is seen in the primary clinic. The parent reports the child had a sore throat and fever 3 weeks ago, but did not come to the office to be seen. The parent asks the nurse how acute rheumatic fever is treated. How should the nurse respond?

Antibiotics are administered to treat the GAS infection and salicylates (aspirin) is used to control the inflammation, reduce fever, and provide comfort. Bedrest and good nutrition.

A 3-year-old admitted with high fevers is not responding to Acetaminophen or Ibuprofen. The child is being evaluated for Kawasaki Disease. Since there is no diagnostic test for Kawasaki Disease, what are the five clinical criteria in addition to 5 days of fever that are used to establish a diagnosis for Kawasaki Disease?

Changes in extremities (red palms and soles- acute phase; peeling of hands and feet -subacute phase) Bilateral conjunctival injection without exudate Changes in oral mucosa (red lips, oropharyngeal redness, strawberry tongue) Polymorphous exanthem Cervical lymphadenopathy (1 lymph node >1.5cm), usually unilateral

A 10-year-old with rheumatic fever is seen in the primary clinic. The parent reports the child had a sore throat and fever 3 weeks ago, but did not come to the office to be seen. The parent told the nurse she thought the doctor said additional treatment may be needed. How should the nurse respond?

Children who had ARF are susceptible to recurrent infections that may result in RHD. Prophylactic treatment is required- Penicillin G is the preferred medication. It is administered IM once a month. The duration of treatment is based on how the ARF affected the child's heart.

A newborn who was born at home was transported to the ED because the baby had very cool lower extremities and the nurse midwife noted weak femoral pulses. The ED nurse obtains 4 extremity blood pressures and notes the upper extremity BPs are higher than the lower extremities. The nurse also assesses weak femoral pulses and cooler lower extremities and bounding pulses in the upper extremities. What cardiac defect should the nurse suspect?

Coarctation of the Aorta

A 5-month-old infant with Down Syndrome and a ventricular septal defect (VSD) is admitted for surgical repair of this congenital defect... What are nursing interventions for an infant requiring Digoxin?

Count apical heart rate for a full minute. Hold if HR lower than 90-110 for infants/young children; 70 for older children; adults 60. Infants rarely receive more than 1ml (50mcg or 0.05mg). Most common signs of digoxin toxicity in infants and children are bradycardia, anorexia, nausea, and vomiting.

A 5-month-old infant with Down Syndrome and a ventricular septal defect (VSD) is admitted for surgical repair of this congenital defect. . The nurse needs to administer Digoxin to this infant. What is the implication for this medication? How does it help this infant?

Digoxin improves contractility, improves cardiac function. Increased cardiac output, decreased heart size, decreased venous pressure, and relief of edema.

A 2 week old (born at 36 weeks gestation) with patent ductus arteriosus (PDA) is admitted for initial placement of a nasogastric tube to begin NG feeds due to FTT related to this congenital defect. The child's cardiac status is stable. The nurse was reassigned to work on the cardiac unit; therefore, the nurse has not cared for a patient with a cardiac defect. What is a PDA?

Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close.

A 3-year-old admitted with high fevers is not responding to Acetaminophen or Ibuprofen. The child is being evaluated for Kawasaki Disease. The patient was diagnosed with Kawasaki Disease later in the shift. What treatments should the nurse expect to be ordered?

High dose intravenous immunoglobulin (IVIG) & salicylate therapy. Monitor cardiac status (I and O, weights). Administer fluids carefully because of myocarditis. Monitor for HF (gallop, decreased urinary output, tachycardia, resp distress) IVIG is a blood product derivative- consent, frequent VS, allergic reactions Skin- cool cloths, soft/loose clothing, mouth care, clear liquids, soft foods Monitor temperature Quiet environment, respite for parents

A 3-year-old admitted with high fevers is not responding to Acetaminophen or Ibuprofen. The child is being evaluated for Kawasaki Disease. What teaching should be included when this patient is ready for discharge?

Irritable for 2 months after onset of symptoms Peeling of hands and feet in 2-3 weeks Arthritis Live vaccines not administered for 11 months (MMR, varicella)- body may not produce appropriate amount of antibodies for lifetime protection Daily temperatures- notify with fever Teach s/s of aspiring toxicity and to notify primary care provider if child is exposed to the flu or chicken pox due to Reye Syndrome. CPR because of MI risk S/S of MI in children Echos may need to be done on outpt basis if child had coronary artery changes See a cardiology for follow up

A 5-month-old infant with Down Syndrome and a ventricular septal defect (VSD) is admitted for surgical repair of this congenital defect. Due to this defect, how does this impact cardio-respiratory blood flow?

Left to right shunt caused by the flow of blood from the higher pressure left ventricle to the lower pressure right ventricle. Increased pulmonary blood flow results.

A 2 week old (born at 36 weeks gestation) with patent ductus arteriosus (PDA) is admitted for initial placement of a nasogastric tube to begin NG feeds due to FTT related to this congenital defect. The child's cardiac status is stable. Due to this defect, how does this impact cardio-respiratory blood flow?

Left to right shunt. Blood begins to shunt from the aorta across the duct to the pulmonary artery. Increased pulmonary blood flow results.

A 10-year-old with rheumatic fever is seen in the primary clinic. The parent reports the child had a sore throat and fever 3 weeks ago, but did not come to the office to be seen. Which heart valve is most commonly affected?

Mitral valve

A newborn who was born at home was transported to the ED because the baby had very cool lower extremities and the nurse midwife noted weak femoral pulses What are nursing interventions the ED nurse can implement while the baby awaits a cardiac catheterization.

Monitor VS, assess resp status, elevate HOB, administer oxygen (if ordered), weigh baby (if not done so already), strict I and O, allow the baby to rest, cluster care. Preprocedural care for cardiac cath: obtain length, allergies (perhaps ask for parental allergies since baby is so young), assess and mark pulses, obtain baseline pox, NPO status (baby will need IVF though to maintain appropriate glucose and electrolyte levels)

A newborn who was born at home was transported to the ED because the baby had very cool lower extremities and the nurse midwife noted weak femoral pulses The nurse is concerned the baby may be in heart failure. What are early signs of heart failure in infants?

Tachypnea and tachycardia at rest, diaphoresis, dyspnea, retractions, activity intolerance (especially during feedings), feeding intolerance, weight gain caused by fluid retention, and hepatomegaly. -Late signs for impaired myocardial function: pallor and duskiness -Late signs of pulmonary congestion: gasping and grunting