Ch. 41 Cardio

A 5-year-old child has undergone a cardiac catheterization and is being prepared for discharge home with the parents. The nurse is teaching the parents how to care for the child at home. The nurse determines that the teaching is successful based on which statement(s) by the parents? Select all that apply. "After several days, we do not need to keep any dressing on the site." "If we notice any drainage or bleeding at the site, we will call the health care provider." "Once our child is home, we do not need to check the temperature anymore." "Our child should not shower for about a week after the procedure." "If our child has pain, we can give acetaminophen or ibuprofen."

"After several days, we do not need to keep any dressing on the site." "If we notice any drainage or bleeding at the site, we will call the health care provider." "If our child has pain, we can give acetaminophen or ibuprofen." Explanation: After a cardiac catheterization, the parents should change the pressure dressing on the day after the procedure and then apply a dry sterile dressing or adhesive bandage for the next several days. They should also inspect the insertion site for redness, irritation, swelling, drainage, and bleeding and report any of these to the health care provider. In addition, the parents should check the child's temperature at least once a day for approximately 3 days after the procedure and report any temperature elevation of 100.4ºF (38ºC) or greater. Tub baths are avoided for approximately 3 days after the procedure. Acetaminophen or ibuprofen may be used for reports of pain. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TEACHING GUIDELINES 41.1 Providing Care After a Cardiac Catheterization, p. 1472.

A group of nurses is reviewing the cardiovascular system and its function. Which statement by one of the nurses demonstrates an understanding of a child's cardiovascular system? "At birth, the infant's right and left ventricle are about the same size." "Between the ages of 5 and 6, the child's left ventricle grows to about two times the size of the right." "The heart rate of the child decreases whenever the child experiences a fever." "The child's heart doesn't mature and function like an adult's until between 8 and 10 years of age."

"At birth, the infant's right and left ventricle are about the same size." Explanation: At birth, both the right and left ventricles are about the same size, but by a few months of age, the left ventricle is about two times the size of the right. If the infant has a fever, respiratory distress, or any increased need for oxygen, the pulse rate goes up to increase the cardiac output. Although the size of the heart is smaller, by the time the child is 5 years old, the heart has matured, developed, and functions just as the adult's heart. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Structural and Functional Differences, p. 1461.

The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse? "We have standardized care plans for children with congenital heart defects and this nursing diagnosis is on the care plan." "Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." "The heart is a pump and it isn't pumping effectively." "It is a difficult process to understand. Rest assured that we are doing everything in your child's best interest."

"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." Explanation: This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1467

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? "This disorder is caused by genetic factors." "Children who have this diagnosis may have had strep throat." "Being up-to-date on immunizations is the best way to prevent this disorder." "The onset and progression of this disorder is rapid."

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1464

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is mostaccurate regarding the diagnosis of rheumatic fever? "This disorder is caused by genetic factors." "Children who have this diagnosis may have had strep throat." "Being up-to-date on immunizations is the best way to prevent this disorder." "The onset and progression of this disorder is rapid."

"Children who have this diagnosis may have had strep throat." Explanation: Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TABLE 41.1 Examples of Questions for Obtaining a Child's Health History, p. 1464.

The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply. "I should plan to have vegetables with each evening meal served." "Adding fresh fruits to my child's lunch is a good idea." "Cooking with palm oil will be helpful." "I need to limit fat intake in meals to 40%." "My child loves chicken and I can still serve it but I need to remove the skin."

"I should plan to have vegetables with each evening meal served." "Adding fresh fruits to my child's lunch is a good idea." "My child loves chicken and I can still serve it but I need to remove the skin." Explanation: Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Dyslipidemia, p. 1499.

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond? "Are you sure you are making nutrient-dense foods?" "Maybe your child doesn't really like the foods your making. This could lead to not gaining sufficient weight." "It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." "It's hard to get your child to eat enough at this age to maintain their weight since they are expending so much energy with the heart condition."

"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning the parents as to whether they are making nutritious foods or foods preferred by the child does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1468

The parents of a 5-year-old child with a cardiovascular disorder tell the nurse they don't understand why their child isn't gaining weight, "We make sure our child has 3 very nutritious meals every day." How should the nurse respond? "Are you sure you are making nutrient-dense foods?" "Maybe your child doesn't really like the foods your making. This could lead to not gaining sufficient weight." "It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." "It's hard to get your child to eat enough at this age to maintain their weight since they are expending so much energy with the heart condition."

"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain." Explanation: Small, frequent feedings will reduce the amount of energy required to feed or eat and prevents overtiring the child. Questioning the parents as to whether they are making nutritious foods or foods preferred by the child does not address the issue of energy expenditure when eating 3 larger meals per day. Just stating that it is "hard to get your child to eat enough" also does not address the situation. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1468

When educating the family of an infant with a small, asymptomatic atrial septal defect (ASD), what information would be included in the education? "Surgery is usually performed in the first two months of life for this." "Most infants do not need surgical repair for this." "The medication indomethacin is used to try to close the hole." "The medication prostaglandin E1 is used to try to close the hole."

"Most infants do not need surgical repair for this." Explanation: Most infants do not need surgical repair for an ASD unless they are symptomatic. The hole will close spontaneously 87% of the time. The medication indomethacin is used to help close the opening of a PDA, and the medication prostaglandin E1 is used to keep a patent ductus arteriosus (PDA) open. These medications are not used for ASDs. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Atrial Septal Defect, p. 1478.

A child will be undergoing a Holter monitor test. Which statement by the parent indicates the need for further instruction? "Wearing a snug shirt the day of the test will be helpful." "My child cannot have any thing to eat or drink after midnight the day of the test." "This test will monitor my child for about 24 hours." "We do not need to alter our activities during the testing period."

"My child cannot have any thing to eat or drink after midnight the day of the test." Explanation: Ambulatory electrocardiographic monitoring (Holter) testing is an exam that spans approximately 24 hours. The test is done to review the activity of the heart. The child is encouraged to follow one's normal activities during the test. There is no need for the child to be NPO prior to or during the test. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 41.1, p. 1466.

A nurse is taking the history of a 4-year-old child who will undergo a cardiac catheterization. Which statement by the parent may necessitate rescheduling of the procedure? "My child seems listless and slightly warm." "My child is allergic to iodine and shellfish." "My child tells me about headaches because of being scared and nervous about the procedure." "My child kept scratching the chest, so I applied hydrocortisone cream to stop the itching."

"My child seems listless and slightly warm." Explanation: Fever and other signs and symptoms of infection may necessitate rescheduling the procedure. Although information about allergies is important, not all contrast media contain iodine as a base. The nurse should assess the head pain and the child's fears in a developmentally appropriate way, but fear of the procedure does not warrant rescheduling. The report of itching on the child's chest should be evaluated and reported to the health care provider but does not necessarily warrant cancellation of the procedure unless determined that it is a sign of a viral infection. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Cardiac Catheterization, p. 1471.

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching? "The feeling of the heart skipping a beat is common." "We need to avoid a tub bath for the next 3 days." "Strenuous activity should be limited for the next 3 days." "We need to watch for changes in skin color or difficulty breathing."

"The feeling of the heart skipping a beat is common." Explanation: Reports of heart "fluttering" or "skipping a beat" should be reported to the doctor as this can be a sign of a complication. The tub bath statement is appropriate because tub baths should be avoided for about 3 days. The strenuous activity statement is appropriate because strenuous activity is limited for about 3 days. Changes in skin color or difficulty breathing indicate potential complications that need to be reported. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1472

The parents of a 2-year-old toddler newly diagnosed with tricuspid atresia ask the nurse, "I do not understand why our toddler's fingertips are spread out and rounder than normal fingertips?" Which response by the nurse is best? "The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." "Increased cardiac workload from your toddler's heart defect affects various parts of the body, including the fingers." "The number of red blood cells has significantly increased from the heart defect, resulting in the cells pooling in the fingertips." "This is a common complication of tricuspid atresia. Unfortunately, there is nothing we can do to treat it."

"The low blood oxygen levels from the heart defect causes the lack of oxygen to the fingers, causing these changes." Explanation: Clubbing (which is what the parents are describing) of fingertips or toes can occur from the chronic hypoxia that occurs with disorders with decreased pulmonary blood flow, such as tricuspid atresia. Using the term "low oxygen levels in the blood" rather than "chronic hypoxia" is a better way to explain to the parents what is happening with their child. Clubbing is not the result of increased cardiac workload. Red blood cell pooling is not the cause of clubbing. Although clubbing is a possible result of tricuspid atresia, telling the parents this is a "common complication" does not address the parent's concerns. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1464

The nurse is caring for a 7-year-old who is being discharged following surgery with a Gore® Helex device to repair an atrial septal defect. The parents of the child demonstrate understanding of the procedure with which statements? Select all that apply. "Our child will be so excited to get back to soccer league in a few days." "We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "It's wonderful that our child will never have an abnormal heart rhythm again." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed."

"We will be sure to not allow our child to ride a bicycle for at least 2 weeks." "We will be sure to monitor our child for any signs of infection and notify the doctor if we notice any." "We know how important our child's medications are so we will write out a schedule to be sure medications are taken as prescribed." Explanation: With the Gore® Helex device, strenuous activity should be avoided for 2 weeks after the procedure, so neither soccer or bicycle riding would be allowed. Children should be monitored for the possible presence of atrial arrhythmias (lifelong) after surgical closure for the defect. Infection is a complication that must be monitored for and reported to the physician, and medications must be given as prescribed. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1474

An 8-year-old child is scheduled for an exercise stress test. Which instruction would be most important for the nurse to emphasize? "You need to report any symptoms you are having during the test." "You need to lie very still during this test." "You'll have to wear the monitor for 24 hours." "You get some medicine that will make you sleepy."

"You need to report any symptoms you are having during the test." Explanation: It is important for the child to report any symptoms felt during the test to help quantify the child's exercise tolerance. Exercise stress testing involves activity. Ambulatory electrocardiographic monitoring is performed over 24 hours. Sedation is not used for an exercise stress test. It is used for an arteriogram. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1466

The nurse is caring for a pediatric client diagnosed with tetralogy of Fallot. After speaking with the physician, the parents state to the nurse, "The doctor said something about our child having too many red blood cells. We don't understand how that could happen?" What is the best response by the nurse? "The doctor was talking about polycythemia. It's common with this type of heart disorder." "It is a very complicated process. Since your child has tetralogy of Fallot, their body is overtaxed with everything it does. The amount of red blood cells being produced is just one more thing the heart has to deal with." "Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." "I'm not really sure what red blood cells have to do with the heart defect your child has. We should ask your doctor."

"Your child's body is trying to compensate for the low blood oxygen levels from the heart defect by making more red blood cells, but this makes the heart actually work harder." Explanation: To compensate for low blood oxygen levels, the kidneys produce the hormone erythropoietin to stimulate the bone marrow to produce more red blood cells (RBCs). This increase in RBCs is called polycythemia. Polycythemia can lead to an increase in blood volume and possibly blood viscosity, further taxing the workload of the heart. The correct response is the clearest and easiest description for the parents to understand. Telling the parents the doctor was discussing polycythemia with them doesn't answer their question. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1475

A nurse is examining a 10-year-old girl who has a heart murmur. On auscultation, the nurse finds that the murmur occurs only during systole, is short, and sounds soft and musical. When she has the girl stand, she can no longer hear the murmur on auscultation. Which statement should the nurse make to the girl's mother in response to these findings? "Your daughter has an innocent heart murmur, which is nothing to worry about." "Your daughter has a functional heart murmur; I recommend that you limit her physical activity so that her heart rate is not elevated for long periods of time." "Your daughter has an organic heart murmur, which indicates that she has some degree of heart disease. The doctor will provide a referral to a good cardiologist." Not say anything, as the girl has an insignificant heart murmur and there is no reason to alarm the mother or her.

"Your daughter has an innocent heart murmur, which is nothing to worry about." Explanation: The symptoms described indicate an innocent heart murmur. Although innocent murmurs are of no consequence, parents need to be told when their child has one because this finding will undoubtedly be discovered again at a future health assessment or during a febrile illness, anxiety, or pregnancy. Activities need not be restricted when a child has an innocent murmur and the child requires no more frequent health appraisals than other children. If a murmur is present as the result of heart disease or a congenital disorder, it is an organic heart murmur. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1465.

What meds are given for infective endocarditis?

-Amoxicillin. azithromycin, clindomycin, (Cillin family) -Heart failure meds

Rheumatic fever is caused by what bacteria?

-Autoimmune -Group A strep

Ventricular dysfunction is caused by what disorders?

-Cardiomyopathy -Endocarditis -MI -Arrythmia -HIV -Sepsis

What disorders are cyanotic?

-Decreased pulm blood flows (Due to obstruction, pressure in R side builds up and becomes greater than L side of heart). -Tetralogy of Fallot and tricuspid atresia

What disorders are acyantic?

-Increased pulm blood flow ( PDA, atrial septal defect (ASD), ventricular septal defect (VSD) and atrioventricular canal defect) -Obstructive disorders (Coarctation of aorta, aortic stenosis, pulmonary stenosis)

Infective carditis s/s?

-Low grade fever -Edema if heart failure occurs -Petechiae on palpebral conjunctiva -Extracardiac emboli -Roth spots -Janeway lesions -Osler nodes -Black lines

Rheumatic fever manifestations?

-Low grade fever -sore throat -rash -arthritis

Coarctation of the aorta?

-Narrowing of the aorta -Needs prostaglandin to keep duct. art. open and if not then no perfusion to the lower extremities will happen -Hypercyanotic spells

Which disoders need prostaglandin to keep the ductus arteriosus open?

-Tricuspid atresia -Pulmonary atresia -Coarctation of the aorta -Hypoplastic L heart syndrome

3 categories that define heart failure?

-Ventricular dysfunction -Volume overload -Pressure overload

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? 60 beats per minute 80 beats per minute 100 beats per minute 150 beats per minute

100 beats per minute Explanation: Digoxin is a cardiac glycoside that works by increasing the contractility of the heart muscle. It decreases conduction and increases the force of the heart beat. The result is a slowing of the heart rate. An 8-month-old infant has a normal range of heart rate of 80 to 150 beats per minute while awake and resting, and 80 to 130 beats per minute while sleeping. The accepted practice for this age child is to withhold the digoxin if the heart rate is 90 beats per minute or less. It would be safe to administer the drug if the heart rate is 100 beats per minute. If the child has a heart rate of 150 beats per minute, further assessment should be made prior to administering the drug. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1469

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant? 60 beats per minute 80 beats per minute 100 beats per minute 150 beats per minute

100 beats per minute Explanation: Digoxin is a cardiac glycoside that works by increasing the contractility of the heart muscle. It decreases conduction and increases the force of the heart beat. The result is a slowing of the heart rate. An 8-month-old infant has a normal range of heart rate of 80 to 150 beats per minute while awake and resting, and 80 to 130 beats per minute while sleeping. The accepted practice for this age child is to withhold the digoxin if the heart rate is 90 beats per minute or less. It would be safe to administer the drug if the heart rate is 100 beats per minute. If the child has a heart rate of 150 beats per minute, further assessment should be made prior to administering the drug. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469.

The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy? 80 to 90/40 to 64 mm Hg 80 to 100/64 to 80 mm Hg 94 to 112/56 to 60 mm Hg 100 to 120/70 to 80 mm Hg

100 to 120/70 to 80 mm Hg Explanation: The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschool-age child's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-age child's blood pressure averages 100 to 120/60 to 75 mm Hg. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Structural and Functional Differences, pp. 1461-1462.

Ductus arteriosus closes in how many days?

5 days, if not then monitor for a year and if not then give indomethacin or ibuprofen or motrin

The nurse is assessing the blood pressure of a toddler. Which finding would the nurse document as a normal finding? 90/64 mm Hg 80/40 mm Hg 100/60 mm Hg 110/60 mm Hg

90/64 mm Hg Explanation: The toddler or preschool-age child's blood pressure averages 80 to 100/64 mm Hg. The normal infant's blood pressure is about 80/40 mm Hg. The school-age child's blood pressure averages 94 to 112/56 mm Hg. An adolescent's blood pressure averages 100 to 120/50 to 70 mm Hg. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Structural and Functional Differences, p. 1462.

Which nursing diagnosis would best apply to a child with rheumatic fever? Ineffective breathing pattern related to cardiomegaly Activity intolerance related to inability of heart to sustain extra workload Disturbed sleep pattern related to hyperexcitability Risk for self-directed violence related to development of cerebral anoxia

Activity intolerance related to inability of heart to sustain extra workload Explanation: Acute rheumatic fever affects the joints, central nervous system, skin, and soft tissue. It causes chronic, progressive damage to the heart and valves. Children with rheumatic fever need to reduce activity to relieve stress on the heart and joints during the course of the illness. Rheumatic fever does not produce cardiomegaly nor does it interfere with respirations or the ability to oxygenate the body. Children with rheumatic fever may develop chorea. These movements are involuntary and are not related to hyperexcitability. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, p. 1495.

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply. Administer furosemide. Initiate intravenous access. Apply oxygen via oxyhood. Feed a high-calorie formula. Begin indomethacin infusion.

Administer furosemide. Initiate intravenous access. Apply oxygen via oxyhood. Begin indomethacin infusion. Explanation: When a newborn with patent ductus arteriosus shows signs of significant blood flow to lungs (retractions, crackles, tachypnea, and hypoxia), nursing actions will focus on applying oxygen to improve oxygenation and decrease work of breathing. Nursing interventions also include reducing cardiac workload and pulmonary flow by initiating intravenous access to administer a diuretic to reduce extra fluid and indomethacin to cause closure of the PDA and stop increased pulmonary blood flow. Feeding the infant is not a priority at this time as aspiration may result from the inability to coordinate sucking and swallowing with increased work of breathing. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Patent Ductus Arteriosus, p. 1481.

The nurse is caring for a child with aortic stenosis. Which health care provider prescription(s) will the nurse question? Select all that apply. Obtain echocardiogram. Apply a cardiac monitor. Administer indomethacin. Prepare for balloon dilation. Give prostaglandin E1 (PGE1).

Administer indomethacin. Give prostaglandin E1 (PGE1). Explanation: Interventions for a child with aortic stenosis include applying a cardiac monitor, obtaining an echocardiogram, and preparing for balloon dilation to relieve the stenosis. Indomethacin is an nonsteroidal anti-inflammatory drug (NSAID) given to cause closure of a patent ductus arteriosus. A child should already have closure of the ductus arteriosus; therefore, the nurse should question this prescription. Prostaglandin E1 (PGE1) is given to maintain patency of the ductus arteriosus. A PGE1 infusion could keep the ductus arteriosus open to allow blood to get to the body in a newborn with severe aortic stenosis. A child should already have closure of the ductus arteriosus; therefore, the nurse should question this prescription. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1470.

Lasix inhibits reabsorption of Na+ causing loss of what medications?

Anticoagulants (Heparin, aspirin, lovenox)

The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first? Contact the health care provider. Apply appropriate oxygen device. Prepare for balloon angioplasty. Assess blood pressure in all extremities.

Assess blood pressure in all extremities. Explanation: An infant with decreased pulse strength in the lower extremities may have coarctation of the aorta. Assessing blood pressures in all extremities is most helpful in assisting the nurse with gathering assessment data prior to contacting the health care provider. The nurse does not have enough information to apply oxygen at this time or prepare the newborn for balloon angioplasty. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1482

Coarctation of the aorta demonstrates few symptoms in newborns. What is an important assessment to make on all newborns to help reveal this condition? Observing for excessive crying Assessing for the presence of femoral pulses Recording an upper extremity blood pressure Auscultating for a cardiac murmur

Assessing for the presence of femoral pulses Explanation: Coarctation of the aorta is a defect where there is narrowing of the aorta, which is the largest vessel carrying oxygenated blood to the body. As a result of this narrowing, blood flow is impeded causing pressure to increase in the area proximal to the defect and decrease distal to the defect. As a result, the blood pressure will be higher in the upper part of the body and decreased in the lower part of the body. The pulses will be full or bounding in the upper part of the body and weak or absent in the lower part of the body. When assessing an infant with coarctation there may be weak or absent femoral pulses. There will also be differences in the blood pressure readings. These infants may or may not have a murmur and will be no more fussy than other babies. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Coarctation of the Aorta, p. 1482.

Atrial septal defect is when what part is not infused?

Atrial septal not fusing during embyonic development and should fix itself spontaneously but if not within 5 years then sx is needed

A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection? Avoid drawing a blood specimen from the right femoral vein before the procedure Keep the child NPO for 2 to 4 hours before the procedure Record pedal pulses Apply EMLA cream to the catheter insertion site

Avoid drawing a blood specimen from the right femoral vein before the procedure Explanation: Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1463

What information would be included in the care plan of an infant in heart failure? Encourage larger, less frequent feedings. Begin formulas with increased calories. Maintain child in the supine position. Administer digoxin even if the infant is vomiting.

Begin formulas with increased calories. Explanation: Infants with heart failure need increased calories for growth. The infants are typically given smaller, more frequent feedings to decrease the amount given and to help conserve energy for feeding. They often are given a higher-calorie formula. The infant should be placed in an upright position or in a car seat to increase oxygenation. The infant should not have any pressure on the diaphragm while in this position. Vomiting is a sign of digoxin toxicity and this should be considered before administering. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1493.

VSD (ventricular septal defect) med for heart failure?

Cardioglycosides (Digoxin), diurectics (loop such as furomeside), betablockers (propanolol, atenolol, sotalol), ACE inhibitors

The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl. Child B with a total cholesterol level of 175 mg/dl and LDL of 105 mg/dl. Child C with a total cholesterol level of 190 mg/dl and LDL of 125 mg/dl. Child D with a total cholesterol level of 220 mg/dl and LDL of 138 mg/dl.

Child A with a total cholesterol of 150 mg/dl and low-density lipoprotein (LDL) of 80 mg/dl. Explanation: Total cholesterol levels below 170 mg/dl and LDL levels less than 100 mg/dl are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dl and LDL levels between 100 and 129 mg/dl are considered borderline. Total cholesterol levels between 170 and 199 mg/dl and LDL levels between 100 and 129 mg/dl are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dl and LDL levels greater than or equal to 130 mg/dl are considered elevated and place this child at greatest risk. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1499

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed? Digoxin term-38 Alprostadil Furosemide Indomethacin

Digoxin Explanation: Digoxin is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force. Alprostadil is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects. Furosemide is used for the management of edema associated with heart failure. Indomethacin is used to close a patent ductus arteriosus. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1469

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting? Feeding problems Bradypnea Bradycardia Yellowish color

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. In a child with CHF, tachypnea would be seen, not bradypnea. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1491

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which signs or symptoms would the infant most likely be exhibiting? Feeding problems Bradypnea Bradycardia Yellowish color

Feeding problems Explanation: The indications of CHF vary in children of different ages. Signs in the infant may be hard to detect because they are subtle, but in infants, feeding problems are often seen. In infants and older children, tachycardia is one of the first signs of CHF. In a child with CHF, tachypnea would be seen, not bradypnea. The heart beats faster in an attempt to increase blood flow. Failure to gain weight, weakness, and an enlarged liver and heart are other possible indicators of CHF but are not as common as tachycardia and may take longer to develop. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1491.

While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first? Advise the mother to bottle feed. Give furosemide intravenously. Administer acetaminophen rectally. Apply oxygen 10 liters/min (LPM) via oxyhood.

Give furosemide intravenously. Explanation: The nurse's first action when a neonate with a cardiac disorder is experiencing signs of fluid overload but has a normal oxygen saturation is to administer a diuretic such as furosemide. Oxygen could be applied if the furosemide was not effective in reducing fluid overload or if the oxygen saturation was low. This will remove fluid from the lungs, allowing the infant to breathe more easily. Although the neonate has an elevated temperature, administration of acetaminophen does not take priority over breathing. If the neonate continues to show signs of pulmonary overload, the nurse could advise the mother to give expressed breast milk through a bottle or nasogastric tube. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469.

The nurse is performing echocardiography on a newborn who is suspected of having a congenital heart defect. The child's mother is concerned about the safety of using this on a newborn and wants to know how this technology works. The nurse assures her that this technology is very safe and may be repeated frequently without added risk. What should the nurse mention in explaining how this diagnostic test works? High-frequency sound waves are directed toward the heart X-rays are directed toward the heart A radioactive substance is injected intravenously into the bloodstream and is traced and recorded on video A microphone is placed on the child's chest to record heart sounds and translate them into electrical energy

High-frequency sound waves are directed toward the heart Explanation: Echocardiography, or ultrasound cardiography, has become the primary diagnostic test for congenital heart disease. An echocardiogram involves high-frequency sound waves, directed toward the heart, being used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers; thickness of walls; relationship of major vessels to chambers; and the thickness, motion, and pressure gradients of valves. You can remind parents that echocardiography does not use x-rays so it can be repeated at frequent intervals without exposing their child to the possible risk of radiation. The other answers refer to other types of diagnostic tests, including X-ray studies, radioangiocardiography, and phonocardiography. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1477

On assessment immediately following cardiac surgery, which condition would the nurse expect to find in an infant? Hypothermia Hypovolemia Hypertension Hyperexcitability

Hypothermia Explanation: Cardiac surgery is often performed under hypothermia to decrease the child's oxygen needs during surgery. The postoperative care nurse should assess the infant's vital signs continuously via monitoring. The temperature should be assessed at least once per hour until an optimal temperature is achieved. The infant would have received IV fluids during surgery so hypovolemia should not be the primary concern. The infant will be sleepy from anesthesia, not hyperexcited. Hypertension, if any, has been monitored throughout the surgery and controlled. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Surgical Procedure and Postoperative Therapeutic Management, p. 1500.

The nurse is educating an adolescent female at risk for hypertension. Which interventions will the nurse recommend? Select all that apply. Begin a beta-blocker. Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight.

Increase hours of sleep. Avoid any smoking. Exercise on a daily basis. Maintain a healthy weight. Explanation: Increasing the hours of sleep, daily exercise, avoiding smoking, and maintaining a healthy weight are all recommended interventions to prevent hypertension in the adolescent. An adolescent at risk for hypertension would not need a beta-blocker. Medication would be used for an adolescent with hypertension that did not improve after less invasive interventions. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1497

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply? Ineffective airway clearance related to altered pulmonary status Ineffective tissue perfusion related to inefficiency of the heart as a pump Impaired gas exchange related to a right-to-left shunt Impaired skin integrity related to poor peripheral circulation

Ineffective tissue perfusion related to inefficiency of the heart as a pump Explanation: A ventricular septal defect permits blood to flow across an opening between the right and left ventricles. It results in increased pulmonary blood flow, but it does not cause cyanosis. The blood in the left ventricle, which flows back into the right ventricle, is already oxygenated. Anytime there is an opening between the heart's ventricles, the heart is not as effective as a pump because the pressure gradients are changed. A ventricular septal defect will not cause respiratory problems or problems with peripheral circulation. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Ventricular Septal Defect, p. 1479.

The nurse is caring for child who present to the emergency department with reports of a fever for 5 days. The nurse notes a diffuse maculopapular rash, reddened cracked lips, erythema of hands, and bilateral conjunctivitis and suspects Kawasaki disease. Which nursing action is priority? Place the child on a soft diet. Initiate intravenous access. Administer acetaminophen. Assess cervical lymph nodes.

Initiate intravenous access. Explanation: A child with signs of Kawasaki disease is at risk for dehydration due to a prolonged fever and oral pain. The priority for the nurse is to establish intravenous access to begin IV fluids. Placing the child on a soft diet will be done after ensuring IV access. Pain is not a priority, and children with Kawasaki disease are given aspirin because of the anti-inflammatory properties of aspirin, instead of acetaminophen. Because the child already has the required four signs of Kawasaki disease, assessing cervical lymph nodes is minimally helpful and could be performed later. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Kawasaki Disease, p. 1498.

A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother? Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing No treatment is necessary, as the defect will resolve spontaneously Insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization Surgical closure by ductal ligation

Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing Explanation: Balloon angioplasty by way of cardiac catheterization is the initial procedure for aortic stenosis. With this procedure, a catheter with an uninflated balloon at its tip is inserted and passed through the heart into the stenosed area. As the balloon is inflated, it breaks any adhesions and opens the area. The other answers refer to interventions related to patent ductus arteriosus, not aortic stenosis. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1474

What does ibuprofen or indomethacin do?

Keep ductus arteriosus open

What does prostaglandin (alprostadil) do?

Keep ductus arteriosus open

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention? Elevate the head of the bed. Notify the doctor immediately. Administer epinephrine. Observe vitals every two hours.

Notify the doctor immediately. Explanation: The nurse would notify the doctor immediately. Cardiac tamponade is a medical emergency and should be addressed. The child can die if intervention is postponed. It would not be appropriate to perform any interventions until confirming that this is the actual diagnosis. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1490

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see? Peeling hands and feet; fever Decreased heart rate and impalpable pulse Irritability and dry mucous membranes Low blood pressure and decreased heart rate

Peeling hands and feet; fever Explanation: Kawasaki disease is an acute systemic vasculitis. Symptoms begin with very high fevers. One of the signs of Kawasaki disease is the peeling hands and feet and in perineal region. The child is usually tachycardic and laboratory values would indicate increased platelets and decreased hemoglobin. Another classic sign of Kawasaki is the strawberry tongue. The other symptoms are not necessarily characteristic of Kawasaki disease. The child should be evaluated if there are impalpable pulses because this could indicate a heart defect or some other serious illness. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1498

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority? Place the child in a knee-to-chest position. Use a calm, comforting approach. Provide supplemental oxygen. Administer morphine as prescribed.

Place the child in a knee-to-chest position. Explanation: The priority nursing action is to place the child in a knee-to-chest position. Once the child has been placed in this position, the nurse should provide supplemental oxygen or administer medication as prescribed. A calm, comforting approach should be used but is not the priority action. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1487

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority? Place the infant in the knee-chest position. Start an IV for fluids. Prepare the infant for surgery. Raise the head of the bed.

Place the infant in the knee-chest position. Explanation: Placing the infant in the knee-chest position is the first priority when caring for an infant with tetralogy of Fallot. Starting IV fluids and preparing the child for surgery would not be necessary since it is known that the infant has a cyanotic birth defect. Raising the head of the bed would not be a priority since the infant needs to be placed in the knee-chest position. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1477

When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover? Leukopenia Polycythemia Increased platelet level Anemia

Polycythemia Explanation: Tetralogy of Fallot is a congenital heart defect causing decreased pulmonary blood flow. This causes mild to severe oxygen desaturation. To compensate for the low blood oxygenation the kidneys produce erythropoietin to stimulate the bone marrow to make more red blood cells (RBCs). The increased amount of RBCs is known as polycythemia. This increased blood volume causes more workload on the heart. It also does not increase the amount of blood reaching the lungs so the child remains desaturated. Leukopenia, increased platelets, and anemia are not associated with tetralogy of Fallot.

Tetralogy of Fallot anomolies?

Pulmonic stenosis, R ventricular hypertrophy, overriding aorta and VSD

A parent brings an infant in for poor feeding and listlessness. Which assessment data would most likely indicate a coarctation of the aorta? Pulses weaker in lower extremities compared to upper extremities Pulses weaker in upper extremities compared to lower extremities Cyanosis with crying Cyanosis with feeding

Pulses weaker in lower extremities compared to upper extremities Explanation: With coarctation of the aorta there is a narrowing causing the blood flow to be impeded. This produces increased pressure in the areas proximal to the narrowing and a decrease in pressures distal to the narrowing. Thus, the infant would have decreased systemic circulation. The upper half of the body would have an increased B/P and be well perfused with strong pulses. The lower half of the body would have decreased B/P with poorer perfusion and weaker pulses. Coarctation is not a cyanotic defect. The cyanosis would be associated with tetralogy of Fallot. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1482

Key signs of heart failure?

Tachycardia, tachypnea, increased work of breathing, shortness of breath, edema

A school nurse finds a 10-year-old's blood pressure is over the 95th percentile. The nurse advises the parent to seek medical attention for the child. What outcome would the nurse expect? The child will probably need surgery. The child will need the blood pressure checked two more times. Advise the child go to the emergency room. This is a normal result for a child this age.

The child will need the blood pressure checked two more times. Explanation: The child will need the blood pressure checked two more times. It is routine to check the blood pressure on three separate occasions to get the most accurate analysis of the blood pressure. The child usually does not need surgery or need to go to the emergency room. This is not a normal result in a blood pressure finding. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1496

The child has returned to the nurse's unit following a cardiac catheterization. The insertion site is located at the right groin. Peripheral pulses were easily palpated in bilateral lower extremities prior to the procedure. Which finding should be reported to the child's physician? Select all that apply. The right groin is soft without edema. The child's right foot is cool with a pulse assessed only with the use of a Doppler. The child has a temperature of 102.4° F (39.1° C). The child is reporting nausea. The child has a runny nose.

The child's right foot is cool with a pulse assessed only with the use of a Doppler. The child has a temperature of 102.4° F (39.1° C). The child is reporting nausea. Explanation: The following information should be reported to the physician following a cardiac catheterization because they are indicative of possible complications: Negative changes to the child's peripheral vascular circulatory status (cool foot with poor pulse), a fever over 100.4° F (37.8° C), and nausea or vomiting. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, TEACHING GUIDELINES 41.1 Providing Care After a Cardiac Catheterization, p. 1472.

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding? The liver size increases due to cardiac medications. The spleen size increases due to frequent infection. The liver size increases in right-sided heart failure. The spleen size increases due to increased destruction of red blood cells.

The liver size increases in right-sided heart failure. Explanation: The liver increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure. The spleen is in the upper left quadrant of the abdomen and would increase in size under certain circumstances, but this is asking for the upper right quadrant information. There are certain medications that can affect the liver, but this would not be the most likely reason for hepatomegaly. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1491

A nurse is caring for an infant who just had open-heart surgery and the parents are asking why there are wires coming out of the infant's chest. What is the best response by the nurse? These wires are connected to the heart and will detect if your infant's heart gets out of rhythm. The wires are measuring the fluid level in the heart. The wires are left in the heart for 1 month after surgery in case of potential arrhythmias. The wires will administer ongoing electrical shocks to the heart to maintain rhythm.

These wires are connected to the heart and will detect if your infant's heart gets out of rhythm. Explanation: Following cardiac repair there is always a possibility of arrhythmias. The wires are placed and connected to an external pacemaker. This is done as a preventive measure and can be used if an arrhythmia occurs. Once it is felt the child is in no danger of an arrhythmia, the wires are removed. There is no set time period in which this occurs. The wires do not deliver ongoing electrical shocks to maintain rhythm. This would be done by a permanent pacemaker implanted under the skin. There is no measurement of fluid in the heart by wires. Any measurements would need to be performed by echocardiogram or cardiac catheterization. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON MEDICAL TREATMENTS 41.1, p. 1469.

Parents are told their infant has a hypoplastic left heart. How would the nurse explain this condition to the family? This is a problem where the right side of the heart did not develop properly. This is a problem where the left side of the heart did not develop properly. There are no surgeries that can help the child live with this heart defect. The infant will have immediate surgery to completely correct the heart defect.

This is a problem where the left side of the heart did not develop properly. Explanation: This is a problem where the left side of the heart did not develop properly. There is a three-step palliative surgery that can be implemented or the child will need a heart transplant. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1486-1487

A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education? Your child may need multiple surgeries to correct this defect. An IV for fluids will be started immediately. This is caused by an opening that usually closes by 1 week of age. This type of defect is caused by having a genetic predisposition for it.

This is caused by an opening that usually closes by 1 week of age. Explanation: A PDA is caused by an opening called the ductus arteriosus. A PDA usually closes by 1 week of age. If it does not close, the defect is usually fixed by a single surgery or during a cardiac catheterization procedure. IV fluids are not a routine intervention for the PDA. Most of the time a PDA occurs in premature infants. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1481

A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation? This is due to the lack of oxygen to the brain. This is due to a decreased amount of oxygen to the peripheral tissue. This is a sign of heart failure. This is considered a medical emergency and the infant needs immediate surgery.

This is due to a decreased amount of oxygen to the peripheral tissue. Explanation: Cyanosis associated with certain congenital heart defects is due to the body naturally compensating and decreasing the amount of oxygen to the peripheral tissue. This keeps the oxygen with the vital organs to sustain life. The lack of oxygen is not in the brain; it is in the systemic flow of the body. Cyanosis is a common finding with these types of heart defects and, in general, does not usually need immediate surgery nor is it a sign of heart failure. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1463

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent? This test will check how blood is flowing through the heart. This noninvasive test will check the electrical impulses in the heart. This test will only determine the size of the heart. This invasive test will measure the blockage in the heart.

This test will check how blood is flowing through the heart. Explanation: An echocardiogram (echo) is a noninvasive ultrasound used to assess the heart wall thickness, the size of the heart chambers, the motion of the valves and septa, and the relationship of the great vessels to other cardiac structures. The test evaluates how blood is flowing through the heart and how effective the heart is in pumping. An echo does not check the electrical impulses. This would be done with an electrocardiogram. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 41.1, p. 1466.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy, the process of digitalization is done for which reason? To decrease the pain to a tolerable level To increase the heart rate To establish a maintenance dose of the drug To build the blood levels to a therapeutic level

To build the blood levels to a therapeutic level Explanation: The use of large doses of digoxin at the beginning of therapy, administered to build up the blood levels of the drug to a therapeutic level, is known as digitalization. A maintenance dose is given, usually daily, after digitalization. Digoxin is used to improve the cardiac efficiency by slowing the heart rate and strengthening the cardiac contractility. Digoxin is not indicated for relief of pain. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, DRUG GUIDE 41.1, p. 1469.

Volume overload is seen in what congenital cardio disorders?

VSD, PDA, ASD

Does the ductus arterisus need to be open for pulmonary atresia?

Yes, give prostaglandins until sx is done

Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot? surgical site infection risk acute parental anxiety fluid overload risk altered cardiopulmonary tissue perfusion risk

altered cardiopulmonary tissue perfusion risk Explanation: Nursing priority following cardiac surgery will focus on assessing for ineffective cardiopulmonary tissue perfusion. Monitoring for excess fluid volume, infection, and parental anxiety will be performed after ensuring cardiopulmonary tissue perfusion is adequate. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1475.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? appropriate mastery of developmental milestones bounding pulse preference to resting on the right side pitting periorbital edema

bounding pulse Explanation: A bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. Narrow or thready pulses may occur in children with heart failure or severe aortic stenosis. A normal pulse would not be expected with aortic regurgitation. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1465.

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the: procedure is noninvasive and not frightening for children. child will return with a pressure dressing over the catheter insertion area. child will require a general anesthetic and needs to be prepared for this. child will have to remain NPO for 6 to 8 hours after the procedure to prevent vomiting.

child will return with a pressure dressing over the catheter insertion area. Explanation: Cardiac catheterization is typically performed with the child awake but using moderate sedation. Only under unusual circumstances will the child need general anesthesia. At the completion of the procedure a pressure dressing will be placed over the catheter insertion site. This is to prevent bleeding. The nurse will monitor this dressing every 15 minutes for the first hour and then every 30 minutes for the second hour. A cardiac catheterization is an invasive procedure and any procedure is frightening to children, especially if their parents are not with them. After the child is fully awake from the procedure the diet can resume. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1471

The nurse is collecting data on a child being evaluated for rheumatic fever. The caregiver reports that over the past several weeks the child seems to have lack of coordination, facial grimaces and repetitive involuntary movements. Based on these symptoms the nurse would suspect what condition? chorea carditis arthralgia polyarthritis

chorea Explanation: Rheumatic fever affects the heart, the central nervous system, skin and subcutaneous tissue. It causes carditis, arthritis, and chorea. Chorea is a disorder characterized by emotional instability, purposeless movements, and muscular weakness. The onset of chorea is gradual, with increasing incoordination, facial grimaces, and repetitive involuntary movements. Polyarthritis means there is arthritis in multiple joints which is common in rheumatic fever, but this is not a symptom of chorea. Arthralgia is a very common symptom of rheumatic fever. It is pain in the joints but again not a symptom of chorea. The heart muscle is affected in rheumatic fever as are the valves but not included in the symptoms of chorea. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, pp. 1494-1495.

When caring for a child who has just had a cardiac catheterization, what is a sign of hypotension? cold, clammy skin and increased heart rate decreased heart rate and dizziness syncope and tachypnea diaphoresis and tachycardia

cold, clammy skin and increased heart rate Explanation: Cold, clammy skin; increased heart rate; and dizziness are signs of hypotension that may be a complication after a cardiac catheterization. Decreased heart rate, syncope, and tachypnea would also be very concerning, but not necessarily a sign of hypotension. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1492.

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: femoral pulse weaker than brachial pulse. bounding pulse. narrow pulse. hepatomegaly.

femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1482

After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: femoral pulse weaker than brachial pulse. bounding pulse. narrow pulse. hepatomegaly.

femoral pulse weaker than brachial pulse. Explanation: A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1482

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? heart failure infective endocarditis cardiomyopathy Kawasaki Disease

heart failure Explanation: Infective endocarditis would present with intermittent, unexplained low-grade fever, fatigue, anorexia, weight loss, or flu-like symptoms. Characteristics of cardiomyopathy include respiratory distress, fatigue, poor growth (dilated), chest pain, dizziness, and syncope. Abdominal pain, joint pain, fever, and irritability are signs of Kawasaki disease. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1491

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child? lower extremities face presacral region hands

lower extremities Explanation: Edema of the lower extremities is characteristic of right ventricular heart failure in older children. In infants, peripheral edema occurs first in the face, then the presacral region, and the extremities. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Nursing Process Overview for the Child with an Alteration in Perfusion/ Cardiovascular Disorder, p. 1464.

The health care provider suspects an infant may have a ventricular septal defect. The parents ask the nurse what diagnostic tests the infant will need to have to determine this diagnosis. For what test(s) should the nurse provide education to the family? Select all that apply. magnetic resonance imaging (MRI) echocardiogram computed tomography (CT) cardiac catheterization stress test

magnetic resonance imaging (MRI) echocardiogram cardiac catheterization Explanation: A ventricular septal defect (VSD) is an abnormal opening between the right and left ventricles. An MRI or echocardiogram with color-flow Doppler may reveal the opening as well as the extent of left-to-right shunting. These studies also may identify right ventricular hypertrophy and dilation of the pulmonary artery resulting from the increased blood flow. Cardiac catheterization may be used to evaluate the extent of blood flow being pumped to the pulmonary circulation and to evaluate hemodynamic pressures. Neither a CT nor stress test are used in the diagnosis of the VSD. A chest x-ray may also be used to determine if there is an enlargement of the heart. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Ventricular Septal Defect, p. 1480.

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers? nonsterioidal anti-inflammatory drugs (NSAIDs) antiviral insulin phenytoin

nonsterioidal anti-inflammatory drugs (NSAIDs) Explanation: Medications used in the treatment of rheumatic fever include penicillin, NSAIDs, and corticosteroids. Insulin would be given for diabetes and phenytoin for seizure disorders. Antivirals are not relevant to the treatment of a bacterial infection. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Acute Rheumatic Fever, p. 1495.

When developing a teaching plan for the parents of a child diagnosed with tricuspid atresia, the nurse would integrate knowledge of what factor as the major mechanism involved? obstruction of blood flow to the lungs increased pulmonary blood flow narrowing of the major vessel mixing of well-oxygenated and poorly oxygenated blood

obstruction of blood flow to the lungs Explanation: Tricuspid atresia is a congenital heart defect in which the valve between the right atrium and right ventricle fails to develop, resulting in no opening to allow blood to flow from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs. It is classified as a disorder of decreased pulmonary blood flow due to obstruction of blood flow to the lungs. Defects with connections involving the left and right sides, such as atrial or ventricular septal defects, will shunt blood from the higher-pressure left side to the lower-pressure right side and subsequently more blood will go to the lungs. A narrowed major vessel leads to an obstructive defect, interfering with the ability of the blood to flow freely through the vessel. Mixed defects such as transposition of the great vessels involve the mixing of well-oxygenated with poorly oxygenated blood, leading to a systemic blood flow that contains a lower oxygen content. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tricuspid Atresia, p. 1477.

What would be the most important measure to implement for an infant who develops heart failure? restricting milk intake daily planning ways to reduce salt intake placing the infant in a semi-Fowler position keeping the infant supine and playing quiet games

placing the infant in a semi-Fowler position Explanation: Placing an infant with heart failure in a semi-Fowler position reduces the pressure of the abdominal contents against the chest and allows for better lung expansion. Keeping the infant supine would cause more pressure on the heart and lungs and increase the work of the heart and lungs. Infants with heart disease need calories to grow. They are given formula or breast milk which is fortified with extra nutrients. Thus the infant can have an intake of the same amount of fluid but receive extra nutrients. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Heart Failure, p. 1493.

3 types of pulmonic stenosis?

subvalvular, valvular or supravalvular

A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? coarctation of aorta tetralogy of Fallot pulmonary stenosis aortic stenosis

tetralogy of Fallot Explanation: Tetralogy of Fallot is associated with cyanosis. The defects include ventricular septal defect (VSD), right ventricular hypertrophy, right outflow obstruction, and overriding aorta. Coarctation of aorta, pulmonary stenosis, and aortic stenosis are acyanotic heart diseases and are not associated with cyanosis. Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder, Tetralogy of Fallot, p. 1475.

After a cardiac catheterization, the nurse monitors the child's fluid balance closely based on the understanding that: the contrast material used has a diuretic effect. blood loss during the procedure can be significant. the insertion of the catheter into the heart stimulates a diuretic response. the prolonged preprocedure fasting state places the child at risk for dehydration.

the contrast material used has a diuretic effect. Explanation: The contrast material has a diuretic effect so the nurse assesses the child closely for signs and symptoms of dehydration and hypovolemia. Although blood loss can occur, this is not the reason for monitoring the child's fluid balance. Catheter insertion into the heart does not initiate a diuretic response. Typically, food and fluid is withheld for 4 to 6 hours before the procedure. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1471

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply. tiring easily when eating shortness of breath when playing crackles on lung auscultation bradycardia hypertension

tiring easily when eating shortness of breath when playing crackles on lung auscultation Explanation: Manifestations of heart failure include difficulty feeding or eating, becoming tired easily when feeding or eating, shortness of breath with exercise intolerance, crackles and wheezes on lung auscultation, tachycardia, and hypotension. Chapter 41: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder - Page 1491