Congenital Heart Disease 38Qw/exp
How can a nurse distinguish between a patient with hypoplastic left heart syndrome and truncus arteriosus? Oxygenated blood flows to left ventricle in hypoplastic left heart syndrome, whereas deoxygenated blood flows into left heart in truncus arteriosus. Oxygenated blood flows to right atrium in hypoplastic left heart syndrome, whereas deoxygenated blood flows into left heart in truncus arteriosus. Deoxygenated blood flows to the left atrium in hypoplastic left heart syndrome, whereas deoxygenated blood flows into the left heart in truncus arteriosus. Oxygenated blood flows to left atrium in hypoplastic left heart syndrome, whereas oxygenated blood flows into left ventricle where blood mixing occurs in truncus arteriosus.
Oxygenated blood flows to left atrium in hypoplastic left heart syndrome, whereas oxygenated blood flows into left ventricle where blood mixing occurs in truncus arteriosus. These findings will help a nurse distinguish patient with hypoplastic left heart syndrome from one with truncus arteriosus. In hypoplastic heart syndrome, most of oxygenated blood cannot leave aorta and is instead shunted to right side back in to pulmonary circulation.
What are some of the clinical manifestations associated with left-sided obstructive lesions? Select all that apply. Peripheral edema Exercise intolerance Right ventricle atresia Pulmonary hypertension Left ventricular hypertrophy
Exercise intolerance The left side of the heart supplies blood to systemic circulation. A left-side obstruction would decrease blood delivery and decrease exercise tolerance. Pulmonary hypertension Increased pressure in left ventricle due to left-side heart obstruction can cause backflow into lungs and hypertension. Correct Left ventricular hypertrophy Increased pressure in left ventricle causes hypertrophy.
A neonate has cyanosis and increased pulmonary blood flow. The family is confused about how increased blood flow to the lungs would decrease oxygen levels in the body. What can the nurse say to explain this pathophysiology? Anatomical features present in this child prevent blood from becoming fully loaded with oxygen in the lungs before going out to the body. The body appears cyanotic due to the lower than normal oxygen levels. Anatomical features present in this child increase pulmonary blood flow and oxygenation in the lungs. The oxygen is quickly used by the overworking left ventricle; this leads to decreased oxygen delivery to the body. Anatomical features present in this child decrease the rate at which blood moves through the lungs. There is an increased volume of blood but it is moving slowly. This allows the lungs to use the oxygen it typically delivers to the blood. Anatomical features present in this child cause the increase in pulmonary blood flow. As blood flow increases, gas exchange in the lungs decreases. This prevents the full amount of oxygen from binding to the red blood cells and cyanosis results.
Anatomical features present in this child prevent blood from becoming fully loaded with oxygen in the lungs before going out to the body. The body appears cyanotic due to the lower than normal oxygen levels. Truncus arteriosus, hypoplastic left heart syndrome, and transposition of the great arteries are three examples of congenital heart disease (CHD) that have cyanosis with increased pulmonary blood flow. Mixing of blood from the right and left sides prevents fully saturated blood from entering systemic circulation, therefore cyanosis is present.
Which statement explains the development of pulmonary hypertension in an infant with a large left-to-right shunting defect? As a large volume of blood leaves the right ventricle and enters the pulmonary vein, this will affect the pulmonary vasculature and lead to pulmonary hypertension in the child suffering from this congenital heart lesion. Any congenital shunt can increase blood volume in the heart affecting both the pulmonary vein and pulmonary artery in delivering blood to the lungs and from the lungs to the heart respectively. The pulmonary vasculature responds to this increased load by vasoconstriction leading to pulmonary hypertension. When a child is suffering from a heart lesion, decreased blood flow leads to vasodilation and eventual remodeling in the pulmonary vessels. Thickened vessel walls are irreversibly vasoconstricted leading to pulmonary hypertension. With left-to-right shunting there is decreased blood volume in the ventricles that can cause vasoconstriction and eventual thickening of the pulmonary vessels. This will eventually cause pulmonary hypertension and respiratory distress in the child with the congenital heart lesion.
Any congenital shunt can increase blood volume in the heart affecting both the pulmonary vein and pulmonary artery in delivering blood to the lungs and from the lungs to the heart respectively. The pulmonary vasculature responds to this increased load by vasoconstriction leading to pulmonary hypertension. Any congenital heart defect that leads to fluid overload in the ventricles can affect the pulmonary vasculature. If more work is required by both the pulmonary artery and pulmonary vein, then the pulmonary vasculature will respond by vasoconstricting leading to pulmonary hypertension. This can further damage the alveoli and cause the respiratory problems often seen in children with congenital heart defects.
The nurse is caring for a patient suffering from a cyanotic heart lesion and has just inserted an IV line. Moments later the child appears to be in moderate distress and action is required. Which clinical manifestation should require the most immediate action? Increase in crying intensity Changes in neurologic status Alterations in blood pressure Notable changes in breathing patterns
Changes in neurologic status Any child with a right-to-left shunt is at increased risk of arterial and venous blood mixing. If air is introduced to an IV line, the venous blood obtaining this air can enter the arterial system and send an air embolus to the brain causing a cerebrovascular accident. This child will require immediate attention since changes in neurologic status can be evidence of a stroke.
How should the nurse explain the reversal of a cardiac shunt due to pulmonary hypertension that went untreated? Changes in the aorta lead to significantly increased aortic pressures. The pressure changes changed the direction of the shunt and now less blood is pumped to the lungs. Changes in superior vena cava (SVC) cause pressure changes in the right atrium. The pressure changes changed the direction of the shunt and now less blood is pumped to the lungs. Changes in the inferior vena cava (IVC) cause pressure changes in the right atrium. The pressure changes changed the direction of the shunt and now less blood is pumped to the lungs. Changes in the pulmonary blood vessels led to significantly increased pulmonary pressures. The pressure differences changed the direction of the shunt and now less blood is pumped to the lungs for adequate oxygenation therefore causing cyanotic spells in the child.
Changes in the pulmonary blood vessels led to significantly increased pulmonary pressures. The pressure differences changed the direction of the shunt and now less blood is pumped to the lungs for adequate oxygenation therefore causing cyanotic spells in the child. Left-to-right shunts cause increased pressure in the pulmonary vein thereby leading to pulmonary hypertension in the child. This creates a thickened right ventricle therefore impeding blood flow in the left-to-right direction. The flow therefore reverses through the shunt bypassing adequate oxygenation.
Closure of the ductus arteriosus occurs shortly after birth. Children born with right-to left shunts begin to experience an increase in cyanosis with this closure. Which explanation describes the pathophysiology of this clinical manifestation? Closure of the patent ductus arteriosus (PDA) decreases the right-to-left shunting. Closure of the ductus arteriosus causes the development of pulmonary hypertension. Closure of ductus arteriosus decreases the volume of blood going to the lungs for oxygenation. Closure of the ductus arteriosus increases the volume of blood going to the lungs. Increased blood flow causes decreased oxygenation.
Closure of ductus arteriosus decreases the volume of blood going to the lungs for oxygenation. In a right-to-left shunt, deoxygenated blood mixes with the oxygenated blood on the left side of the heart. This can decrease blood flow through the pulmonary trunk. When there is a PDA, mixed blood from the left side can go to the lungs for oxygenation. When the ductus arteriosus closes, this alternate pathway for oxygenation is lost.
A child has been diagnosed with hypoplastic left heart syndrome. Which action by the nurse will be a priority for providing long term management of this child? Contact provider as surgical consult is needed Ensure adequate weight gain through proper feeding Administer diuretics as ordered to help control fluid overload Administer digoxin as ordered and prepare to administer on long term basis
Contact provider as surgical consult is needed This child will need a surgical consult in order to be assessed for a 3 step surgical procedure called "staged palliation". This procedure is for long-term management and is meant to correct the blood flow pattern in and out of the heart and help to improve the child's blood oxygenation.
During development, pulmonary veins may aberrantly attach to the superior vena cava. What are the possible outcomes or clinical manifestations of this anomaly? Select all that apply. Cyanosis Tachycardia Peripheral edema Pulmonary hypotension Mixed blood will be delivered to systemic circulation
Cyanosis Cyanosis will occur because oxygenated blood is not sent to systemic circulation. Tachycardia Tachycardia occurs in an effort to increase cardiac output (CO) and increase oxygen delivery. Peripheral edema There will be decreasing peripheral pulses that would not promote edema. Mixed blood will be delivered to systemic circulation Pulmonary arteries deliver oxygenated blood to the deoxygenated right side of the heart. This causes a mixing of blood. There must be an open PDA to allow blood to flow to left side of the heart and distribute mixed blood to systemic circulation.
What physiological changes are augmented by strenuous exercise and high altitudes in the patient with pulmonary arterial hypertension (PAH)? Select all that apply. Cyanosis Peripheral edema Pulmonary edema Right-sided heart hypertrophy Increased pulmonary venous pressure
Cyanosis Patients with PAH can develop cyanosis with strenuous exercise and high altitudes as pulmonary blood flow rate may not be adequate. Correct Peripheral edema Peripheral edema is possible as the right side of the heart is volume- and pressure- overloaded. Right-sided heart hypertrophy The right side of the heart can develop hypertrophy due to increased pressure within pulmonary arteries.
Which statement explains the appearance of cyanosis in an individual with polycythemia secondary to congenital heart disease (CHD)? Cyanosis will not be evident due to the significant increase in hemoglobin. Cyanosis will appear in the presence of higher oxygen saturation levels (less desaturated) than normal. Cyanosis will appear in the presence of lower oxygen saturation levels (increased desaturation) than normal. Cyanosis is related to anemia, not polycythemia. Cyanosis is not expected in a patient with polycythemia secondary to CHD.
Cyanosis will appear in the presence of higher oxygen saturation levels (less desaturated) than normal. In children with polycythemia, cyanosis will appear when hemoglobin is less desaturated.
Pulmonary artery stenosis can precipitate regurgitation and prevent the closure of the foramen ovale. Which manifestation can occur if the foramen ovale remains patent in a patient with pulmonary stenosis? Decreased blood flow to the systemic circulation Increased blood flow to the pulmonary circulation Decreased oxygenation of blood entering systemic circulation Increased oxygenation of blood entering systemic circulation
Decreased oxygenation of blood entering systemic circulation The patent foramen ovale allows the blood to bypass the pulmonary circulation. Blood contains lower oxygen saturation levels when entering systemic circulation.
A child with aortic stenosis may experience symptoms of myocardial infarction (MI). How can these symptoms occur in a patient without vascular disease? A child with aortic stenosis experiences MI symptoms due to the maximal exertion required by the left side of the heart. Decreased pressure in the aorta results in decreased elastic recoil. Subsequently, less blood is delivered to the coronary arteries. A child with aortic stenosis experiences MI symptoms due to the decrease in oxygenated blood returning to the heart from the lung. Increased pressure in the aorta results in increased elastic recoil. Subsequently, more blood is delivered to systemic circulation than to coronary circulation.
Decreased pressure in the aorta results in decreased elastic recoil. Subsequently, less blood is delivered to the coronary arteries. Aortic stenosis results in high left ventricular pressures as the blood has difficulty leaving the ventricle through the stenosis. This prevents a normal increase in aortic stretch due to high volume and pressure. During ventricular diastole, less elastic recoil of the aorta results in less blood entering the coronary arteries, resulting in symptoms of MI.
In doing the respiratory assessment in a patient with heart failure (HF), which assessment findings should the nurse expect to see? Select all that apply. Distinctive cough Abnormal lung sounds Deep breaths with activity Distinctive odor on the breath Increased number of respirations
Distinctive cough Patients suffering from heart failure may have an accumulation of fluid in the lungs, and a distinctive cough may be heard in doing a respiratory assessment in these patients. Correct Abnormal lung sounds If there is congestion in the lungs, this may be heard by the nurse while performing the respiratory assessment on the child. Correct Deep breaths with activity A child with heart failure will often need to take deep breaths with any sort of exertion, and this would be an expected finding in the respiratory assessment.
A mother is concerned that her child suffering from heart failure (HF) has started to experience abdominal pain. What explanation by the nurse can be provided to the mother to help her understand this coexisting condition? Heart failure causes ischemia leading to abdominal pain. Fluid overload causing congestion can lead to abdominal pain. H. pylori infections often occur in heart failure patients causing abdominal pain. Heart failure can lead to increased secretion of abdominal acids therefore causing stomach pain in the child.
Fluid overload causing congestion can lead to abdominal pain. Since many children with heart defects experience right-sided heart failure, they can experience congestion in the abdomen due to inadequate delivery of blood back to the heart.
Pulmonary arterial hypertension (PAH) management is designed to treat the symptoms of heart failure (HF). How does treating HF symptoms facilitate the management of PAH? Select all that apply. Improving right-sided heart function and fluid management will decrease the symptoms of PAH. Increasing afterload will force the heart to increase contractility and therefore decrease PAH. Improving left-side heart functions will increase cardiac output to systemic circulation, therefore decreasing pulmonary arterial hypertension. Increasing preload will increase ventricular stretch and improve contractility (Frank-Starling Mechanism) which will overcome the afterload of the PAH.
Improving right-sided heart function and fluid management will decrease the symptoms of PAH. The right side of the heart cannot match the afterload of the PAH and begins to undergo fibrosis and chamber dilation. Increasing contractility will help match afterload and decrease EDV. Decreasing blood volume will also improve right-side function. Correct Increasing afterload will force the heart to increase contractility and therefore decrease PAH. PAH is the cause of increased afterload. Drugs targeting pulmonary circulation to decrease afterload can be useful.
Tachycardia, though initially beneficial, potentiates heart failure in the long-term. What is the relationship between tachycardia and heart failure? Tachycardia will increase heart's consumption of oxygen that will decrease delivery of oxygen in systemic circulation. Tachycardia alters the oxygenation that occurs in lungs, leading to decreased oxygen saturation. This change leads to heart failure. Increased heart rate (HR) increases metabolic demand and decreases filling and resting time for the heart. These changes lead to heart failure. Increased HR will increase coronary artery perfusion and increase oxidative stress in the heart muscle. These changes lead to heart failure.
Increased heart rate (HR) increases metabolic demand and decreases filling and resting time for the heart. These changes lead to heart failure. Tachycardia, although beneficial to compensate for early HF, increases myocardial oxygen consumption, decreases diastolic filling time and resting phase of the heart, and decreases coronary artery perfusion. Over time, this will lead to heart failure.
What is the relationship between right-sided heart failure and pulmonary artery stenosis? Decreased pressures on the right side of the heart cause backflow, peripheral edema and failure. Increased blood flow to the pulmonary circulation can lead to right-sided heart failure due to increased workload. Increased pressure developed in the right ventricle can cause hypertrophy and eventual failure of the right side of the heart. Decreased venous return limits the preload on the right side of the heart. This leads to the development of pulmonary artery stenosis.
Increased pressure developed in the right ventricle can cause hypertrophy and eventual failure of the right side of the heart. Development of hypertrophy and the increased workload of the right ventricle are caused by the stenotic PA. The RV has to increase its contraction efforts to overcome the resistance from the PA, and this can lead to right sided heart failure.
The parent of a patient with aortic stenosis would like more information about a new diagnosis of pulmonary venous hypertension. What information should the nurse provide regarding treatment and outcomes? Select all that apply. Keep regular follow-up appointments for observation. Increase water consumption to increase blood volume. Use of vasodilators will improve both the aortic stenosis and the pulmonary venous hypertension. Interventional correction of the stenotic valve will improve cardiac output and decrease the pulmonary hypertension. Pay close attention to symptoms such as exercise intolerance, chest pain, dizziness, syncope, and changes in breathing patterns.
Keep regular follow-up appointments for observation. Keep regular appointments for observation of the aortic stenosis and progression of PAH. Changes in symptoms may require medical intervention. Athletes, depending on the severity of the stenosis and PAH, may need to limit or abstain from competitive sports. Interventional correction of the stenotic valve will improve cardiac output and decrease the pulmonary hypertension. Surgical valvuloplasty decreases the stenosis and improves cardiac output.
The mother of a child with tetralogy of Fallot states that over the past two weeks the child has been experiencing periodic episodes of increased cyanosis, irritability, and moments of deep breathing in the morning. After child is assessed and vitals appear stable what is the most important action for the nurse to take next? Administer oxygen as needed. Administer vasoconstrictors as ordered. Reinforce the importance of the knee-chest position that can increase blood flow to the lungs. Left-to-right shunting will cause volume overload on the heart. Contact the providers as the child is in need of a surgery consult.
Left-to-right shunting will cause volume overload on the heart. Contact the providers as the child is in need of a surgery consult. Left-to-right shunting will increase the volume on the right side of the heart, resulting in both volume and pressure overload. This child is experiencing "tet spells" that include episodes of increased cyanosis with crying, deep respirations, and other abnormal breathing patterns, and increased pulmonary venous return. This evidence of increased hypoxia leaves the child at risk for cerebrovascular accident. Surgical consult is necessary.
What is a major concern associated with transposition of the great vessels when the patient has patent ductus arteriosus (PDA) but no additional septal defect? Limited areas for mixing of blood Limited delivery of blood to lungs Limited oxygenation of blood sent to lungs Limited delivery of blood to systemic circulation
Limited areas for mixing of blood Patient relies on the mixing of blood through the fetal structures (and a septal defect), if present.
A newborn infant has pulmonary atresia with intact ventricular septum. The parents want to know why the health care provider said it was important to keep fetal structures open. How can the nurse explain the rationale for maintaining fetal structures in the newborn infant? Maintaining open fetal structures will allow blood to bypass lungs. This will allow for use of mechanical ventilation. Maintaining open fetal structures will allow blood to make its way to the lungs. This will allow for oxygenation of the blood for the baby. Maintaining open fetal structures will shift pressure in the ventricles. High pressure generated on right side of the heart will force pulmonary blood flow. Maintaining open fetal structures will allow for reversal of blood flow in the heart and body. This will allow for oxygenation of blood from left side of the heart and right side of the heart will pump blood to body.
Maintaining open fetal structures will allow blood to make its way to the lungs. This will allow for oxygenation of the blood for the baby. In the fetus, blood bypasses nonfunctioning lungs using ductus arteriosus and foramen ovale. Foramen ovale will continue to let deoxygenated blood move to left side of the heart. Ductus arteriosus will now have reversed flow; blood will move from aorta into ductus arteriosus and to pulmonary circulation for oxygenation of blood. Then, mixed blood can be pumped to body.
What is the benefit of maintaining a patent ductus arteriosus (PDA) for a child with tetralogy of Fallot? PDA eliminates cyanosis. PDA can be maintained to eliminate cyanosis. PDA will help to maintain the pulmonary blood flow. PDA can be maintained to decrease aortic blood flow. PDA may decrease the shunting of blood from the left side.
PDA will help to maintain the pulmonary blood flow. Tetralogy of Fallot is associated with pulmonary stenosis and right ventricular outflow tract obstruction. This leads to a right-to-left shunt. Maintaining the PDA will create an alternative pathway for blood to take to the lungs and therefore help to oxygenate blood and reduce hypoxemia experienced by the child.
What is the relationship between the fetal cardiac anatomical features and the survivability of complex cardiac lesions in the early neonatal stage? Fetal structures can prevent the formation of pressure gradients and reduce shunting. Patent fetal structures can be removed during surgery and used during the surgical repair. Fetal structures close quickly to prevent aberrant flow. This prevents the mixing of oxygenated and deoxygenated blood. Patent fetal structures maintain pathways for the movement of blood and allow for mixing of oxygenated and deoxygenated blood.
Patent fetal structures maintain pathways for the movement of blood and allow for mixing of oxygenated and deoxygenated blood. Fetal structures (foramen ovale and ductus arteriosus) that can be maintained after birth can improve survivability of patients with heart defects. Theses maintained pathways allow for the movement of blood around possible obstructions or due to pressure gradients. They also allow for the mixing of oxygenated and deoxygenated blood which can reduce hypoxia and therefore improve survivability in children with heart defects.
What conclusions can be drawn regarding clinical manifestations for a patient with a left-to-right ventricular shunt and decreased pulmonary blood flow? Select all that apply. Patient may have polycythemia. Patient may be hypoxemic, resulting in cyanosis. Patient may have increased pulmonary pressures. Patient may have increased oxygen saturation on left side of heart. Patient may have increased cardiac workload and ventricular strain
Patient may have polycythemia. Polycythemia results from decreased systemic oxygenation. The kidney responds by increased RBC production. Correct Patient may be hypoxemic, resulting in cyanosis. Decreased pulmonary blood flow and mixing of blood in the ventricles can result in hypoxemia and cyanosis. Patient may have increased cardiac workload and ventricular strain. Cardiac workload and ventricular strain would increase due to shunting blood and lesion or malformation that limits pulmonary blood flow.
Which statement helps to explain why a patient with Down syndrome might have a marked increase in pulmonary blood flow? Patients with Down syndrome often have left-sided heart failure leading to pulmonary hypertension. Patients with Down syndrome often have decreased pulmonary resistance that leads to increased pulmonary blood flow. Patients with Down syndrome often have cardiac defects associated right-sided hypertrophy. The patient may have pulmonary stenosis. Patients with Down syndrome often have cardiac defects associated with the genetic syndrome. The patient may have an atrioventricular septal defect (AVSD).
Patients with Down syndrome often have cardiac defects associated with the genetic syndrome. The patient may have an atrioventricular septal defect (AVSD). AVSD (atrioventricular septal defect) is often associated with genetic syndromes such as Down syndrome. In AVSD there is abnormal development of both septa and AV valves. Left-to-right shunting increases pulmonary blood flow.
A nurse is measuring blood pressure (BP) in a patient with a stenotic lesion. What should the nurse expect when comparing blood pressures proximal and distal to the lesion? Proximal and distal pressures will be the same; it is the rate of flow that is different. Proximal and distal pressures will be the same since the blood flow rate will be the same. Proximal to the lesion, pressure will be low or absent; distal to the lesion, pressure will be increased. Proximal to the lesion, pressure will be high; distal to the lesion, pressure will be decreased or absent.
Proximal to the lesion, pressure will be high; distal to the lesion, pressure will be decreased or absent. Pressure increases proximal to the lesion (obstruction/stenosis). Distal to the lesion, pressures are decreased. The force of BP pushes against the obstruction. After the obstruction, no additional force is generated.
What should the nurse expect to see regarding pulmonary blood flow if an infant had a ventricular left-to-right shunt? Select all that apply. Pulmonary artery thickening Irreversible vasoconstriction Increased pulmonary blood flow Pulmonary arterial hypertension (PAH) Very high pulmonary vascular resistance
Pulmonary artery thickening Due to increased pressure, pulmonary artery thickening would be an expected finding in a patient with left-to-right shunt. Increased pulmonary blood flow Increased pulmonary blood flow would be expected in a patient with left-to-right shunt. Pulmonary arterial hypertension (PAH) PAH is an expected finding in a patient with left-to-right shunt.
A child presents to the clinic suffering from Truncus Ateriosus. After the nurse administers the diuretic, which physiologic change can the nurse expect to see in the patient over the course of treatment? Reduction in volume overload thereby increasing cardiac output (CO) Increasing resistance in the systemic circulation thereby reducing any potential cyanotic episodes Reduction in vascular resistance and therefore a decrease in the pressure in the common ventricular outflow tract Reduction in blood return to the right side of the heart thereby allowing more blood to enter the common outflow tract
Reduction in volume overload thereby increasing cardiac output (CO) With diuretic therapy the nurse will expect to see a reduction in volume overload in the heart, thereby improving cardiac output and lowering the risk for heart failure.
In the patient with heart failure, many organ systems will be altered. Which affected organ systems have the greatest impact on potentiating the volume overload causing heart failure (HF)? Select all that apply. Renal system Lymphatic system Pulmonary system Integumentary system Gastrointestinal (GI) system
Renal system The renal system maintains fluid and electrolyte balance for body. When cardiac output (CO) is decreased, glomerular filtration rate (GFR) can decrease, leading to activation of renin-angiotensin-aldosterone system (RAAS). Pulmonary system Increased volumes and pressures in the pulmonary system can lead to pulmonary hypertension and edema.
Atrial septal defects are conservatively treated as many spontaneously close. What assumptions can be made regarding the possible outcomes if the defect does not close? Select all that apply. Right-sided pressures will increase. There will be increased systemic pressures. Right side of heart will be volume overloaded. There will be increased pulmonary blood flow. There will be increased oxygen saturation on right side of the heart.
Right-sided pressures will increase. Volume from the high pressure, left side of the heart will create increased pressures on right side of the heart. Right side of heart will be volume overloaded. Volume from the high pressure, left side of the heart will create a volume overload of right side of the heart. Correct There will be increased pulmonary blood flow. Volume from the high pressure, left side of the heart will cause an increase in pulmonary blood flow. Correct There will be increased oxygen saturation on right side of the heart. Volume from highly saturated, left side of the heart will mix with deoxygenated blood on the right side. This will increase oxygen saturation on right side of the heart.
In response to the pathophysiology of heart failure (HF), there is activation of the sympathetic nervous system and the release of hormones in an effort to maintain cardiac output (CO). How do these two systems synergistically increase cardiac output? Select all that apply. Sympathetic nervous system activity increases heart rate. Sympathetic nervous system activity increases stroke volume. Sympathetic nervous system activity initiates vasodilation in most of the peripheral vasculature. Endocrine function of hormones from the heart, such as atrial naturietic peptide, work to increase blood volume. Endocrine function of the hormones of renin-angiotensin-aldosterone-system (RAAS) leads to increased intravascular volume.
Sympathetic nervous system activity increases heart rate. Sympathetic outflow increases heart rate which increases CO. Correct Sympathetic nervous system activity increases stroke volume. Sympathetic outflow increases stroke volume which increases CO. Endocrine function of the hormones of renin-angiotensin-aldosterone-system (RAAS) leads to increased intravascular volume. In response to low blood volume and low blood pressure, the RAAS system works to increase sodium and water reabsorption in the kidney to increase blood volume and increase CO.
The nurse notes that QP/QS ratio (pulmonary-to-systemic ratio) is normal, however the right side of the heart has increased saturation. What conclusion can be drawn from this data? There is a right-to-left shunt. There is a left-to-right shunt. There is increased blood flow out of the right ventricle. There is decreased pulmonary blood flow leading to pulmonary hypotension.
There is a right-to-left shunt. When pulmonary-to-systemic ratio is norma, equal amounts of blood are being pumped by both sides of the heart. A right-to- left shunt would decrease oxygen saturation on the left side of the heart.
What is the most important rationale for monitoring nutritional intake in a child with heart failure (HF)? To determine if child is expending enough energy. The more child eats, the more energy they can expend. To determine if child is obtaining enough nutrients to support increased energy demands of the heart. To determine if patient has pain associated with heart failure, as increased pain will result in decreased dietary intake. To determine extent and sidedness of heart failure. Right-sided failure will not alter feeding habits. Left-sided failure results in decreased appetite and subsequent weight loss.
To determine if child is obtaining enough nutrients to support increased energy demands of the heart. If less nutrition is consumed while more energy is expended, resulting in fewer calories being consumed, the child will develop failure to thrive (FTT).
In patients with coarctation of the aorta, infusion of prostaglandin E1 may be used to keep the ductus arteriosus open. What is the rationale for facilitating patent ductus arteriosus (PDA) when the patient has coarctation of the aorta? To increase oxygenation of blood entering descending aorta To increase pressures in left ventricle and force perfusion of aorta To decrease blood flow distal to lesion and increase blood flow to pulmonary circulation. PDA maintains flow from aorta to lungs To increase blood flow to descending aorta by allowing deoxygenated blood from pulmonary trunk to mix with blood distal to lesion
To increase blood flow to descending aorta by allowing deoxygenated blood from pulmonary trunk to mix with blood distal to lesion Coarctation of the aorta is an obstructive lesion that decreases blood supply to abdominal organs and lower periphery. Maintaining PDA will increase blood flow in the descending aorta.
What is the rationale for administering potent vasoconstriction agents to a child experiencing a hypercyanotic episode? Select all that apply. To decrease the afterload To increase stroke volume To increase systemic vascular resistance To decrease the degree of right-to-left shunting To increase blood flow into the pulmonary circulation
To increase systemic vascular resistance Vasoconstriction will increase systemic vascular resistance and help maintain BP. This increase in pressure will help limit shunting of blood, thereby helping to improve movement of blood out of right ventricle into pulmonary artery and to lungs for oxygenation. Correct To decrease the degree of right-to-left shunting Vasoconstriction can help to limit amount of blood that enters left ventricle through ventricular septal defects. This will help to limit amount of deoxygenated blood entering left ventricle and the aorta into systemic circulation. Correct To increase blood flow into the pulmonary circulation Potent vasoconstrictors can help to limit amount of deoxygenated blood that enters aorta and help to increase amount of blood entering pulmonary artery and lungs for proper oxygenation.
When caring for a child with a right-to-left shunt, what precaution is essential when obtaining IV access? Carefully inspect tubing to ensure adequate pressure in the vein. Use meticulous attention to avoid introducing air bubbles in tubing of IV line. Use careful attention to the access site; placement in the forearm will limit accidental removal. Ensure that the patient will be able to walk to limit deep vein thrombosis. Placement of the IV into a vein of the upper extremity is preferred.
Use meticulous attention to avoid introducing air bubbles in tubing of IV line. There is an increased risk of air embol in patients with right-to-left shunts, which can cause stroke or heart attack.
What is the relationship between left-to-right shunt congenital heart defects and increased pulmonary blood flow? Cardiac workload is increased but pulmonary blood flow is decreased. Cardiac workload is decreased and this will decrease pulmonary blood flow. Volume overload results in the left side of the heart. This decreases pulmonary blood flow. Volume overload results in the right side of the heart and this increases pulmonary blood flow.
Volume overload results in the right side of the heart and this increases pulmonary blood flow. Volume shunts from the left to the right side of the heart resulting in right-sided volume overload. The increase in volume leads to an increase in pulmonary blood flow.
