Peds Cardio ch. 41
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?
"Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs."
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?
"It's great you are providing nutritious meals, but small, frequent meals will tire your child less and promote weight gain."
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.
"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."
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."
Right sided heart failure symptoms
-Pitting Edema -Ascites -Hepatic enlargement -JVD -Parasternal lift -Nausea -Decreased appetite -Cold extremities -Diaphoresis
A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?
80 beats/min
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
Blue baby syndrome
Blue Baby SyndromeBlue Baby TOF is the most common cause of blue baby syndrome in newborns. Babies are "blue" due to the cyanosis experienced in this heart disorder.
Which of the following conditions is best associated with tetralogy of Fallot (TOF)?
Blue baby syndrome TOF is the most common cause of blue baby syndrome in newborns. Babies are "blue" due to the cyanosis experienced in this heart disorder.
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.
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?
Children who have this diagnosis may have had strep throat
he 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?
Children who have this diagnosis may have had strep throat
The murmur of a patent ductus arteriosus can be best described as which of the following?
Continuous Continuous-murmur the blood flow through the patent ductus arteriosus creates a continuous murmur that exists in both systole and diastole Machine like murmur Machine-like Merman This murmur is classically described as having a machine-like quality due to continuous clicking noises. Important to note that while the machine-like murmur is often the hallmark sign a systolic ejection murmur may also be heard
The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?
Digoxin
The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?
Digoxin
A nurse is assessing a 6-year-old male child brought to the pediatrician's office for sore throat and fever. Assessment reveals lethargy; dry, warm skin; capillary refill time <3 seconds; lungs clear to auscultation. Vital signs: temperature, 100.1°F (37.8°C); heart rate, 128 beats/min; respiratory rate, 28 breaths/min. The nurse performs a throat culture, which is positive for group A streptococcus (GAS). Urine sample results: dark concentrated urine; urine specific gravity 1.04.
Group A streptococcus
A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?
NSAIDS
A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?
Notify the doctor immediately
Which of the following is the most likely virus associated with patent ductus arteriosus?
Often due to congenital rubella Patent ductus arteriosus is a common outcome of congenital Rubella infection close to delivery. However, the frequency of PDA caused by congenital Rubella has significantly decreased due to immunization.
Overriding Aorta
Overriding AortaOver-riding A-orca In TOF, the aorta sits above the VSD, giving it biventricular access. This is problematic because deoxygenated blood from the right ventricle can then make its way into systemic blood flow.
Which of the following is an acronym or mnemonic associated with tetralogy of Fallot (TOF)?
PROVe Acronym the acronym PROVe can be used to help remember the four specific abnormalities generally associated with TOF: P for pulmonary infundibular stenosis, R for RVH, O for overriding aorta, V for VSD, and the "e" is silent without and associated pathology
PROVe Acronym prove-proof stamp
PROVe AcronymProve-proof Stamp The acronym "PROVe" can be used to help remember the four specific abnormalities generally associated with TOF: P for pulmonary infundibular stenosis, R for RVH, O for overriding aorta, V for VSD, and the "e" is silent without an associated pathology.
Tetralogy of Fallot Boot-shaped heart
Patients show a "boot-shaped" heart on X-ray due to RVH.
A 1-year-old with tetralogy of Fallot turns blue during a temper tantrum. What will the nurse do first?
Place child in the knee to chest position
Which of the following is a risk factor for having a patent ductus arteriosus?
Prematurity in premature infants, the patent ductus arteriosus closes later than it would in term babies, possibly related to the relative immaturity of the lungs
Pulmonary Infundibular Stenosis lungs made of stone
Pulmonary Infundibular StenosisLungs made of Stone One of the tetralogies that can occur is pulmonary infundibular stenosis. Pulmonary infundibular stenosis is described as a narrowing of the right ventricular outflow tract. It occurs at the pulmonary valve, or just below at the infundibulum.
Edema of the lower extremities is characteristic of ? ventricular heart failure in older children
Right
Right Ventricular Hypertrophy Right Vent Hiker-trophy
Right Ventricular HypertrophyRight Vent Hiker-trophy Due to the increased pressure and resistance of the right ventricular outflow tract, the right heart becomes pathologically hypertrophied. This RVH can cause the heart to be visualized as "boot-shaped."
A child with heart disease is receiving digoxin and a diuretic. Which laboratory test result would be most important for the nurse to monitor?
Serum potassium level
Tetralogy of Fallot Squatting for Tet Spells
Squatting for Tet SpellsSquatting Often patients, especially children, squat to alleviate cyanotic tet spells. This is a therapeutic action because squatting increases systemic resistance. The increase in systemic resistance allows more blood to be pumped into the pulmonary system and for improved oxygenation.
At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important?
Taking pedal pulses for the first 4 hours
Tetralogy of Fallot
Tetralogy of Fallot (TOF) is a congenital birth defect of the heart that leads to cyanosis. It presents with the combination of four different heart defects and is the most common cause of blue baby syndrome. The four pathologies seen in this condition are pulmonary infundibular stenosis, right ventricular hypertrophy (RVH), overriding aorta and ventricular septal defect (VSD).
A nurse is providing education to a family about cardiac catheterization. What information would be included in the education?
The catheter will be placed in the femoral artery
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 causes the lack of oxygen to the fingers causing theses changes
Tetralogy of Fallot Surgery
The only definitive treatment for TOF is surgical correction of the respective heart malformations.
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 infants heart gets out of rhythm
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
Ventricular Septal Defect VSD
Ventricular Septal Defect (VSD)Vase-hole-heart Patients with TOF have a VSD which allows deoxygenated blood from the right ventricle to mix with oxygenated blood from the left ventricle. Because pulmonary stenosis causes right-sided outflow obstruction, blood is preferentially pushed toward the left side, and a right-to-left shunt is seen.
The nurse is caring for an infant with Down syndrome who has been diagnosed with atrioventricular canal defect. The parents asks the nurse, "Why do you not put oxygen on our baby more often when his lips and fingernails are blue?" What is the best response by the nurse?
While it seems that oxygen would help, it actually worsens this condition. Treating the cause of the disease will help.
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 symptoms you are having during the test
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:
a cerebrovascular accident "stroke"
The nurse receives the shift report of multiple pediatric clients. Which pediatric client will the nurse see first?
a toddler with tetralogy of fallot squatting quietly in the corner of the room
The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention?
accentuated third heart sound
Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?
altered cardiopulmonary tissue perfusion risk
The nurse is assessing an infant and notes brachial pulses of 2+ and femoral pulses of 1+. Which action will the nurse perform first?
assess the blood pressure in all extremities
What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?
breastfeed with small, frequent feeds
is an abnormal enlargement of the distal phalanges usually associated with cyanotic heart disease or avanced chronic pulmonary disease
clubbing
A femoral pulse that is weak or absent in comparison to the brachial pulse is associate with
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
normally closes shortly after birth but may remain open in some children with congenital heart disease
ductus arteriosus
The normal heart rate is lower in infancy than adulthood true or false
false
After assessing a child, the nurse suspects coarctation of the aorta based on a finding of:
femoral pulse weaker than brachial pulse
Tetralogy of Fallot is a congenital heart defect that refers to a combination of how many heat defects occurring together?
four
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?
heat failure
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 RBC
Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?
involuntary limb movement macular rash on trunk tender swollen joints
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 extremeties
A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?
peeling hands and feet; fever
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 chest position
An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?
place the infant in the knee chest position
When reviewing the record of a child with tetralogy of Fallot, what would the nurse expect to discover?
polycthemia
The nurse is caring for a child who has been experiencing hypercyanotic episodes. Which treatments will be effective in managing them? Select all that apply.
provide supplemental oxygen assist the child to a knee 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
Edema of the lower extremities is characteristic of _______ ventricular heart failure in older children.
right
A child with a cardiac structural defect is receiving oxygen therapy. In which position should the child be placed to promote optimal benefits?
semi-fowler
What will the nurse include in the discharge plan of care for a newborn with ventricular septal defect?
signs and symptoms to watch for information about cardiology appointments primary care for follow up telephone number for questions
What therapeutic action is most commonly seen in patients with tetralogy of Fallot (TOF)?
squatting for Tet Spells
What is the most likely definitive intervention in tetralogy of Fallot (TOF)?
surgery
A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis?
tetralogy of fallot
The nurse has administered oral penicillin as ordered for prophylaxis of endocarditis. The nurse instructs the parents to immediately report which reaction?
wheezing
The nurse is caring for children at a local hospital. Which child warrants immediate attention from the nurse?
1-week-old newborn whose oxygenation is not improving with oxygen
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
Which of the following is the most likely clinical feature of tetralogy of Fallot (TOF)?
Pulmonary Infundibular Stenosis Lungs made of Stone one of the tetralogies that can occur is pulmonary infundibular stenosis described as a narrowing of the right ventricular outflow tract. It occurs at the pulmonary valve or just below the infundibulum Right Ventricular Hypertrophy Due to the increased pressure and resistance of the right ventricular outflow tract, the right heart becomes pathologically hypertrophied. This RVH can cause the heart to be visualized as "boot-shaped" Overriding Aorta In TOF, the aorta sits above the VSD, giving it biventricular access. This is problematic because deoxygenated blood from the right ventricle can then make its way into the systemic blood flow. Ventricular Septal Defect VSD patients with TOF have a VSD which allows deoxygenated blood from the right ventricle to mix with oxygenated blood from the left ventricle. Because pulmonary stenosis causes right sided outflow obstruction, blood is preferentially pushed toward the left side and a right to left shunt is seen
Tetralogy of Fallot
Tetralogy of Fallot is shown in this image by the Tetris-logs flowing in this lazy river. The blue baby is laying on a log, trying to get some rest and relaxation while soaking up the sun, and this represents blue baby syndrome, which can present with this disorder. The PROVe acronym helps to remember the four dysfunctions in this heart disorder, which is shown by the prove-proof stamp. The P is for pulmonary infundibular stenosis, which is shown by the lungs made of stone. The R in PROVe is for right ventricular hypertrophy, shown by the right vent hiker-trophy. The O is for an overriding aorta, the over-riding A-orca, and the fourth defect is a ventricular septal defect; V for VSD, shown as the vase-hole-heart. The "e" is silent without an associated pathology. Patients with Tetralogy of Fallot can show a boot-shaped heart on X-ray, which is represented by the boots on the heart. Kids use a squatting position for tet spells of this disease, and this is shown by the child squatting to get to the final stage, narrowly avoiding the surgeon's swinging-scalpel, which represents surgery being a definitive treatment for Tetralogy of Fallot. Let's review this disease. It can present early with blue baby syndrome. PROVe is an acronym to help you remember the physiological defects; P is for pulmonary infundibular stenosis, R is for right ventricular hypertrophy, O is for overriding aorta and V is for ventricular septal defect. Patients can have a boot-shaped heart on X-ray, and often use squatting to alleviate tet spells. Surgical correction is the definitive treatment.
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?
softening of the nail beds
At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important?
taking pedal pulses for the first 4 hours
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 need the blood pressure checked two more times
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
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 in right sided heart failure
A mother asks the nurse if the reason the infant has a congenital heart defect is because of something she did while pregnant. What is the best response by the nurse?
there are several reasons an infant can have a heart defect; let's talk about those causes
A mother is asking for more information about her infant's patent ductus arteriosus (PDA). What would be included in the education?
this is caused by an opening that usually closes by 1 week of age
A mother asks why her infant with a cyanotic heart defect turns blue. What is the nurse's best explanation?
this is due to a decreased amount of oxygen to the peripheral tissue
An S3 heart sound may be heard in children true/false
true
An S3 heart sound may be heard in children.
true
Congenital cardiac anomaly refers to an enlargement of the heart caused by hypertrophy or thickening of the walls of the heart.
true
Depending on age, the structure and function of the infant's and child's cardiovascular system differ from those of adults.
true
Most children with atrial septal defects are asymptomatic
true
breastfeeding a child before and after cardiac surgery may boost the infants immune system
true
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
In children what is the best indicator of changes in fluid status?
weight
