UWorld Pediatrics: Cardiovascular and Respiratory

A 3-month-old client has stopped breathing. Identify the area where the nurse should check the client's pulse.

The brachial artery is used to detect a pulse in an unresponsive client age <1 year. - Located in between armpit and elbow.

What is a VSD and its bloodflow pattern?

septal opening between ventricles causes left-to-right shunting, leading to excess blood flow to the lungs.

When monitoring an infant with a left-to-right-sided heart shunt, which findings would the nurse expect during the physical assessment?

1) Diaphoresis during feedings 2) Heart murmur 3) Poor weight gain

The nurse is teaching a 9-year-old child with asthma how to use a metered-dose inhaler (MDI). Place the instructions in the appropriate order.

1) First shake MDI and attach it to the spacer. 2) Exhale completely to optimize inhalation of the medication. 3) Place lips tightly around the mouth piece. 4) Deliver a single puff of medication into spacer. 5) Take a slow, deep breath and hold it for 10 seconds to allow for effective medication distribution. 6) After the dose, rinse mouth with water to remove any left-over medication from oral mucous membranes. Spit out the water to ensure no medication is swallowed.

The home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. Which of the following signs of heart failure should the nurse teach the parents to report to the health care provider?

1) cool extremities 2) weight gain 3) decrease in amount of wet diapers 4) puffiness around eyes - TOF often leads to right ventricular hypertrophy

The nurse is caring for a newborn with patent ductus arteriosus. Which assessment finding should the nurse expect?

A loud machine like murmur

A 3-month-old who weighs 8.8 lb (4 kg) has just returned to the intensive care unit after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the health care provider?

Chest tube output of 50 mL in the past hour - The nurse should immediately report chest tube drainage >3 mL/kg/hr over 3 consecutive hours or >5-10 mL/kg over 1 hour, which could indicate postoperative hemorrhage. Cardiac tamponade can occur rapidly in children and can be life-threatening.

The emergency nurse is admitting a 12-year-old client who reports palpitations. Which action should the nurse anticipate?

Instruct patient to hold their breath and bear down - SVT is 200-300/min

A 2-year-old child is brought to the emergency department for a severe sore throat and fever of 102.9 F (39.4 C). The nurse notes that the child is drooling with distressed respirations and inspiratory stridor. What action should the nurse take first?

Place child in tripod position to open airway

When is a systolic ejection murmur heard?

Pulmonic stenosis

A nurse is assessing a 1-month-old infant with an atrial septal defect (ASD). Which assessment finding does the nurse expect?

Murmur

What is the second stage of Kawasaki's disease?

Subacute: - Skin begins to peel from the hands and feet. The child remains very irritable.

What is coarctation of the aorta and what are its manifestations?

abnormal aortic narrowing that results in decreased cardiac output. - The client will exhibit elevated pulse pressure in the upper extremities and diminished pressures in the lower extremities. ***

What is Kawasaki disease?

childhood condition that causes inflammation of arterial walls (vasculitis). - The coronary arteries are affected in KD, and some children develop coronary aneurysms.

What is tretology of fallot? (need more info) ***

cyanotic congenital heart defect commonly manifested by signs of irritability and clubbing of fingers due to oxygen saturation chronically remaining between 65-85% until the client can undergo surgical repair. - Further evaluation of the client's oxygenation is necessary but not urgently required.

When do tet spells occur?

occur during stressful or painful procedures; on waking; and with hunger, crying, and feeding. - Providing a calm environment; reducing hunger with small, frequent meals; and swaddling during procedures can help prevent hypercyanotic spells.

What heart sound is heard in VSD?

Harsh systolic murmur

The nurse assesses a child who has been treated for an acute asthma exacerbation. Which client assessment is the best indicator that treatment has been effective?

Increase in O2 sat and peak flow

Down syndrome (trisomy 21) is often associated with what cardiac anomaly?

It is often associated with the cardiac anomaly AV canal defect. - Assessment typically includes a loud murmur that requires no immediate action when vital signs are stable. - Surgery will correct the anomaly when the neonate grows in size and can tolerate the invasive procedure better.

What is a diastolic murmur heard in?

Mitral stenosis and aortic regurgitation

The triage nurse is assessing an unvaccinated 4-month-old infant for fever, irritability, and open-mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate?

Most cases of epiglottitis are preventable by immunization. - The majority of cases of epiglottitis are caused by Haemophilus influenza type B (HiB), which is covered under the standard vaccinations given during the 2- and 4-month visits.

A nurse is assisting a new mother as she is breastfeeding her infant. The infant has been diagnosed with tetralogy of Fallot. During feeding, the infant becomes cyanotic and is having difficulty breathing. What should be the nurse's first action?

Place infant in knee to chest position

A nurse is teaching the parents of an infant with tetralogy of Fallot. Which of the following actions should the nurse include to reduce the incidence of hypercyanotic spells?

1) encourage smaller, frequent feedings 2) offer a pacifier when infant begins to cry 3) promote a quiet period upon waking 4) swaddle infant during procedures

The nurse is assessing a 3-year-old client in the emergency department and finds dyspnea, high fever, irritability, and open-mouthed drooling with leaning forward. The parents report that the symptoms started rather abruptly. The client has not received age-appropriate vaccinations. Which set of actions should the nurse anticipate?

Intubation in OR with prepared trach kit nearby - When assessing a client with symptoms suggestive of epiglottitis (eg, acutely ill, drooling, leaning forward, dyspnea), the nurse should prepare for an emergency airway.

The nurse is reviewing discharge instructions with the parents of a child who just had a tracheostomy. Which statement made by the parents indicates teaching has been effective?

Clients with a tracheostomy should always carry two spare tubes, one the same size and one a size smaller, to ensure that the tube can be replaced quickly and effectively.

What is the third stage of Kawasaki's disease?

Convalescent: - Symptoms disappear slowly. The child's temperament returns to normal. - Monitor for signs of HF.

What does the initial treatment for Kawasaki's disease include?

IV gamma globulin (IVIG) and aspirin. - IVIG creates high plasma oncotic pressure, and signs of fluid overload and pulmonary edema develop if it is given in large quantities. - Therefore, the child should be monitored for symptoms of heart failure (eg, decreased urinary output, additional heart sounds, tachycardia, difficulty breathing).

What does left to right shunting cause?

Results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation.

The nurse in a clinic is caring for an 8-month-old with a new diagnosis of bronchiolitis due to respiratory syncytial virus (RSV). Which instructions can the nurse anticipate reviewing with the parent?

The focus of home care is on monitoring respiratory status and periodic nasal suctioning using saline nose drops to ease breathing. - Additional fluids should be offered.

What does a VSD put the patient at risk for?

places the client at risk for congestive heart failure (CHF) and pulmonary hypertension. - Clinical manifestations of VSD include a systolic murmur auscultated near the sternal border at the third or fourth intercostal spaces, and hallmark CHF signs (eg, diaphoresis, tachypnea, dyspnea, grunting when eating).

What is the first stage of kawasaki's disease?

Acute: - Sudden onset of high fever that does not respond to antibiotics or antipyretics. - The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue).

The nurse has provided teaching about home care to the parent of a 10-year-old with cystic fibrosis. Which of the following statements by the parent indicates that teaching has been effective?

Cystic fibrosis causes increased viscosity of exocrine gland secretions. - Clients require pancreatic enzyme supplements with meals and snacks; a diet high in carbohydrates, protein, and fat; and increased salt intake during times of significant perspiration. - Clients should also incorporate chest physiotherapy and exercise into their daily routine.

The nurse is providing discharge instructions to the parent of a child with Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported to the health care provider?

Fever - Parents are instructed to monitor them for fever by checking the temperature (orally or rectally) every 6 hours for the first 48 hours following the last fever. - Temperature should also be checked daily until the follow-up appointment. - If the child develops a fever, the health care provider should be notified as this may indicate the acute phase of KD recurrence.