ATI Chapter 20: Cardiovascular Disorders

Most reliable diagnostic test for rheumatic fever?

Blood antistreptolysin O titer: Elevated or rising titer, most reliable diagnostic test

Manifestations of hypoxemia

Cyanosis, poor weight gain, tachypnea, dyspnea, clubbing, polycythemia

What is the Jones Criteria?

The diagnosis of rheumatic fever. presence of two major criteria or the presence of one major and two minor criteria following an acute infection with GABHS infection. Major criteria Carditis Subcutaneous nodules Polyarthritis Rash (erythema marginatum) Chorea Minor criteria Fever Arthralgia

Labs for rheumatic fever?

Throat culture for GABHS: currently recommend screening all school-aged children who have sore throats Blood antistreptolysin O titer: Elevated or rising titer, most reliable diagnostic test C-reactive protein (CRP): Elevated in response to an inflammatory reaction Erythrocyte sedimentation rate: Elevated in response to an inflammatory reaction

Manifestations of anaphylaxis:

Urticaria, periorbital or perioral angioedema, stridor, bronchospasm

A nurse is caring for a school-aged child who has heart failure. The nurse has assessed the child and found the clinical manifestations listed below. Sort the clinical manifestations into the systems category in which they belong. Categorize manifestations as myocardial, pulmonary, or vascular. A) Tachycardia B) Retractions C) Ascites D) Pallor E) Tachypnea F) Heptomegaly G) Weak pulses H) Orthopnea I) Weight Gain J) Nasal flaring

Myocardial - pallor, weak pulses, tachycardia Pulmonary retractions, tachypnea, orthopnea, nasal flaring Vascular hepatomegaly, weight gain, ascites The child who has congestive heart failure has impaired myocardial function which manifests as sweating, tachycardia, fatigue, pallor, cool extremities with weak pulses, hypotension, gallop rhythm, and cardiomegaly. Heart failure also causes pulmonary congestion manifested by tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, and exercise intolerance. As cardiac output decreases blood begins to pool in the vascular space leading to systemic venous congestion. Manifestations of systemic venous congestion include hepatomegaly, peripheral edema, ascites, neck vein distention, periorbital edema, and weight gain. NCLEX Connection: Physiological Adaptation, Alterations in Body Systems

What is rheumatic fever?

Rheumatic fever is an inflammatory disease that occurs as a reaction to Group A beta-hemolytic streptococcus (GABHS) infection of the throat.

When does rheumatic fever occur?

Rheumatic fever usually occurs within 2 to 6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS.

S/S of rheumatic fever?

- Hx of recent upper respiratory infection - Fever - Tachycardia - cardiomegaly - new or changed heart murmur, - muffled heart sounds - pericardial friction rub - chest pain - Nontender, subcutaneous nodules over bony prominence Large joints (knees, elbows, ankles, wrists, shoulders) with painful swelling, indicating polyarthritis. ​​​​​​​Findings can be present for a few days and then disappear without treatment, frequently returning in another joint.​​​​​​​ - Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly, indicating erythema marginatum - CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor activities; labile emotions; and random, uncoordinated movements of the extremities​​​​​​​ - Irritability, poor concentration, and behavioral problems

Diagnostic for rheumatic fever?

1. Radiography (chest x-ray) To assess for cardiomegaly. 2. Cardiac function ECG to reveal the presence of conduction disturbances and to evaluate the function of the heart and valves. Echocardiography to document pericardial effusions. ​​​​​​​ 3. Jones criteria The child should demonstrate the presence of two major criteria or the presence of one major and two minor criteria following an acute infection with GABHS infection.

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? (SATA) A) Weak femoral pulses B) Cool Skin of lower extemities C) Severe cyanosis D) Clubbing of the fingers E) Decreased blood pressure in lower extremities

A, B, E When recognizing cues while assessing an infant who has coarctation of the aorta, the nurse should expect the infant to have weak femoral pulses, cool skin on the lower extremities, and decreased blood pressure in the lower extremities. These clinical manifestations are caused by narrowing of the lumen of the aorta which causes and obstruction of blood flow from the ventricle.

A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? Select all that apply. A Erythema marginatum (rash) B Continuous joint pain of the fingers C Tender, subcutaneous nodules D Decreased erythrocyte sedimentation rate E Elevated C-reactive protein

Answer) A, E When recognizing cues while caring for the child who is suspected of having rheumatic fever, the nurse should expect to find an erythema marginatum (rash) and an elevated C-reactive protein. B) A client who has rheumatic fever exhibits migratory joint pain of the large joints, not continuous joint pain of the fingers. C) A client who has rheumatic fever exhibits nontender subcutaneous nodules of bony prominences, not tender subcutaneous nodules. D) Rheumatic fever is caused by Group A beta-hemolytic streptococcus, which results in an elevated erythrocyte sedimentation rate, not a decreased erythrocyte sedimentation rate.

A nurse is caring for an infant who has the following clinical manifestations: systolic murmur, wide pulse pressure, bounding pulses, and rales when auscultating the lungs. Which of the following congenital heart conditions should the nurse suspect? A) Tetralogy of Fallot B) Patent Ductus Arteriosus C) Ventricular Septal Defect D) Pulmonary Stenosis

Answer) B The newborn who has a patent ductus arteriosus has clinical manifestations that include a systolic murmur, wide pulse pressures, bounding pulses, and rales when auscultating the lungs. A)The newborn who has tetralogy of Fallot has clinical manifestations that include cyanosis, hypoxia, and a systolic murmur. C) Newborns who have a ventricular septal defect have clinical manifestations that include a loud, harsh murmur at the left sternal boarder. Manifestations of heart failure may be present. D)Newborns who have pulmonary stenosis have clinical manifestations that include a systolic murmur, cardiomegaly, and varying degrees of cyanosis dependent on the degree of the defect. Manifestations of heart failure may be present.

The nurse in this scenario is caring for a school-aged child who had a cardiac catherization using the femoral vein one hour ago. Which of the following actions should the nurse take? A Remove pressure dressing from the insertion site. B Palpate pulses distal to the insertion site. C Place the child in a semi-fowlers position. D Maintain the child on NPO status.

Answer) B When caring for a child who has had a cardiac catherization using the femoral vein, the nurse should implement interventions to promote and maintain the child's recovery as well as identify any complications that the child may experience. Therefore, the nurse should palpate pulses distal to the insertion site each time the vital signs are assessed. Weak pulses in the affected extremity may indicate impaired circulation in the extremity. A) The nurse should not remove the pressure dressing at the insertion site one hour after the procedure. The pressure dressing should remain in place for at least 24 hours after the procedure to help prevent post-procedure bleeding. C) The nurse should not place the child in a semi-fowlers position one hour after the procedure. The child should remain in a supine position with the affected extremity in a straight position for 4 to 8 hours after the procedure to help prevent post-procedure bleeding. D) The nurse should not maintain the child on NPO status. The child should begin taking fluids as soon as possible after the procedure to help prevent dehydration and to assist with removing the dye from the body.

A nurse is providing education to the parent of a child who has infective endocarditis. Which of the following statements by the parent indicates understanding of the teaching? A) My child will need IV antibiotics for the next 7 days B) I will need to let our dentist know about my child's diagnosis C) My child will need to avoid high altitudes until the infection is gone D) Some children with his diagnosis eventually require a lung transplant

Answer) B When evaluating the outcomes of teaching to the parents, the nurse should recognize that the following statement indicates understanding of the teaching, "I will need to let our dentist know about my child's diagnosis." Children who have had a diagnosis of infective endocarditis require prophylactic antibiotic therapy prior to dental procedures. A) "My child will need IV antibiotics for the next 7 days" is an incorrect statement because the child will require antibiotics for 2 to 8 weeks following the diagnosis, not 7 days. C) "My child will need to avoid high altitudes until the infection is gone" is an incorrect statement because the child who has PAH should avoid high altitudes, not the child who has infective endocarditis. D) "Some children with this diagnosis eventually require a lung transplant" is an incorrect statement because the child who has PAH may eventually require a lung transplant, not the child who has infective endocarditis.

The nurse in this scenario is providing discharge teaching for cardiac catherization to the child's mother. Which of the following instructions should the nurse include in the teaching? A "Your child may resume their normal level of activity in 24 hours." B "You should administer acetaminophen to your child for discomfort at the insertion site." C "Drainage and swelling are expected at the insertion site for the first week after the procedure." D "It is expected for the extremity that was used for the procedure to be cool to the touch." Submit

Answer) B When providing discharge education to the guardian of a child who has had a cardiac catherization, the nurse should inform the guardian that they can administer a mild analgesic such as acetaminophen or ibuprofen to the child for discomfort at the insertion site. A) When providing discharge education to the guardian of a child who has had a cardiac catherization, the nurse should inform the guardian that the child should avoid strenuous activity for several days following the procedure. C) When providing discharge education to the guardian of a child who has had a cardiac catherization, the nurse should inform the guardian that drainage and swelling at the site are manifestations of infection and should be reported to the provider. D) When providing discharge education to the guardian of a child who has had a cardiac catherization, the nurse should inform the guardian that the child's extremities should both be warm to the touch. The nurse should instruct the guardian to report any changes in warmth or color to the provider as these findings may indicate impaired blood flow to the extremity.

A nurse is caring for a 2-year-old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A) Place on NPO status for 12 hours prior to procedure B) Check for iodine or shellfish allergies prior to procedure C) Elevate the affected extremity following the procedure D) limit fluid intake following the procedure

Answer) B When taking action while caring for a child who has a heart defect and is scheduled for cardiac catheterization, the nurse should check for iodine or shellfish allergies prior to the procedure. A) The child should remain NPO 4 to 6 hr prior to the procedure, not for 12 hours. C) The affected extremity should be maintained in a straight position following the procedure, not elevated. D) Fluids should be encouraged, not limited, after the procedure to maintain adequate urine output and promote excretion of the dye.

A nurse is assessing an infant who has heart failure. Which of the following manifestations should the nurse expect to find? SATA A) Bradycardia B) Cool Extremities C) Peripheral edema D) Increased urinary output E) Nasal flaring

Answer) B, C, E When recognizing cues for the infant who has heart failure, the nurse should recognize that cool extremities, peripheral edema, and nasal flaring are manifestations of heart failure. Cool extremities occur due to the hearts inability to adequately circulate oxygenated blood. Peripheral edema occurs because the heart is unable to adequately circulate blood through the body and back to the heart. Nasal flaring occurs due to inadequate oxygenation of blood. A) The nurse should expect the infant who has heart failure to be tachycardic, not bradycardic. D) The nurse should expect the infant who has heart failure to have decreased urinary output, not increased urinary output.

A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A "Do not offer your baby fluids after giving the medication." B "Digoxin increases your baby's heart rate." C "Give the correct dose of medication at regularly scheduled times." D "If your baby vomits a dose, you should repeat the dose to ensure that the correct amount is received."

Answer) C When taking action and providing teaching to the caregiver of an infant who has a prescription for digoxin, the nurse should instruct the caregiver to administer the correct amount of digoxin at regularly scheduled times to maintain therapeutic blood levels. A) The nurse should include in the instructions that Digoxin can be given without regard to food or fluids, however, if the child has teeth, give water after administration to prevent tooth decay. B) The nurse should include in the instructions that Digoxin slows the heart rate by increasing contractility of the heart. Digoxin does not increase the heart rate. D) The nurse should include in the instructions that it is not recommended to repeat digoxin following an episode of emesis because it is impossible to determine how much medication was lost.

Medications for rheumatic fever?

Antibiotic prophylaxis - Two daily oral doses of penicillin V - Monthly IM injection of penicillin G - Daily oral dose of sulfadiazine The length of treatment varies according to residual heart disease, ranging from 5 years to indefinitely.