Cardiovascular Disorders
Before for a patient can have a surgery to repair a Tetralogy of fallot they will first have to have a?
Shunt placement
A complete closure of the tricuspid valve that results in mixed blood flow Is considered what?
Tricuspid atresia -An arterial opening needs to be present to allow blood to enter the left atrium.
In what defect(s), there is a right to left shift allowing deoxygenated blood to enter the systemic circulation?
Tricuspid atresia Tetralogy of Fallot -Defects that decrease pulmonary blood flow have an obstruction of pulmonary blood flow and an anatomic defect (ASD or VSD) between the right and left sides of the heart.
Expected findings in cardiomyopathy with DCM:
palpations syncope infant poor feeding respiratory distress
cardiomyopathy in newborns generally occurs due to?
poorly controlled maternal diabetes.
cardiomyopathy diagnostic procedures are:
radiography (chest x-ray) ECG echocardiogram cardiac catheterization
Infection of the inner lining of the heart and the valves that can enter the bloodstream is what infective bacterial?
Infective bacterial endocarditis.
When would you do a surgical procedure for coarctation of the aorta?
Repair of defect recommended for infants 6 months old or less in age.
Patent ductus arteriosus nonsurgical procedures/therapies:
-Administration of indomethacin (to allow for closure) -Insertion of coils to occlude PDA durning cardiac catheterization -Administration of Diuretics (furosemide) -Provide extra calories for infants
Pulmonary stenosis nonsurgical procedures/ therapies:
-Ballon angioplasty with cardiac catheterization
Aortic stenosis nonsurgical procedure/ therapies:
-Ballon dilation with cardiac catheterization -Administer beta blockers , calcium channel blockers
Ventricular septal defect nonsurgical procedure/ therapies are:
-Closure durning cardiac catheterization -Careful observations for spontaneous closure -Diuretics
Atrial septal defect nonsurgical procedure/ therapies are:
-Closure durning cardiac catheterization -Diuretics -Low dose aspirin 6 months after procedure
Therapeutic measures for cardiomyopathy are which of the following select all that apply A. Beta blockers B. Calcium channel blockers C. Ace inhibitors D. Anticoagulants E. Heart transplant
A. Beta blockers B. Calcium channel blockers C. Ace inhibitors D. Anticoagulants E. Heart transplant all of the above are correct
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by adenoma. Which of the following findings should the nurse report to the provider? A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positiive Trousseau's Sign
A. Tachycardia and hypertension D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. thyrotoxicity (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.
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 1.8kg (4lb) B. Heart rate of 125/min C. Soft, flat fontanel D. Systemic murmur
A. Weight gain of 1.8kg (4lb) A 4 lb weight gain indicates increased fluid and worsening of the child's heart failure; therefore; the nurse should report this to the provider. *systemic murmur is an expected finding in VSD.
A nurse is providing teaching to the parent of an infant who has heart failure and a new prescription for digoxin elixir. Which of the following pieces of information should the nurse include> A. Withhold the medication if the infant's heart rate is less than 110/min B. Mix the medication in 120mL (4oz) of infant formula C. Expect the infant to vomit frequently while taking this medication D. Double the dose if the infant had increased edema
A. Withhold the medication if the infant's heart rate is less than 110/min -The parent should withhold the medication if the infant's heart rate is less than 110/min.
In Congenital heart disease what disease(s) cause increased pulmonary blood flow?
ASD- Atrial septal defect VSD- Ventricular septal defect PDA- Patent ductus arteriosus these increased pulmonary blood flow allow blood to shift from the high pressure left side of the heart to the right, lower pressure side of the heart.
A narrowing of the aorta valve?
Aortic stenosis
A hole in the septum between the right and left atria that results in increased blood flow (left-to-right shunt) is indicative of what defect?
Atrial Septal Defect (ASD)
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 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 durning 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 durning feedings E. Provide gavage feeding if respiratory rate exceeds 80/min
Surgical procedures in an infant for pulmonary stenosis?
Brock procedure
Abnormalities of the myocardium which interfere with its ability to contract effectively and can lead to heart failure is?
Cardiomyopathy
A narrowing of the lumen of the aorta, usually at or near the ductus arterious, that results in obstruction of blood flow to the ventricles is what obstructive defect?
Coarctation of the aorta -Elevated blood pressure in the arms -Bounding pulses in the upper extremities -Decreased blood pressure in the lower extremities -Cool skin in the lower extremities -Weak or absence femoral pules -Heart failure in infants -Dizziness, fainting, headaches, or nosebleeds in older children
Complications that arise from Endocarditis are:
Heart failure Myocardial infraction Embolism
Coarctation of the aorta Nonsurgical procedure/therapies:
Infants and children -ballon angioplasty Adolescents -placement of stents
If an infant is experiencing a tricuspid atresia what would they present like?
Cyanosis Dyspnea Tachycardia
What are the 3 classes of cardiomyopathy?
Dilated (DCM) -Most common Hypertrophic (HCM) -Autosomal genetic increases in heart muscle mass leads to abnormal diastolic function Restrictive -Rare; prevents filling of the ventricles and causes a decrease in diastolic volume.
What kinds of spells can tricuspid atresia and tetralogy of fallot cause?
Hypercyanotic spells (blue, or "Tet" spells) manifest as acute cyanosis and hyperpnea.
Left side of the heart is underdeveloped. An ASD or patent foramen oval allows for the oxygenation of the blood is what mixed defect?
Hypoplastic left heart syndrome Signs and symptoms -Mild cyanosis -Heart failure -Lethargy -Cold hands and feet -Once PDA closes, progression of cyanosis and decreased cardiac output results in eventual cardiac collapse
Surgical procedures for Aortic stenosis?
Norwood procedure Aortic Valvotomy
Hypoplastic left heart syndrome surgical procedures happens in three stages that start directly after birth.
Norwood procedure Glenn shunt Fontan procedure
Defects where blood flow exiting the heart meets an area of narrowing (stenosis), which causes obstruction of blood flow is an indication of what defect?
Obstructive defects -The pressure that occurs before the defect is increased (ventricle) and the pressure that occurs after the defect is decreased. This results in decreased cardiac output. *these children can present with manifestations of heart failure.
What defects can decrease cardiac output?
Obstructive defects.
An infant who has Ventricular septal defect (a hole in the septal wall between the ventricles) can have increased pulmonary vascular resistance but it is unlikely to have cyanosis why?
Oxygenation of the blood remains adequate for systemic circulation.
An infant who has a patent ductus arteriosus will have blood vessel connecting the pulmonary artery to the aorta. The infant can have increased pulmonary vascular resistance, but?
Oxygenation of the blood remains adequate in systemic circulation.
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, what does this do for the systemic circulation?
Oxygenation of the blood remains adequate in systemic circulation.
The normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (left-to-right shunt) this is indicative of what defect?
Patent Ductus Arteriosus (PDA) - Systolic murmur (machine hum) -wide pulse pressure -bounding pulses -asymptomatic (possibly) -Rales
Surgery to switch the arteries in a patient that has transposition of the great arteries will happen within what time frame?
The first two weeks of life. -IV prostaglandin E (keeps the ducts open)
What type of surgical procedure would there be for patent ductus arteriosus?
Thoracoscopic repair (ligate vessels)
A hole in the septum between the right and left ventricle that results in increased blood flow (left to right shunt) is indicative of what defect?
Ventricular Septal Defect (VSD) -many VSDs close spontaneously early in life -loud harsh murmur auscultated at the left sternal border
Complete repair for a tetralogy of fallot will be replaced within what time frame?
Within the first year of life.
Expected findings in cardiomyopathy with HCM:
chest pain syncope dyspnea
The truncus ateriosus surgical procedure happens....
first month of life.
Although anyone can develop PAH (pulmonary artery hypertension), There can be a genetic link in children who have family who have PAH. What are the expected findings?
-Dyspnea with exercise -Chest Pain -Syncope
Infants with narrowing of the aorta valve will have what signs and symptoms?
-Faint pulses -Hypotension -Tachycardia -Poor feeding tolerance
Children would present in what way if they had tricuspid atresia?
-Hypoxemia -Clubbing of the fingers
Children with narrowing of the aorta valve will have what signs and symptoms?
-Intolerance to exercise -Dizziness -Chest pain -Possible ejection murmur
Atrial septal defect surgical procedure are:
-Patch closeure -Cardiopulmonary bypass
Ventricular septal defect surgical procedures are:
-Pulmonary artery banding -Complete repair with patch ( increased risk for heart block)
What are the defect(s) of obstructive defects?
-Pulmonary stenosis -Aortic stenosis -Coarctation of the aorta
In tetralogy of fallot what are the four defects that result in mixed blood flow?
-Pulmonary stenosis -Ventricular septal defect -Overriding aorta - Right ventricular hypertrophy
What are the diagnostic procedures in Pulmonary artery hypertension?
-Radiography (chest x-ray) - Electrocardiogram -Echocardiography -Cardiac catheterization
Failure of septum formation, resulting in single vessel that comes of the ventricles is what mixed defect condition?
-Truncus arteriosus Signs and Symptoms - Heart failure -Murmur - Variable cyanosis - Delayed growth -Lethargy - Fatigue - Poor feeding habits
What are the manifestations of endocarditis?
-low-grade fever -malaise -decreased appetite with weight loss
Obstruction of blood flow from the ventricles due to a narrowing in the pulmonary valve or pulmonary artery is what defect?
Pulmonary Stenosis -Systolic ejection murmur -Asymptomatic (possibly) -Cyanosis varies with defect, worse with severe narrowing -Cardiomegaly -Heart failure
At birth a baby would present like what if they have tetralogy of fallot?
-Cyanosis at birth - progressive cyanosis over the first year of life -Systolic murmur - Episodes of acute cyanosis and hypoxia (blue or "Tet" spells)
A nurse is caring for a child who has bacterial endocarditis. The child is scheduled to receive moderate- term antibiotic therapy and requires a peripherally inserted central catheter (PICC). Which of the following statements should the nurse include when teaching the child's parent? A. "The PICC line will last for several weeks with proper care." B. "The public health nurse will rotate the insertion site every 3 days." C. " You will need to ensure the arm board is in place at all times." D. " Your child will go to the operating room to have a line placed."
A. "The PICC line will last for several weeks with proper care." A PICC line is the preferred venous access device for short- to moderate- term IV therapy. It can remain in place for long periods with proper care.
A nursing is assessing a client who has a fluid volume overload from a cardiovascular disorder. Which of the following manifestations should the nurse expect? (Select all that apply) A. Jugular vein distension B. Moist crackles C. Postural hypotension D. Increased heart rate E. Fever
A. Jugular vein distension B. Moist crackles D. Increased heart rate The increased venous pressure due to excessive circulating blood volume results in neck vein distension. Moist crackles are an indicator of pulmonary edea that can quickly lead to death. Fluid volume excess (hypervolemia) is an expansion of fluid volume in the extracellular compartment, which results in an increased heart rate and bounding pulses.
A nurse is caring for an infant who has tetralogy of Fallot and is experiencing a hypercyanotic episode. Which of the following actions should the nurse take? A. Place the infant in a Knee-chest position B. Initiate a fluid restriction C. Provide oxygen by nasal cannula D. Administer acetaminophen
A. Place the infant in a Knee-chest position - The nurse should place the infant in a knee-chest position durning a hypercyanotic episode. This position reduces the return of desaturated blood from the legs through the venous system and promotes the diversion of blood into the pulmonary artery.
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 the 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 the infant's urinary output
A. Tell the guardian that a repeat dose of the medication should not be given. -The greatest risk to this infant is an injury from digoxin toxicity. Therefore, the priority action for the nurse to take is to instruct the guardian not to administer another dose of the medication. The nurse should follow-up with the guardian frequently to determine if the child has further episodes of vomiting. If so, the nurse should notify the provider immediately because vomiting is a possible indication of digoxin toxicity.
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 (VSD) C. Coarctation of the aorta D. Patent ductus arteriosus (PDA)
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.
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 (VSD) 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 teh systemic circulation without oxygenation.
A nurse is providing care for a child with pulmonary artery hypertension. The child and family are waiting for the nurse to care for them. What should the nurse prepare the child and family for? A. A blood transfusion B. A lung transplant C. Pain medication D. Treatment options
B. A lung transplant
A nurse is caring for an infant who is experiencing a hypercyanotic episode. The nurse should expect to administer what medication to treat hypercyanotic episode? A. Administer Acetaminophen B. Administer Morphine C. Administer Iv Na solution D. Administer IV push Acetaminophen
B. Administer Morphine -The nurse should expect to administer morphine to treat the hypercyanotic episode
A nurse is assessing a child who has ventricular septal defect (VSD). 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 - The sound is transmitted in the direction of blood flow, so any back flow of blood from the left to the right ventricle through the septal defect is best heard in this area.
A infant is being seen for patent ductus arteeriosus. The provider wants the nurse to administer indomethacin (to allow for closure). What teaching should the nurse give to the parent of the infant? A. Give extra feedings B. Provide extra calories for infants C. Do not feed the baby with medication D. The infant can take indomethacin with juice
B. Provide extra calories for infants
An infant that is experiencing a hypercyanotic episode an needs oxygen. What device should the nurse expect to put on the infant to deliver the oxygen?
Face mask -The nurse should apply the face mask to the infant to deliver 100% oxygen to treat the hyprecyanotic episode.
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 microunits/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.
What do the manifestations of pulmonary blood flow indicate findings of?
Heart failure -increased blood volume on the right side of the heart increases pulmonary blood flow
High risk children require what prior to dental and surgical procedures?
Prophylactic antibiotics -The high risk group of children are the children who have, -artificial heart valves -previous diagnosis of infective endocarditis -unrepaired cyanotic congenital heart disease - repaired congenital heart disease using prosthetic material or device durning the first 6 months of the procedure -residual defects after congenital heart disease repair.
High blood pressure in the arteries of the lungs that is a progressive and eventually fatal disease. What disease is this that there is no cure for?
Pulmonary artery hypertension
Surgical procedures in a child for pulmonary stenosis?
Pulmonary valvotomy
A surgical procedure for tricuspid atresia has surgery in 3 stages.
Shunt placement Glenn procedure Modified Fontan procedure
A condition in which the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to left ventricle instead of the right. A septal defect or a PDA must exist in order for to oxygenate the blood. What condition is this?
-Transposition of the great arteries Signs and Symptoms -Murmur depending on presence of associated defect -Severe to less cyanosis depending on the size of the associated defect -Cardiomegaly -Heart failure
Expected findings in cardiomyopathy clients?
-tachycardia and dysrhythmias -dyspnea -Hepatosplenomegaly -fatigue and poor growth
A nurse is reviewing the morning laboratory results of an infant who is receiving digoxin and furosemide for treatment of heart failure. Which of the following findings should the nurse report to the provider? A. Sodium 140 mEq/L B. Calcium 10.2 mg/dL C. Chloride 100 mEq/L D. Potassium 3.2 mEq/L
D. Potassium 3.2 mEq/L The nurse should identify that the potassium level of 3.2 mEq/L is below the expected reference range of 4.1 to 5.3 mEq/L for an infant. Therefore, the nurse should report this to the provider.
