HESI Cardiovascular defect- PEDS
The nurse recognizes that Mrs. Rorberts' concerns are consistent with postpartum depression, as well as anxiety related to Keith's illness. How can the nurse communicate physical assessment findings in a therapeutic manner for this mother?
"It's difficult to cope with the loss of the robust baby you anticipated. However, I can see that your baby is well cared for." This statement acknowledges her grief and gives an empowering message by validating her caring skills.
When assessing the client, which subjective and objective data support the client's diagnosis of decreased cardiac output related to cardiac output?
-Pale, cool extremities -Increased heart size on x-ray -Hypotension Decreased cardiac output results in poor circulation to the extremities. Chest x-rays reveal cardiomeagly which is caused by fluid overload on the right heart. Systemic circulation is deceased and results in hypotension.
Keith is successfully digitalized and is starting on a maintenance dose of digoxin (Lanoxin). The maintenance does for Keith is 10 mcg/kg daily. He weighs 11.02 lbs (5 kg). The dose on hand is an elixir of 0.05mg/mL. How many mL will the nurse administer?
1.0
The nurse provides instruction to Mrs. Roberts regarding administration of digoxin (Lanoxin) to 3-month old Keith. The mother is advised not to give the digoxin (Lanoxin) if the pulse is below what rate?
90 bpm The cut off for infants is 90 to 110 bpm. However, if the pulse is significantly lower than the previous rate, the digoxin (Lanoxin) may also need to be held.
Which explanation provides an accurate but nonthreatening description of the cardiac catheterization procedure?
A small catheter will be guided through the skin to the heart. Films will be taken to allow the physician to determine the best way to treat your baby. The terms "small" and "guided" are accurate but nonthreatening. The message also stresses healing.
Keith's parents are anxious about surgery. Which psychological instruction should the nurse provide to the parents?
A tour of the Pediatric Intensive Care Unit. The tour should include pointing out comforting aspects of the environment.
The nurse wishes to further allay parental anxiety. The nurse explains healing interventions and the parents' role in care. The nurse explains measures that will be implemented to improve Keith's cardiac function. Which is the most important intervention for the nurse to implement?
Administering Digoxin and catopril Digoxin is an inotropic drug that increases the strength of the cardiac contraction. Captopril is an angio-tension inhibitor that reduces afterload on the heart.
The nurse includes parents in care by providing them with accurate information about the basic pathophysiology of VSD. Which explanation by the nurse is most accurate about VSD?
An opening in the heart chambers allows blood from the left heart to flow to the right heart and to the pulmonary artery, thus more blood flows to the lungs. VSD causes shunting of blood from the left ventricle to the right since the left side of the heart has higher pressures. Increased blood flows into the lungs causing increased pulmonary resistance.
The nurse observes bleeding at the catheter insertion site. It is essential for the nurse to take which action?
Apply continuous pressure an inch above the percutaneous skin site. The catheter enters the vein about an inch above the skin puncture site. Pressure applied here will stop the bleed.
Oral feedings are to be initiated. The nurse develops a feeding care plan. Essential elements to include in the nutritional plan of care for Keith include which of the following?
Limit feedings to 20 mins Infants with cardiac disease are exercise intolerant. Feeding is equivalent to exercise in infancy. Feeding time is limited to conserve energy.
Keith is stabilized and is prepared for cardiac catheterization. He returns to the unit following a right sided catheterization via the right femoral vein. Which postcatheterization nursing care takes priority?
Conduct neurovascular assessments of the lower extremities Coolness, lack of pulse, or blanching may indicate vascular obstruction. Both extremities are assessed as a basis for comparison.
The nurse wishes to reduce cardiac demands on Keith's heart. Which is the most appropriate measure to incorporate in the client's plan of care?
Consolidate nursing care to allow for rest periods. Infants with cardiac defects fatigue easily. Nursing care should be consolidated to allow sufficient periods of uninterrupted rest.
In addition to treating the hypoxia, what additional benefit is there to the administration of oxygen to this client?
Decreased pulmonary vascular resistance Oxygen is a vasodilator, thus it decreases pulmonary vascular resistance, which, in turn, will reduce the workload on the heart.
Which are the most common assessment findings in the immediate postoperative period following VSD repair?
Dysrhythmis and conduction disorders Dysthrythms are common after cardiac surgery. Right bundle branch block is common after VSD repair due to direct injury or suturing in the intraventricular septum.
The nurse determines that Keith has an alteration of pulmonary function based on exercise intolerance (fatigue during feeding) and which of the following signs?
Intercostal retractions Retractions are observed in heart failure, especially in infants
Initially a digitalizing dose of 20 mcg/kg is ordered by mouth every 12 hours over 24 hours. What measures must the nurse implement to assure client safety?
Monitor for dysrhythmias via ECG monitor Digoxin (Lanoxin) must be monitored to observe for a prolonged PR interval and slower heart rate which are desired effects as well as dysthrthmias which are adverse effects.
The HCP prescribes catopril (Capoten) 1.5 mg by mouth. It is most important for the nurse to implement which intervention?
Monitor the blood pressure This drug is a vasodilator and the intended effect is to lower blood pressure.
Keith had chest tubes inserted during surgery. The nurse observed that over the last 4 hours the chest tubes drained 25 mLs of bloody drainage. Which priority action should the nurse take?
Notify the HCP immediately The amount of drainage exceeds 3 mL/kg/hr and is an indication of possible hemorrhage.
The nurse is late for Keith's 0800 feeding. She hears him cry and enters the room to find him cyanotic with a respiratory rate of 70. What immediate action should the nurse take?
Place in knee-chest position and give morphine This is a hypercyanotic or Tet spell caused by infundibular spasm. They are often seen in the morning or when the child is acutely stressed. Treatment also includes 100% O2.
The nurse observes that Mrs. Roberts becomes hypervigilant and often mentions that the baby is fragile. Which concepts in anticipatory guidance need to be introduce by the nurse?
Promoting independence and consistent limit setting This mother is at risk for maladaptive parenting. She needs to be counseled to treat the infant normally. Infants with cardiac disease are at risk for developmental delays. Mrs. Roberts needs guidance to promote normal development.
How should the nurse interpret these findings?
Respiratory acidosis and hypoxemia The client has pulmonary hypertension as evidenced by the prominent pulmonary arteries seen on an x-ray. This finding is often associated with respiratory acidosis and hypoxia.
The nurse monitors Keith's blood pressure. Readings are 110/65 mmHg. Which nursing intervention is most important during the postoperative period?
Report the findings to the HCP
The nurse provides Mrs. Roberts with an explanation of heart failure for infants with structural heart defect. Which is the best explanation the nurse could provide about heart failure in infants?
There is increased pressure in the right heart caused by the septal opening. Until the hole is patched during surgery, the heart does not beat effectively. This causes congestion in the lung and venous circulation. The term failure is frequently interpreted by parents as a fatal diagnosis. It is critical to provide accurate information and stress healing measures.
The nurse auscultates Keith's lungs and hears a loud holosystolic murmur at the base of the left sternal border. The nurse recognizes this murmur is associated with which congenital heart defect?
Ventricular septal defect This murmur is characteristic of ventricular septal defect.
Which findings support the nurse's initial observation that Keith has an alteration of cardiac function?
Weak peripheral pulses Infants with congenital defects often have heart failure. Peripheral pulses are weak due to inability of the heart to pump adequately.
