RNSG 2201 Care of Children and Family Evolve Ch 27

What does the nurse teach the parents who are concerned and fearful of their child's bluish color?

"The child has cyanosis associated with a lack of oxygen." (The nurse teaches the parents that the child has a bluish color because of reduced oxygen saturation. This condition, called cyanosis, occurs when blood has deoxygenated hemoglobin at a concentration of 5g/dL or more. Despite a near-normal partial pressure of oxygen, patients with polycythemia have a high concentration of deoxygenated hemoglobin, and may appear cyanotic. In cyanotic children, fluid restriction can cause dehydration and increase the risks of cerebrovascular accidents. The nurse must reassure the parents that the bluish color of the skin or mucous membrane does not imply a lack of oxygen to the brain.)

A nurse is caring for a fragile infant with a serious congenital heart disease. What does the nurse teach the mother about feeding the infant?

Allow 30 minutes to complete a feeding. (The nurse should teach the mother to give the infant about 30 minutes to complete a feeding. This is considered a reasonable feeding time. A 3-hour feeding schedule works well for most infants. Feeding every 2 hours does not provide enough rest between feeds. If the infant is fed every 4 hours, an increased volume of feeding will be needed, which many infants may not be able to tolerate. Prolonging the feeding time to 45 minutes can exhaust the infant and decrease the resting period between feeds.)

A nurse is caring for an infant with heart failure. What is the best intervention for decreasing the cardiac demand of the infant?

Allow the infant to have uninterrupted periods of sleep. (It is essential to ensure uninterrupted periods of sleep and minimize unnecessary stress in the infant. This can help decrease the cardiac demand. The nurse administers prescribed antibiotics to combat respiratory tract infections, because they can exacerbate heart failure. Humidified supplemental oxygen and positioning the infant properly can help in reducing any respiratory distress.)

Which heart defect causes narrowing of the aortic valve?

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

Which congenital heart defect is described as the incomplete fusion of the endocardial cushions?

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

A child receiving antihypertensive therapy presents with a cough and angioedema. Which drug does the health care provider need to discontinue?

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

Which is the priority nursing intervention for reducing the risk for perfusion problems after cardiac catheterization?

Checking the pulses distal to the catheterization site (Monitoring the pulses distal to the catheterization site helps reduce the chance of perfusion problems after cardiac catheterization. Resuming a regular diet, using acetaminophen or ibuprofen for pain, and monitoring the site for redness, swelling, drainage, bleeding, temperature, and color are appropriate nursing interventions but will not reduce the chance of perfusion problems after cardiac catheterization.)

A nurse is assessing an infant with a suspected cardiac anomaly. Which manifestation indicates the infant has chronic tissue hypoxemia?

Clubbing (All of these are signs of hypoxemia. However, only clubbing occurs due to chronic tissue hypoxemia and polycythemia. Cyanosis occurs even with mild hypoxemia and increases when the hypoxemia becomes severe. Diminished pulses and gasping respirations are signs of poor perfusion. They occur due to severe hypoxemia and tissue hypoxia rather than chronic tissue hypoxemia.)

What clinical manifestation does the nurse expect to find during the assessment of an infant with coarctation of the aorta?

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

Why do children with persistent hypoxemia have an increased likelihood of postoperative bleeding compared to normal children?

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

The nurse is caring for a child with Kawasaki disease (KD). Which intervention performed at the time of diagnosis does the nurse refer to for evaluating long-term complications?

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

Which postoperative care does the nurse include for a child immediately after surgery?

Ensure the child is warm immediately after surgery. (Hypothermia is expected immediately after surgery from hypothermia procedures, effects of anesthesia, and loss of body heat to the cool environment. The operating room is kept fairly cold, and this adds to the hypothermia. During this period, the child is kept warm to prevent additional heat loss. Heart rate and respirations are counted for 1 full minute, compared with the electrocardiogram monitor, and recorded with activity. The heart rate is normally increased after surgery. The lungs are auscultated for breath sounds hourly. Diminished or absent sounds need further assessment. Fluids are restricted during the immediate postoperative period. This is done to prevent hypervolemia, which places additional demands on the myocardium, predisposing the child to cardiac failure.)

Which medications are diuretics used in the management of heart failure? Select all that apply.

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

The nurse is reviewing the laboratory results of a child with congenital heart disease. What finding indicates that the child is at risk for coronary artery disease?

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

Both coarctation of the aorta and Kawasaki disease are cardiovascular dysfunctions seen in infants. How is coarctation of the aorta different from Kawasaki disease?

It is a congenital heart disease. (Coarctation of the aorta is a congenital heart disease found in infants. It is characterized by an obstruction of blood flow from the left ventricle. Kawasaki disease is not a congenital heart disease. It is an acute vasculitis occurring in infants or children with normal cardiac structure. Without treatment, some children develop cardiac sequelae. It is a self-limiting disease that resolves by itself in 6 to 8 weeks.)

A child with heart failure has been prescribed digoxin and enalapril. How does the action of digoxin differ from that of enalapril?

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

What does the nurse do when the digoxin dose of a child is missed?

Keep the child on the same medication schedule. (There is a very narrow margin of safety between therapeutic, toxic, and lethal doses of digoxin. The nurse keeps the child on the same medication schedule when a single dose of digoxin is missed. The dose should not be increased. Doubling the dose may cause digoxin toxicity. If more than two consecutive doses have been missed, the primary health care provider must be notified.)

A nurse is caring for a child who has just undergone cardiac catheterization. Which interventions does the nurse implement? Select all that apply.

Keep the site clean and dry. Administer acetaminophen or ibuprofen to relieve the child's pain. Assess pulses, temperature, and color of extremities. Remove the pressure dressing the day after catheterization and cover the site with an adhesive bandage. (Nursing care after cardiac catheterization includes removing the pressure dressing the day after catheterization and covering the site with an adhesive bandage. It is also important to keep the site clean and dry. Administering acetaminophen or ibuprofen for pain is important. Assessing the pulses, temperature, and color of extremities are some of the most important nursing responsibilities in decreasing the risk of complications. Ambulation is not encouraged until after a period of time in which the leg is kept straight to ensure clotting and prevent complications.)

The nurse is caring for a child with heart failure. What teaching does the nurse give to the parents of the child about reducing the workload on the child's heart while hospitalized?

Medication may be used to sedate the child. (The nurse should teach the parents about minimizing the metabolic needs of the child and lessening the workload on the heart. An irritable or crying child has a greater demand for oxygen, which increases cardiac demands. Nurses may use medication to sedate the child. Parents should not play with the child too often, because this increases cardiac demands. The child should be allowed to rest as much as possible, without any external or environmental stimuli. The child should be placed in a semi-Fowler position to reduce the effort of breathing. The child should have a neutral thermal environment to prevent cold stress.)

A child has undergone a cardiac catheterization procedure. Which nursing intervention should the nurse employ during the immediate postcatheterization phase?

Monitor both oral and intravenous fluid intake. (The child is at risk for hypovolemia and dehydration due to blood loss in the catheterization laboratory, preprocedure nothing by mouth (NPO) status, and the diuretic action of the contrast media used during the procedure. Hence, the nurse should monitor both the oral and the intravenous fluid intake of the child. Vital signs need to be monitored every 15 minutes during the immediate postcatheterization phase. Especially, the heart rate needs to be carefully assessed for evidence of dysrhythmias and bradycardia. If the dressing is bloody, the nurse should reinforce the dressing. The pressure dressing is removed on the day after the catheterization. The affected extremity is not kept elevated. It is maintained straight for 4 to 6 hours after venous catheterization and for 6 to 8 hours after arterial catheterization to facilitate healing of the cannulated vessel.)

Which nursing interventions are most important when the nurse is managing the care for a child with Kawasaki disease? Select all that apply.

Monitor temperature carefully. Check the patency of the intravenous line. (Kawasaki disease (KD) is an acute systemic vasculitis. It is important to monitor the child's temperature carefully because fever reflects ongoing inflammation, which may indicate the need for further treatment. Intravenous immunoglobulin (IVIG) is administered to improve ventricular function. The nurse should check the patency of the intravenous line, because extravasation can result in tissue damage. If the child develops arthritis, passive range-of-motion exercises may be advised. If the body temperature is very high, acetaminophen is given along with high doses of aspirin. Although children with KD may be partially dehydrated, fluids need to be administered with utmost care due to the usual finding of myocarditis.)

The infant with cyanotic disease becomes acutely hypercyanotic during an intravenous catheter insertion. Which intervention does the nurse employ first?

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

Which intervention should the nurse take when obtaining a blood pressure measurement for a child with systemic hypertension?

Quiet the child when the blood pressure is recorded. (The nurse must quiet the child to obtain an accurate blood pressure reading and to avoid false readings caused by excitement. Initial evaluation of the child should include pressure at the four extremities, with the child in the supine position, to rule out coarctation of the aorta. Falsely elevated blood pressure readings can be avoided by using properly fitted cuffs. Blood pressure should be measured with the arm at the level of the heart for accuracy.)

Which clinical manifestations result from pulmonary congestion in children with congestive heart failure?

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

How is an electrocardiography (ECG) test different from cardiac magnetic resonance imaging (MRI)? Select all that apply.

The ECG involves the placement of leads on the skin. The ECG provides information about electrolyte imbalances. (An electrocardiography (ECG) test involves the placement of leads, or electrodes, on the skin. These transmit the electrical impulses generated by the heart into a recording machine. It can provide information about electrolyte imbalances and their impact on heart rate and rhythm. Both ECG and cardiac magnetic resonance imaging (MRI) are noninvasive. An ECG requires no anesthesia. Infants and young children can be made to stay still during an ECG by resting them in a parent's lap during the procedure. Children under the age of 7 often require anesthesia during an MRI test. An ECG test does not involve high-frequency sound waves. It measures the electrical activity of the heart and records it on a graph paper.)

After cardiac catheterization of a child, which assessment finding is most concerning to the nurse?

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

Which is considered a mixed cardiac defect?

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

What is the primary reason for a newborn with congenital heart disease to be kept well-hydrated?

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

Which is the primary therapy for secondary hypertension in children?

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

Before discharge, what teaching does the nurse give to the parents of a child who has been implanted with a pacemaker? Select all that apply.

Understand the settings of the pacemaker inserted. Learn cardiopulmonary resuscitation (CPR). Ensure that the child wears a Medic-Alert device. (Parents need to know the settings of the pacemaker to be able to detect possible problems with it. Parents should learn CPR in case it is needed during an emergency. They should ensure that the child wears a Medic-Alert device in case of an emergency. Parents and the child, if old enough, are taught to take a pulse, not a blood pressure measurement. Parents should have a paper identification card with specific pacer data in case of an emergency.)