C.V. Disturbances (Peds Exam II)
What nursing considerations should be taken in patients taking digoxin?
Check potassium levels, check apical pulse for 1 min BEFORE administering as dose should be held if HR <70 bpm in a child or <90 bpm in an infant, digoxin toxicity (often presents as bradycardia)
What should be checked in the cardiovascular system?
Chest symmetry and cap refill.
What are the symptoms of Kawasaki Disease?
Fever (that lasts for at least 5 days) with extreme irritability. Inflammation of blood vessels, potential coronary artery disease
What does Cardiac Echo show in cases of Tetralogy of Fallot?
Mixed blood entering the aorta.
What are the clinical signs and symptoms of a child with Kawasaki disease?
Red/bloodshot eyes, red & cracked lips or red tongue, red/swollen hands or feet, high fever, rash involving much of body
ID the defect: Cyanotic Decreased Pulmonary Blood flow Cardiac Echo = mixed blood entering the aorta
Tetralogy of Fallot
ID the defect: Hypercyanotic episodes Poor weight gain Polycthemia boot shaped heart on X-Ray
Tetralogy of Fallot
What are examples of Cyanotic Defects?
Tetralogy of Fallot (ToF) Transposition of the Great Arteries (TGA).
What does ToF stand for?
Tetralogy of Fallot; a cyanotic defect causing decreased pulmonary blood flow.
What is coarctation of the aorta?
A congenital condition characterized by narrowing of the large blood vessel branching off the heart.
What is the nursing care for Kawasaki Disease?
Administration of Aspirin and Immune globulin, ensuring comfort, maintaining skin cleanliness.
What are the frequent assessments for Kawasaki Disease?
Administration of Aspirin and Immune globulin. Provide comfort Keep skin clean and dry, lubricate lips, cool compresses Frequent small soft foods and tepid liquids Passive ROM to facilitate joint movement
A nurse is reviewing the risk factors for the development of congenital heart disease with a client who is planning to conceive. Which of the following conditions should the nurse include as a maternal risk factor? A. Preeclampsia B. Alcohol consumption C. Placenta previa D. Late prenatal care
B. Alcohol consumption
When may the dose of digoxin be withheld?
If the pulse is abnormal (<70 bpm in a child or <90 bpm in an infant)
What can be done once bowel sounds are positive?
Begin clear liquids and advance the diet.
What do obstructive heart defects hinder?
Blood flow through the heart or the large vessels near it
A nurse is planning preoperative teaching for a school-age child who is scheduled for cardiac surgery. Which of the following actions should the nurse plan to take when teaching the child? A. Limit teaching sessions to 10 min B. Use simple, concrete terms when giving explanations C. Use photographs to help explain the procedure D. Conduct the teaching session 2 days before the procedure
C. Use photographs to help explain the procedure
What are symptoms of heart defects seen upon when assessing past history?
Cyanosis, poor weight gain, cough, syncope, respiratory infections, tiring/sweating/breathing fast
What are some symptoms parents should look for in a child with a heart defect?
Cyanosis, poor weight gain, increased respiratory infections.
What symptoms should parents look for in a child with a heart defect?
Cyanosis, poor weight gain, increased respiratory infections.
What are the different types of heart defects?
Cyanotic, acyanotic, or obstructive defects
What is the difference between cyanotic and acyanotic heart defects?
Cyanotic: decreased pulmonary blood flow, Acyanotic: increased pulmonary blood flow
What is the main complication of untreated coarctation of the aorta?
Cyanosis or acyanosis, depending on the severity.
What are cyanotic heart defects?
Defects causing decreased pulmonary blood flow.
What are acyanotic heart defects?
Defects causing increased pulmonary blood flow.
What can blood flow changes in congenital heart defects result in?
Deoxygenated blood circulating the body or increased blood flow to the lungs
What can blood flow changes in congenital heart defects cause?
Deoxygenated blood to circulate or increased blood flow to the lungs.
Why is Transposition of the Great Arteries life-threatening at birth?
Dependent on mixing of systemic and pulmonary blood.
What can bradycardia indicate in children taking Digoxin?
Digoxin toxicity.
Give examples of acquired cardiac dysfunction.
Eisenmenger Syndrome and Kawasaki disease.
What is the long-term consequence of an untreated congenital heart defect?
Eisenmenger Syndrome, a severe type of pulmonary hypertension.
What is the effect of Acyanotic Defects on pulmonary blood flow?
Increased pulmonary blood flow.
What can be used to treat hypercyanotic spells?
Morphine Sulfate.
What should be evaluated in the respiratory system?
Respiratory rate and pattern.
What should one know about blood flow changes caused by congenital heart defects?
The specific changes (increase or decrease) of pulmonary blood flow.
What are signs of distress during feeding?
Tiring, sweating, breathing heavy/fast.
What does TGA stand for?
Transposition of the Great Arteries; a type of cyanotic defect.
Give an example of a defect causing increased pulmonary blood flow.
Ventricular Septal Defect (VSD).
What are potential early (24-48 hour) post-op complications?
fever/early infection, ileus, pulmonary consolidation from immobility, slow to "wake up" due to CNS perfusion state, acute renal failure (usually transient), patch/stent/repair failure
Hypercyanotic Spells (treatment)
•Knee Chest •100% Oxygen Blow-by •Morphine IV or SQ to relax infant and relax spasm of infundibulum. •Anticipate Triggers •Calm Approach •Knee Chest
At what heart rate should you withhold Digoxin?
<70 bpm in a child <90 bpm in an infant. • OR as ordered (ATI INFANT withhold <110/min)
A nurse in a provider's office receives a phone call from the guardian of an infant who just vomited after the administration of digoxin. Which of the following actions should the nurse take first? A. Tell the guardian that a repeat dose of medication should not be given B. Verify the prescribed medication regimen C. Determine if the infant has been exposed to others who are ill D. Ask the guardian about the infant's urinary output
A. Tell the guardian that a repeat dose of medication should not be given
What is a distinctive feature of Tetralogy of Fallot in an X-ray?
Boot shaped heart.
What is a distinctive sign of Tetralogy of Fallot on an X-ray?
Boot-shaped heart.
ID the defect: * Neither cynotic or acynotic BUT still obstructs blood flow •Diminished pulse in lower extremities •Poor color •Delayed capillary refill time •Decreased urine output •Congestive Heart Failure with pulmonary edema
Coarctation of the aorta
What should parents understand about exercise tolerance in children with heart defects?
It may be limited, especially in older children.
When providing nursing teaching, what should be encouraged for joint movement in children with Kawasaki Disease?
Passive range of motion exercises
What are examples of Acyanotic Defects?
Patent Ductus Arteriosis (PDA) and Ventricular Septal Defect (VSD).
What does PDA stand for?
Patent Ductus Arteriosis; a type of acyanotic defect.
What are diuretics used to treat?
Pulmonary and peripheral edema.
What can symptoms in the respiratory system indicate?
Pulmonary edema and increased work of breathing (WOB).
What is Eisenmenger Syndrome?
RIGHT --> LEFT FLOWING SHUNT d/t increase mmHg in the R.V. A severe type of pulmonary hypertension, a long-term complication of an untreated congenital heart defect. originally caused by left-to-right shunting of blood from a hole in the heart wall.
What should be monitored during the post-op hospital course?
Strict I & O, daily weights, deep breathing & coughing, weaned off sedation/pain meds/vasoactive drips, 24-48 hours ambulating, bowel sounds, line removal (central line, urine catheter, chest tube), post-op appointment
Can Coarctation of the Aorta be classified as both acyanotic and cyanotic?
Yes.
What are potential immediate (first 24 hours) post-op complications?
hemorrhaging due to inhibited clotting from bypass or suture failure (>30 ml/kg/hour out of chest tube)
ID the defect: Life threatening at birth Baseline oxygen saturations often run at 70-80 on Postnatal survival is dependent upon mixing of systemic and pulmonary blood. Requires a connection to allow mixing of blood
Transposition of the great arteries
ID the defect: •Cyanotic •Respiratory distress •Cardiac Echo will show separate blood flow •Xray shows egg on a string cardiac borders
Transposition of the great arteries
What is Kawasaki Disease?
An acute systemic vasculitis that can lead to coronary artery disease if not treated early.
A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? A. Diastolic murmur B. Murmur at the left sternal border C. Cyanosis that increases with crying D. Widened pulse pressure
B. Murmur at the left sternal border A ventricular septal defect (a hole in the septal wall between the ventricles) is an acyanotic heart defect. A systolic murmur can be heard best at the lower left sternal border. The sound is transmitted in the direction of blood flow, so any backflow of blood from the left to the right ventricle through the septal defect is best heard in this area. Incorrect Answers: A. A diastolic murmur is an expected finding in a child who has an atrial septal defect. C. Cyanosis that increases with crying is an expected finding in a child who has an atrioventricular canal defect. D. Widened pulse pressure is an expected finding in a child who has patent ductus arteriosus.
What factors should be considered in managing children with heart diseases at home?
Financial cost for care, emotional support, and education for parents/guardians about the disorder.
What dietary recommendations is a part of comfort measures for nursing management of children with Kawasaki Disease?
Frequent small soft foods and tepid liquids
In Kawasaki DZ what causes the wall of coronary arteries to weaken?
Aneurysm
What are the potential complications of Kawasaki Disease?
Aneurysms leading to ischemic heart disease and infarcts
What is a potential symptom of Kawasaki Disease?
Aneurysms leading to ischemic heart disease and potentially infarcts.
What complications can arise from Kawasaki Disease?
Aneurysms, leading to ischemic heart disease and infarcts.
What should be checked before administering Digoxin?
Apical pulse for 1 minute.
A nurse is providing teaching to the guardian of a child who has Kawasaki disease. Which of the following statements by the guardian indicates an understanding of the teaching? (Select all that apply.) A. "My child will likely be irritable for the next few weeks." B. "I will notify my child's doctor if the skin on her hands or feet begins to peel." C. "I will ensure my child does not receive any live vaccines for at least 18 months." D. "I will keep a record of my child's temperature until she has no fever for several days." E. "My child will have joint stiffness primarily at the end of the day."
Correct Answers: A. "My child will likely be irritable for the next few weeks." C. "I will ensure my child does not receive any live vaccines for at least 18 months." D. "I will keep a record of my child's temperature until she has no fever for several days" - diagnosed with Kawasaki disease will likely be irritable for up to 2 months. - Kawasaki disease receives high doses of gamma globulin during the initial phase, which might result in the inability to produce adequate antibodies in response to a live vaccine; therefore, these vaccines should be delayed for 11 months. **temperature of this child who has Kawasaki disease should be recorded until she has been afebrile for several days. Incorrect Answers: B. Peeling of the skin of the hands and feet is expected for a child who has Kawasaki disease. The peeling does not cause any pain and usually occurs between the second and third week. There is no need to report this manifestation to the child's provider. E. A child who has Kawasaki disease will likely have joint stiffness and arthritis-related symptoms for several weeks. The joint stiffness is typically worse during cold weather and in the morning.
A nurse is caring for a child who has tetralogy of Fallot. Which of the following laboratory values should the nurse expect to find? A. Platelet count of 20,000/mm^3 B. WBC 4,000/mm^3 C. Thyroid stimulating hormone 7.0 microunts/mL D. RBC 6.8 million/uL
D. RBC 6.8 million/uL A child who has tetralogy of Fallot experiences cyanosis; therefore, the body responds by increasing RBC production (polycythemia) in an attempt to supply oxygen to all body parts. Incorrect Answers: A. A platelet count of 20,000/mm^3 is below the expected range. A child who has tetralogy of Fallot will not have a decreased platelet count. B. A WBC count of 4,000/mm^3 is below the expected reference range. A child who has tetralogy of Fallot will not have neutropenia. C. This hormone level is above the expected reference range. A child who has tetralogy of Fallot will not have changes in thyroid function levels.
A nurse is teaching the parents of a child who has rheumatic fever. Which of the following statements by a parent indicates an understanding of the teaching? A. "My child may take aspirin for his joint pain." B. "My child will need a blood transfusion prior to discharge." C. "I will need to wear a gown when I'm in my child's room." D. "I will apply lotion to my child's peeling hands."
A. "My child may take aspirin for his joint pain." Children who have rheumatic fever may take salicylates (aspirin) to control the inflammatory process that occurs in the joints. Incorrect Answers: B. A child who has rheumatic fever does not require blood transfusions since there is no blood loss from this disorder. C. A child who has rheumatic fever only needs standard isolation precautions. Rheumatic fever is an immune response that occurs after an infection with group Aß-hemolytic streptococci. D. Kawasaki disease causes peeling hands, but rheumatic fever does not.
An 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following responses should the nurse provide? A. "Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." B. "I cannot administer routine vaccines to children while they are in the hospital." C. "Your child can receive the MMR vaccine once his fever is gone." D. "I can administer the measles and rubella vaccines, but I cannot administer the mumps vaccine."
A. "Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." The nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines like MMR. The MMR immunization should be postponed for 3 to 6 months. Incorrect Answers: B. The toddler cannot receive the vaccine while in the hospital because the antibodies in the IVIG can interfere with the action of the MMR vaccine. However, hospitalization is not the reason for the immunization delay. C. The toddler will not be able to receive the MMR vaccine for a minimum of 3 months after completion of IVIG treatment, as the antibodies in the IVIG can interfere with the action of the MMR vaccine. D. These 3 vaccines are preferably given together as a single vaccine. The MMR vaccine contains live viruses, and the antibodies of the IVIG can interfere with the action of the vaccine.
A nurse is caring for a 4-month-old infant who has tetralogy of Fallot and experiences a hypercyanotic spell. Which of the following actions should the nurse take? A. Place the infant in knee-chest position • B. Begin CPR • C. Prepare to intubate the infant • D. Administer IV adenosine
A. Place the infant in knee-chest position The nurse should identify that a hypercyanotic spell occurs when a vascular spasm reduces pulmonary blood flow and forces blood to shunt from the right ventricle to the left ventricle through the ventricular septal defect. The nurse should place the infant in a knee-chest position to increase systemic vascular resistance, which will help force more blood through the pulmonary artery. Incorrect Answers: B. The nurse should identify that a hypercyanotic spell is a temporary period of hypoxia that can occur in response to crying, feeding, or straining during a bowel movement. The nurse should not initiate CPR because the infant is still breathing and has a pulse. C. The nurse should administer 100% oxygen via facemask to treat the hypoxia that occurs during a hypercyanotic spell. D. The nurse should not administer adenosine to an infant experiencing a hypercyanotic spell. Adenosine is an antiarrhythmic used in the treatment of supraventricular tachycardia.
A nurse is caring for a group of infants with congenital heart defects. For which of the following defects should the nurse expect to observe cyanosis? • A. Transposition of the great arteries • B. Ventricular septal defect • C. Coarctation of the aorta • D. Patent ductus arteriosus
A. Transposition of the great arteries An infant who has transposition of the great arteries will have severe cyanosis because reversal of the anatomical position of the aorta and pulmonary artery allows venous blood to enter the systemic circulation without oxygenation. Incorrect Answers: B. An infant who has a ventricular septal defect (a hole in the septal wall between the ventricles) can have increased pulmonary vascular resistance but is unlikely to have cyanosis because oxygenation of the blood remains adequate for systemic circulation. C. An infant who has coarctation of the aorta (constricted segment of the aorta that obstructs blood flow to the body) is unlikely to have cyanosis. Even though the left ventricle must generate higher than normal pressures for adequate stroke volume, oxygenation of the blood remains adequate for the systemic circulation. D. An infant who has a patent ductus arteriosus will have a blood vessel connecting the pulmonary artery to the aorta. The infant can have increased pulmonary vascular resistance, but oxygenation of the blood remains adequate for systemic circulation.
A nurse is assessing a 2-month-old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider? A. Weight gain of 1.8 kg (4 lb) B. rate of 125/min C. Soft, flat fontanel D. Systemic murmur
A. Weight gain of 1.8 kg (4 lb) A 4 lb weight gain indicates increased fluid and worsening of the child's heart failure; therefore, the nurse should report this finding to the provider. Incorrect Answers: B. A heart rate of 125/min is an expected finding in a 2-month-old infant. C. A soft, flat fontanel is an expected finding in a 2-month-old infant. D. A systemic murmur is an expected finding in an infant who has a ventricular septal defect.
What teaching should parents of a child with Kawasaki Disease be given on its management?
Avoid contact sports for the child, limit strenuous activity, and monitor cardiac
A nurse is planning care for an infant who has heart failure. Which of the following interventions should the nurse include in the plan to meet the nutritional needs of the infant? (Select all that apply.) A. Offer the infant a feeding every 2 hr B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min
B. Allow 30 min to complete each feeding C. Gradually increase the caloric density of the formula D. Position the infant semi-upright during feedings E. Provide gavage feeding if respiratory rate exceeds 80/min The nurse should allow 30 minutes for each feeding. This length of feeding allows adequate intake without causing the infant to get overly fatigued or to lose needed rest time before the next feeding. The nurse should plan to provide the infant with a formula that has increased caloric density. An infant who has heart failure has an increased metabolic rate due to impaired cardiac function. Adding expressed breast milk or enteral nutrition formula or oil to the formula provides the infant with increased calories in a decreased volume of feeding. The nurse should gradually increase the caloric density of the feeding by 2 kcal/oz/day to promote infant tolerance and decrease the risk of diarrhea. The nurse should plan to hold the infant in a semi-upright position during feedings to promote maximum chest expansion and decrease the risk of respiratory distress. The nurse should plan to withhold oral feedings and provide gavage feedings if the infant shows indications of stress or fatigue. An infant who has a respiratory rate of 80/min to 100/min has tachypnea, which is an indicator of infant stress.
What is an important factor in pediatric heart history assessment?
How the baby feeds. Also color (ever turned blue), tiring/sweating/breathing fast or heavy, cough, weight gain or unable to gain weight, exercise intolerance in older children, syncope/dizziness, increased # of respiratory infection
What does it indicate if a child has turned blue?
Potential cyanosis.
What are diuretics commonly prescribed for?
Treating pulmonary and peripheral edema.
