Chapter 41: Cardiac Disorders in Children

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse? "It will determine if the heart is enlarged." "It will determine disturbances in heart conduction." "It will show if blood is being shunted." "This image will clarify the structures within the heart."

"It will determine if the heart is enlarged."

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? "We can stop the penicillin when her symptoms disappear." "If she needs dental surgery, we might need additional medication." "She needs to take the drug for the full 14 days." "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear."

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? "We can stop the penicillin when her symptoms disappear." "If she needs dental surgery, we might need additional medication." "She needs to take the drug for the full 14 days." "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."

"We can stop the penicillin when her symptoms disappear."

S/S of Kawasaki Disease

- strawberry tongue - dry fissured lips

S/S if Digoxin Toxicity

-N and V -lethargy -bradycardia

s/s of CHF in children

-failure to gain weight - fatigue - weak - restless - irritable pale, mottled skin

Therapeutic Range for Digoxin

0.8-2

Normal BP for a 13 yr old

100 to 120/70 to 80 mm Hg

____________ is indicated for temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects.

Alprostadil

___________would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects.

Alprostadil

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

Assessing for the presence of femoral pulses

A disorder involving increased pulmonary blood flow

Atrial Septal Defect

Right ventricular heave, fixed split second heart sound and systolic ejection murmur are found with what cardiac disorder?

Atrial Septal Defect

The nurse is caring for a 3-month-old infant with history of congenital heart disease. The infant is brought to the emergency department with nausea and vomiting for 3 days. Admission laboratory results confirm dehydration. The nurse realizes that the dehydrated infant is at risk for:

CVA

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?

Chorea- jerky movements of the face and upper extemeties

With ___________ ___ ___ _______ 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.

Coarctation of the Aorta

The nurse is assessing the heart rate of a 6-month-old infant and determines it to be 82 beats/min. What action should the nurse take first? Conduct a focused cardiovascular assessment. Reassess the heart rate in 5 minutes. Report the finding to the health care provider. Obtain a health history from the parent.

Conduct a focused cardiovascular assessment.

coaractation

Congenital narrowing of short section of aorta

________ is indicated for atrial fibrillation. It increases the contractility of the heart muscle by decreasing conduction and increasing force.

Digoxin

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.

S/S Ventricular Septal Defect

Holosystolic Harsh Murmur along the left sternal border

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? Right ventricular heave Holosystolic harsh murmur along the left sternal border Fixed split-second heart sound Systolic ejection murmur

Holosystolic harsh murmur along the left sternal border

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe?

IVIG Acetaminophen Aspirin

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia? Increased WBC Increased RBC Decreased WBC Decreased RBC

Increased RBC

The medication ______________ is used to close a patent ductus arteriosus.

Indomethacin

________________ __________ is an acute systemic vasculitis. It is the most common form of acquired heart disease in children. The treatment is directed to reduce the inflammation in the walls of the coronary arteries and prevent thrombosis.

Kawasaki disease

What kind of pulse is associated with aortic stenosis

Narrowed pulse pressure

A nurse is administering digoxin to a 3-year-old child. What would be a reason to hold the dose of digoxin?

Nausea and Vomiting

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 DR IMMEDIATELY

A harsh, continuous machine like murmur under the left clavicle is seen with what cardiac disorder?

Patent ductus arteriosus

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

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

What is a sign of extracardiac emboli?

Roth Spots

Roth Spots

Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. D

A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor? Erythrocyte sedimentation rate Oxygen saturation level Serum sodium level Serum potassium level

Serum potassium level

A child with transposition of the great vessels will have?

Significant cyanosis without presence of a murmur

Atrial septal defects in children most likely resolve without treatment. t or f

TRUE

A nursing instructor is preparing for a class about the structural and functional differences in the cardiovascular system of infants and children as compared to adults. What would the instructor include in the class discussion?

The heart's apex is higher in the chest in children younger than the age of 7 years.

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 liver size increases in right-sided heart failure. The spleen size increases due to increased destruction of red blood cells. The spleen size increases due to frequent infection.

The liver size increases in right-sided heart failure.

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.

S/S of coarctation of aorta

Weak lower extremities pulse + low B/P high upper extremities pulse + High B/P

When caring for a child with Kawasaki disease, the nurse would know that: a. management includes administration of aspirin and IVIG. b. joint pain is a permanent problem. c. antibiotics should be administered every 8 hours by IV. d. steroid creams are used for the hand peeling.

a. management includes administration of high dose aspirin and IVIG.

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

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

b. cold, clammy skin and increased heart rate

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? a. "The onset and progression of this disorder is rapid." b. "Being up-to-date on immunizations is the best way to prevent this disorder." c. "Children who have this diagnosis may have had strep throat." d. "This disorder is caused by genetic factors."

c. "Children who have this diagnosis may have had strep throat."

Abrupt cessation of chest output accompanied by an increase in heart rate and filling pressure is indicative of _________ ___________.

cardiac tamponade

When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the:

child will return with a pressure dressing over the catheter insertion area

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.

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.

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 cardiomyopathy Kawasaki Disease infective endocarditis

heart failure

Chorea

lack of coordination, facial grimaces and repetitive involuntary movements

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

A newborn is diagnosed with tetralogy of Fallot. When explaining this condition to the mother, which defect would the nurse's description include? overriding of the aorta left ventricular hypertrophy stenosis of the aorta atrial septal defect

overriding of the aorta

The nurse is caring for an 8-month-old infant with a suspected congenital heart defect. The nurse examines the child and documents which expected finding? steady weight gain since birth softening of the nail beds appropriate mastery of developmental milestones intact rooting reflex

softening of the nail beds

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

tetralogy of Fallot

Holosystolic harsh murmur along the left sternal border are seen with what cardiac disorder?

ventricular septal defect