Circulation & Perfusion Acquired/Congenital

Which artery carries deoxygenated blood?

Pulmonary artery (only artery in the body to carry deoxygenated blood- an artery because carries blood away from the heart)

What cardiovascular defect results in obstruction to blood flow?

Aortic stenosis (aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion)

What should the nurse assess prior to giving digoxin?

Apical pulse rate

The nurse is caring for a child who had undergone a cardiac catheterization. During recovery, the nurse notices the dressing is saturated with bright red blood. The nurse's first action is to:

Apply direct pressure 1" above the puncture site

Decreasing the demands of the heart is a priority in care for the infant with HF. In evaluating the infant's status, which finding is indicative of achieving this goal?

Appropriate weight gain for age

After returning from cardiac catheterization, the nurse determines that the pulse distal to the caterer insertion site is weaker. How should the nurse respond?

Record data on the assessment flow record (The pulse distal to the catheterization site may be weaker for the first few hours after catheterization but should gradually increase in strength. Documentation provides a baseline. The extremity is maintained straight for 4-6 hours)

What action by the school nurse is important in the prevention of rheumatic fever?

Refer children with sore throats for throat cultures (Nurses have a role in prevention, primarily in screening school-age children for sore throats caused by group A streptococci)

The nurse finds that a 6-month-old infant has an apical pulse of 166 bpm during sleep. What inuring intervention is most appropriate at this time?

Report data to the practitioner (One of the earliest signs of HF is tachycardia (sleeping heart rate >160 bpm) as a direct result of sympathetic stimulation)

A 10-year-old child is recovering form a sore throat. The parent states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause is

Rheumatic fever (to make dx of RF, major and minor criteria are used. Major writers include carditis, subcutaneous nodules, erythema marginatum, chorea, and arthritis. Minor criteria include fever, and previous hx of RF)

What are some acquired heart diseases?

Rheumatic fever Kawasaki disease

A 3-year-old child is 4 hours post cardiac catheterization via the right femoral artery. Which assessment finding should the nurse report to the provider?

Right pedal pulse weaker than left

A child has been admitted for Kawasaki disease and is started on aspirin and warfarin. For which nursing diagnosis does the nurse plan interventions as the priority?

Risk for bleeding related to medication effects

A family member, who is caring for a 2-month-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is:

"Squatting helps to increase systemic vascular resistance, which will decrease the right to left shunt that is occurring in the ventricles and this helps increase oxygen levels"

A newborn baby is born with transposition of the great arteries (TGA). You're explaining the condition to the parents. Which statement by the father demonstrates he understood the education provided about this condition?

"The aorta and pulmonary artery are switched, which causes the aorta to arise from the right ventricle and the pulmonary artery to arise from the left ventricle"

A 2-month-old is showing signs and symptoms of heart failure. An echocardiogram is ordered. The test shows the infant has ventricular septal defect (VSD). Which statement below best describes the blood flow in the heart due to this congenital heart defect?

"The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow"

You're caring for a child with coarctation of the aorta and educating the parents about the child's condition. Which statement by the parents demonstrates they understood the pathophysiology of this defect?

"This condition can lead to LEFT-SIDED HF" "The narrowing of the aorta leads to a high blood pressure in the arteries that are found before the site of narrowing in the aorta" "The NARROWING of the aorta leads to a decrease blood pressure in the arteries that are found after the site of narrowing" "The lower extremities (not the upper) will experience a decrease in blood flow due to the defect in the aorta"

As the nurse you know which statements are TRUE about Tetralogy of Fallot?

- "Tetralogy of Fallot is a cyanotic heart defect" - "In this condition the heart has to work harder to pump blood to the lungs, which cause the right ventricle to work harder and enlarge" - "Tetralogy of Fallot can be treated with palliative surgery (used to help alleviate symptoms until the child is old enough for complete repair) and complete repair) - "Many patients with this condition will experience clubbing of the nails"

After the birth of a newborn with severe coarctation of the aorta, the physician orders a prostaglandin infusion. As the nurse you know that this medication will have what type of therapeutic effects?

- Allow a connection between the aorta and pulmonary artery - Decrease the workload on the left ventricle - Increase blood flow to the lower extremities (If coarctation of the aorta is severe in a newborn, they may be started on a prostaglandin infusion to keep the ductus arteriosus open (allows a connection between the pulmonary artery and aorta), which will help decrease the work load on the left ventricle and help blood flow to the lower extremities)

A newborn baby, who is diagnosed with transposition of the great arteries, is ordered by the physician to be started on an infusion of prostaglandin E. The purpose of this medication is to:

- Allow a continued connection between - aorta and pulmonary artery via the ductus arteriosus (Prostaglandin E is an infusion that can be given to a baby with TGA. This will provide temporary relief from the TGA by keeping the ductus arteriosus open (normally this structure will close after birth). The ductus arteriosus will keep the connection between the aorta and pulmonary artery open, which will allow unoxygenated and oxygenated blood to mix and enter circulation. In TGA, oxygenated blood is not able to enter the systemic circulation, but if this structure is kept open it will allow this to occur. This infusion is only temporary until a balloon atrial septostomy or arterial switch procedure can be performed)

The student studying pediatric cardiac disorders learns that which anomalies comprise the disorder tetralogy of Fallot?

- An overriding aorta (positioning of the aorta over the defect) - Hypertrophic right ventricle - Pulmonary stenosis - VSD

You're educating the parents of a patient with transposition of the great arteries about the treatment options. Which treatment option below provides a permanent solution and is performed within the first few weeks of life?

- Arterial switch procedure (This procedure is an open heart surgery where the pulmonary after and the aorta are switched back to where they should be along with their coronary arteries and is performed within the first few weeks of life. Prostaglandin E infusion and balloon arterial septostomy are TEMPORARY treatments used until an arterial switch procedure can be performed)

Which are the most serious complications for a child with Kawasaki disease?

- Coronary thrombosis - Coronary stenosis - Coronary artery ANEURYSM

Digoxin administration info for parents:

- Give at regular intervals - If child vomits the med back up, do not give make up dose - If miss a dose, do not give extra dose - Do not mix in formula to make it taste better (child may not drink all the formula and not get complete dose)

A 4-month-old is scheduled to take Digoxin for treatment of a VSD. The patient's apical pulse is 89 beats per minute. As a nurse you will?

- Hold the dose - Notify the physician (Before giving Digoxin, the apical pulse should be checked for 1 complete minute. The infant's HR is too low in this scenario. Guidelines say to hold Digoxin in infants if the apical pulse rate is less than 90-110 bpm, children <70 bpm, adults <60 bpm.

A child has a large VSD with left-to-right shunting. Which info about VSDs does the faculty member explain to the nurse student?

- Murmur present - Most common type of congenital heart defect - Some VSDs can close spontaneously

The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes the risk of cerebrovascular accidents (strokes) occurring. What strategy is an important objective to decrease this risk?

- Prevent dehydration (In children with persistent hypoxia, polycythemia develops. Dehydration must be prevented in hypoxemic children because it potentiates the risk of strokes)

What structural defects constitute tetralogy of Fallot?

- Pulmonary stenosis - Ventricular septal defect - Overriding aorta - Right ventricular atrophy

Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4 C (101.1 F). What action should the nurse perform?

- Report findings to the practitioner (In the first 24-48 hours after surgery, the body temp may increase to 37.8 (100) as part of the inflammatory response to trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection and immediate investigation is indicated)

You're providing discharge education to the parents of a child who had surgery to repair coarctation of the aorta. What should the nurse include in the teaching about issues that can arise after surgery that must be closely monitored by a cardiologist?

- Restenosis of the aorta - Hypertension (After repair of the aorta, there is always the chance the aorta can narrow again (restenosis) and that the child continues to have HTN that must be treated with medication)

You're providing an in-service to a group of new nurses who will be caring for patients who have Tetralogy of Fallot. How does blood normally flow through the heart?

- Unoxygenated blood enters through the superior and inferior vena cava and travels to the right atrium - The pulmonic valve receives blood from the right ventricle and allows blood to flow to the lungs via the pulmonary artery - The left atrium allows blood to flow down through the bicuspid valve (mitral) into the left ventricle - Oxygenated blood leaves the left ventricle and flows up through the aortic valve and aorta to be pumped to the rest of the body

A newborn baby with transposition of the great arteries has an echocardiogram performed to detect if any other defects are present in the heart. As the nurse, you know that what other defects can most commonly occur with TGA?

- Ventricle septal defect - Patent ductus arteriosus - Atrial septal defect (Some babies may have slight communication between the right and left side of the heart in TGA, if another type of congenital heart defect is present (which many times this is the case). The other defects present in TGA may actually provide short-term benefits because it will allow unoxygenated blood to mix with oxygenate blood to enter the body. These other defects most commonly include: VSD (doesn't allow much mixing), ASD, or patent ductus arteriosus (PDA- usually keep open on purpose after birth with a medication called prostaglandin E (alprostadil) to allow for more oxygenated blood to enter the body until surgery is performed)

A 4-month old is diagnosed with Tetralogy of Fallot. You're providing an illustration to the parent to help him understand the pathophysiology of this condition. What defects must be present in the illustration to help the parent understand their child's condition?

- Ventricular Septal Defect - Right Ventricular Hypertrophy - Displacement of the aorta - Pulmonic stenosis (Let the condition's name help you: "TETRAOLOGY"... this means there will be FOUR problems with this heart defect.

A newborn has severe coarctation of the aorta. What signs/sx's would you expect to find in this patient?

- Very strong bounding pulses in the upper extremities - Cool legs and feet - Absent/diminished femoral pulses

Congenital heart defects are classified by which of the following?

-Defects with increased pulmonary blood flow -Defects with decreased pulmonary blood flow -Mixed defects -Obstructive defects

A concerned mother brings her 3-month-old to the clinic. The mother states the infant seems to be small for its age. In addition, she states the infant fatigues very easily while feeding and rarely finishes a feeding. While collecting a thorough health history, what other signs and symptoms described by the mother may indicate the child has a congenital heart defect, such as VSD?

-Frequent treatment for lung infections -Diaphoresis when nursing -Swelling in the hands and feet

A child has coarctation of the aorta (CoA). The parents report that the child is hesitant to participate in activities due to aching in his legs. Which information does the nurse provide?

Aching or pain is due to lower blood pressure in the legs (In CoA, the b/p in lower extremities is lower than b/p in upper extremities- lack of perfusion with oxygenated blood leads to pain or aching in the legs)

As the RN you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient:

Activity intolerance Failure to thrive (A patient with TOF will have activity intolerance because remember this is a cyanotic heart defect where there is not enough oxygen in the blood (due to the structural defect of the heart) and any activity intolerance (feeding, crying, play etc) can increase the demands for oxygen. Therefore, the patient will experience activity intolerance. In addition, the patient can experience failure to thrive because the constant hypoxemia (low oxygen in the blood) experienced can lead the child to have poor growth, weight loss, clubbing of the nails, etc. Remember organs need plenty of oxygen to work and grow but in TOF this isn't happening very well)

Your newborn patient has a severe case of transposition of the great arteries. The baby does not have any other defects and is therefore experiencing severe cyanosis and needs medical intervention immediately. The newborn is started on prostaglandin E and is scheduled for a balloon atrial septostomy. Select the statement below that best describes this procedure.

During this procedure a hole in the atrial septum is enlarged, which will be temporary. (A balloon atrial septostomy (this is TEMPORARY UNTIL SURGERY is performed) is a procedure performed during a heart cath and is done to enlarge a hole in the atrial septum. A catheter is inserted into the heart through a vessel to enlarge the foramen oval or and atrial septal defect already present in the intertribal septum. WHY? This allows unoxygenated and oxygenated blood to mix and enter systemic circulation and will be temporary until surgery can be performed)

A child is recovering from Kawaski disease. The child should be monitored for which?

ECG changes (the most serious complication of KD is the development of coronary artery aneurysms and the potential for myocardial infarction in children with aneurysm formation)

After returning from cardiac catheterization, the nurse monitors the child's vital signs. The heart rate should be counted for how many seconds?

60

A 2-year-old is receiving digoxin. The nurse would notify the practitioner and withhold the medication if the apical pulse is less than which rate?

90 bpm (safe to administer between 100-120 bpm)

What child has a cyanotic congenital heart defect?

A 2-month-old with tetralogy of Fallot (VSD is acyanotic congenital heart defect)

A child is hospitalized with HF has extremely high blood pressure. Which medication does the nurse prepare to administer?

Enalapril (Vasotec) (calcium channel blocker that reduces systemic vascular resistance, or after load)

What type of drug reduces HTN by interfering with production of angiotensin II?

ACE inhibitors (Angiotensin-converting enzymes) (Diuretics lower b/p by increasing fluid output, Vasodilators act on the vascular smooth muscle, beta-blockers interfere with beta stimulation and depress renin output)

Which drug should not be used to control secondary HTN in a sexually active adolescent female who uses intermittent birth control?

ACE inhibitors (can cause birth defects)

You're performing a head-to-toe assessment on a newborn with severe corarctation of the aorta. You note a systolic heart murmur. Where is the heart murmur best auscultated in a patient with this condition?

At the left interscapular area (the back near the shoulder blade)

The nurse is caring for a 9-month-old who was born with a CHD. Assessment reveals a HR of 160, cap refill of 4 seconds, bilateral crackles, and seat on the scalp. These are signs of:

CHF

What drug is an angiotensin-converting enzyme (ACE) inhibitor?

Captopril (Capoten)

The nurse is caring for a child with Kawaski disease in the acute phase. What clinical manifestations should the nurse expect to observe?

Cervical lymphadenopathy Strawberry tongue Erythematous palms

As the nurse you know that some patients who have coarctation of the aorta will develop collateral circulation of the arteries due to the abnormality on the aorta. Which option below indicates a patient is experiencing collateral circulation?

Chest x-ray that demonstrates notching on the ribs (the body creates extra circulation to bypass the narrowing, which will be seen on the ribs and cause them to have a notched out appearance on a chest x-ray)

What statement best identifies the cause of HF?

Consequence of an underlying cardiac defect (HF is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filing pressures to meet the body's metabolic demands)

What primary nursing intervention should be implemented to prevent bacterial endocarditis?

Counsel parents of high risk children (prophylactic abx for dental procedures and maintaining excellent oral health)

Select all the signs and symptoms of how a newborn with transposition of the great arteries may present after birth:

Cyanosis - Low oxygen levels Increased heart rate Increased respiratory rate (Babies with TGA will experience severe cyanosis after birth that will become worse and not resolve on its own. This is because the pulmonary and systemic circulations are not working together. Hence, the oxygenated blood never reaches the systemic circulation (it just keep re-circulating on the left side of the heart). Therefore, the baby will have cyanosis (a bluish skin tone) until medical intervention is performed along with low oxygen levels (this is leading to the cyanosis), increased respiratory and heart rate (due to the low oxygen levels....the heart and lungs are trying to compensate by getting more oxygen to the body's organs/tissues but it is unsuccessful)

The nurse is preparing to give digoxin to a 9-month-old infant. The nurse checks the dose and draws up 4 mL of the drug. The most appropriate nursing action would be?

Do not give the dose; suspect dosage error (Infants rarely receive more than 1 mL (50mcg. Or 0.05 mg) of digoxin in one dose)

The mother of a toddler reports to the nurse that the child becomes cyanotic when he cries. Which question by the nurse is most important to ask the mother?

Does he squat while he cries? (the mother is describing a TET spell, which is a hallmark sign of Tetralogy of Fallot)

True/False: The signs and symptoms of a ventricular septal defect are most commonly detected in a baby following birth.

FALSE: Signs/Sx's of a VSD are NOT commonly found in a baby after birth, but rather a little later on. VSD signs/sx's most likely start to present around 1-3 months after birth. WHY? In utero, the baby has the same pressure on the right side and left side of the heart. However, after birth the lungs start to work and this pressure changes gradually over the next 2-3 weeks. The pressure in the right side will decrease compared to the left side. Therefore, when a large VSD is present and the pressure changes will cause blood to begin shunting from the LEFT ventricle to the RIGHT ventricle (hence increasing lung blood flow which leads to pulmonary HTN and eventually heart failure). Therefore, at about 1-3 months of life the infant will be presenting with heart failure, growth problems, and respiratory issues.

The nurse is teaching parents about administering digoxin. What instructions should the nurse tell the parents?

Give the medication at regular intervals

A nurse is assessing a school-age child admitted with a new heart murmur, arthritis-type symptoms, erythema marginatum, and fever. When taking the child's history, which question is most likely to provide important information?

Has your child had a sore throat in the last 2-3 weeks? (Displaying manifestations of rheumatic fever)

A cardiac defect that allows blood to shunt from the (high pressure) left side of the heart to the (lower pressure) right side can result in which condition?

Heart Failure

The parents of a child with transposition of the great vessels asks the nurse why the child looks blue. Which response by the nurse is the most appropriate?

Her body gets blood that doesn't have much oxygen (In this condition the aorta arises from the right side of the body, so systemic circulation consists of oxygenated poor blood)

During a well child checkup for an infant with tetralogy of fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse's first action should be to:

Hold the child in knee-chest position to decrease venous blood return

What medication used to treat HF is a diuretic?

Hydrochlorothiazide (Diuril) (Captorpil is ACE inhibitor; digoxin is a digital glycoside, and carvedilol is a beta-blocker)

A child is prescribed warfarin (Coumadin). Which laboratory values does the nurse monitor?

INR PTT

The nurse is caring for a child with Kawasaki disease. A student nurse who is on the unit asks if there are medications to treat this disease. The nurse's response to the student nurse is:

IVIG (IV Immunoglobulin) and aspirin

As a nurse you know that if a patient has a large VSD and does not receive treatment, the patient may develop Eisenmenger Syndrome. This syndrome causes?

If the VSD is not treated, (later in life) a reversal of blood shunting (shunting from right to left) will occur due to the extensive pulmonary HTN in a condition called Eisenmenger's Syndrome. With this shunting, unoxygenated blood will start to enter circulation and cyanosis and clubbing can start to be seen. It is irreversible and a lung or heart transplant is the current option.

An infant is discharged after open heart surgery. The infant is going home on oxygen and with multiple medications. Which instruction by the nurse is the priority?

If your baby is irritable, check O2 sat

A parent of a 7-year-old girl with a repaired VSD calls the cardiology clinic and reports that the child is just not herself. Her appetite is decreased, she has had intermittent fevers around 38 (100.4), and now her muscles and joints ache. Based on this information, how should the nurse advise the mother?

Immediately bring the child to the clinic for evaluation (These are insidious ex's of bacterial endocarditis)

What nutritional component should be altered in the infant with HF?

Increase calories

What blood flow pattern occurs in a VSD- ventricular septal defect?

Increased pulmonary blood flow (The opening in the septal wall allows for blood to flow from higher pressure left ventricle into lower pressure right ventricle. This left-to-right shunt creates increased pulmonary blood flow)

A 1-year-old has been admitted for complete repair of tetralogy of Fallot. What assessment finding should the nurse expect to be documented?

Increasing cyanosis (Elective repair of TOF is usually performed in the first year of life. Indications for repair include increasing cyanosis and the development of hypercyanotic spells)

What can an electrocardiogram (ECG0 detect?

Ischemia Injury Dysrhythmias Conduction delay

A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has:

Kawasaki Disease

In an infant with cyanotic cardiac anomaly, the nurse would expect to see:

Little to no improvement in color with oxygen administration (with a cyanotic defect, the shunting of blood is right to left, so there is little if any improvement in the oxygenation of the blood with administration of O2. Infants with cardiac anomalies are usually difficult feeders, have difficulty gaining weight, and have an increase in heart rate with activity)

An adolescent is being placed on a beta-blocker. What should the nurse inform the adolescent with regard to this medication?

Medication may cause fatigue Side effects may include impotence Side effects may include bradycardia Cold extremities

An infant is diagnosed with transposition of the great vessels. Prostaglandin E is given IV. The parents ask how long the child will remain on the prostaglandin E. What is the appropriate response by the nurse?

Prostaglandin E will be given continuously until corrective surgery is performed (To provide intracardiac mixing for child with transposition of the great arteries, IV prostaglandin E is administered continuously to keep the ductus arteriosus open to temporarily increase blood mixing and provide and oxygen sat of 75% or to maintain cardiac output until surgery. It is discontinued after surgery)

The health care provider suggests surgery be performed for ventricular septal defect (VSD) to prevent what complication?

Pulmonary HTN

If a VSD was present, you may hear a harsh ___________ that is located at the lower left sternal border and starts at S1 and extends into S2.

Murmur (holosystolic or pansystolic)

The parents of a young child with HF tell the nurse that they are nervous about giving digoxin. The nurse's response should be based on which knowledge?

Parents need to learn specific, important guidelines for administration of digoxin

Indomethacin (Indocin) may be given to close which congenital heart defect in newborns?

Patent Ductus Arteriosus (PDA) (Prostaglandins allow duct to remain open- Indocin helps to close the duct)

A 3-month-old has a hypercyanotic spell. What should be the nurse's first action?

Place the child in the knee-chest position

What signs/sx is a major clinical manifestation of rheumatic fever?

Polyarthritis (Polyarthritis, which is swollen, red, hot, and painful joints, is a major clinical manifestation)

Hypoxic spells in the infant with a congenital heart defect (CHD) can cause:

Polycythemia Blood clots CVA Developmental delays Brain damage

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?

Polycythemia (Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, in increased number of red blood cells)

You're caring for a newborn who has TOF with severe cyanosis. You anticipate the newborn will be started on _____________?

Prostaglandin E (Alprostadil) (Prostaglandin E will keep the ductus arteriosus open after birth. This will help with keeping the oxygen levels up because it allows more blood flow to the lungs that is oxygenated via the ductus arteriosus. Remember this usually closes shortly after birth, but in a patient with severe TOF this opening needs to stay opened until surgery can be performed)

A child with heart failure is on digoxin. The laboratory value a nurse must closely monitor is which?

Serum Potassium (fall in K enhances effect of digoxin, increasing risk of digoxin toxicity)

Which finding might delay a cardiac catheterization procedure on a 1-year-old:

Severe diaper rash (child with severe diaper rash has potential for infection if the interventionist makes the standard groin approach)

When a cardiac defect causes the mixing of arterial and venous blood in the right side of the chamber, the nurse might expect to find:

Signs of pulmonary congestion (mixing of the blood in right side will cause excessive blood flow to the lungs and pulmonary congestion)

An adolescent is being placed on an ACE inhibitor. What should the nurse inform the adolescent with regard to this medication?

Stay well hydrated Avoid rapid position changes Side effects may include dry cough

While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to?

Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen (The patient is experiencing a "tet spell". This is where during any type of activity like feeding, crying, playing, etc. the child's hart (due to Tetralogy of Fallot) is unable to maintain proper oxygen levels in the blood (these activities place extra work on the heart and it can't keep up). Therefore, there are low amounts of oxygen in the blood, and the skin will become cyanotic and the respiratory rate will increase (this is the body's way of trying to increase the oxygen levels in the body but it doesn't work because it's not a gas exchange problem in the lungs but a heart problem). The nurse would want to place the infant in the knee-to-chest position. WHY? This increases systemic vascular resistance (which will help decrease the right to left shunt that is occurring in the heart....hence help replenish the body with oxygenated blood). In addition, the nurse would want to place the patient on oxygen)

A chest radiography examination is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should be based on knowledge that the radiograph provides which information?

Supplies information on heart size and pulmonary blood flow patterns

You are assessing the heart sounds of a patient with severe case of Tetralogy of Fallot. You would expect to hear a _________ murmur at the ______ of the sternal border?

Systolic; Left

A 6-month-old who has episodes of cyanosis after crying could have the CHD of decreased pulmonary blood flow called:

TOF (Tetralogy of Fallot)

True/False: In a normal heart without any type of congenital heart defect, the pulmonary vein carries oxygenated blood away from the lungs to the left side of the heart.

TRUE (The pulmonary vein carries oxygenated blood away from the lungs to the left side of the heart. Don't get the pulmonary vein and artery confused. The pulmonary artery carries UNOXYGENATED blood from the RIGHT side of the heart t the LUNGS. Remember in TGA the roles of the aorta and pulmonary artery are switched. In TGA, the aorta will actually carry unoxygenated blood from the right side of the heart to the lungs. It normally should carry oxygenated blood from the left side of the heart (specifically the left ventricle) to the body)

Nursing care of the child with Kawaskaki disease is challenging because of which occurrence?

The child's irritability (Irritability is a hallmark of Kawaski and is most challenging problem)

An adolescent is placed on a calcium channel blocker. What should the nurse inform the adolescent with regard to this medication?

The medication may increase heart rate The medication may cause constipation The medication may cause peripheral edema

When caring for a child with Kawasaki disease, what would the nurse know to provide safe and effective care?

Therapeutic management includes administration of gamma globulin and salicylates (High dose IVIG (immunoglobulin therapy is indicated to reduce the incidence of coronary artery abnormalities when given with the first 10 days of the illness. Aspirin is also part of the therapy)

A 6-month-old infant presents to the clinic with FTT, hx. Of frequent respiratory infections, and increasing exhaustion during feedings. On physical examination, a systolic murmur is detected, no central cyanosis, and chest radiography reveals cardiomegaly. An echocardiogram is done that shows left-to-right shunting. This assessment data is characteristic of what?

VSD

Tetralogy of Fallot (TOF) involves which defects?

VSD Right Ventricle hypertrophy Pulmonic stenosis Overriding aorta

What clinical manifestation is a common sign of digoxin toxicity?

Vomiting

HF is a problem after the child has had a congenital heart defect repaired. The nurse knows signs of HF are what?

Wheezing Decreased b/p Decreased urine output Increased HR