Congenital heart defects
Kawasaki disease
High fever that doesn't respond to therapy Swollen hands/feet, enlarged joints Enlarged cervical lymph nodes (inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. Tx: administer Ibuprofen for inflammation and platelet aggregation IV immunoglobulin to decrease immune response ASA 80-100mg/kg/day-fever, then 3-5mg/kg/day-antiplatelet
pulmonic stenosis
Narrowing at the entrance to the pulmonary artery causes Right ventricular hypertrophy and decreased pulmonary blood flow PDA partially compensates for obstruction-keep open by administering prostaglandins (R) sided heart failure loud systolic ejection murmur cardiomegaly-(R) ventricular enlargement Tx: balloon angioplasty
Nursing care for Acyanotic Defects (VSD, ASD, PS, PDA, AS, COA)
THINK CHF daily weights, I&O, palpate pulses, cap refill, assess for changes in skin color/integrity, diuretics, fluid restriction, elevate HOB, feed smaller amounts, adjust nipple size, gavage feed
Nursing care for cyanotic defects (TOF, Tricuspid Atresia, TofGV, Truncus Arteriosus)
Think cyanosis, clubbing, PGE, dyspnea and surgery Ineffective tissue perfusion R/T altered oxygenation Monitor O2 saturation, administer oxygen Teach parents signs and treatment of hypercyanotic episodes Risk for infection Administer prophylactic antibiotics Disallow visitors with respiratory illnesses Delayed growth and development Monitor food and fluid intake, I & O Daily weights
prostaglandin
Vasodilator, administered IV to maintain ductal patency Monitor infusion flow rate, main side effect is decrease in blood pressure when first started Evaluate peripheral perfusion and respiratory status frequently Use air filter on tubing to prevent air emboli
1. The nurse explains that a ventricular septal defect will allow: a. blood to shunt left to right, causing increased pulmonary flow and no cyanosis. b. blood to shunt right to left, causing decreased pulmonary flow and cyanosis. c. no shunting because of high pressure in the left ventricle. d. increased pressure in the left atrium, impeding circulation of oxygenated blood in the circulating volume.
a
10. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. The nurse can determine the father understood the instructions when he states "If the baby turns blue, I will: a. hold him against my shoulder with his knees bent up toward his chest." b. lay him down on a firm surface with his head lower than the rest of his body." c. immediately put the baby upright in an infant seat." d. put the baby in supine position with his head elevated."
a
2. The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is: a. a loud, harsh murmur with a systolic tremor. b. cyanosis when crying. c. blood pressure higher in the arms than in the legs. d. a machinery-like murmur.
a
4. When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting: a. increases the return of venous blood back to the heart. b. decreases arterial blood flow away from the heart. c. is a common resting position when a child is tachycardic. d. increases the workload of the heart.
a
5. An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood is: a. circulated through the lungs again, causing pulmonary circulatory congestion. b. shunted past the pulmonary circulation, causing pulmonary hypoxia. c. shunted past cardiac arteries, causing myocardial hypoxia. d. circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.
a
9. The nurse is caring for a child with a diagnosis of Kawasaki disease. The child's parent asks the nurse, "How does Kawasaki disease affect my child's heart and blood vessels?" The nurse's response is based on the understanding that: a. inflammation weakens blood vessels, leading to aneurysm. b. increased lipid levels lead to the development of atherosclerosis. c. untreated disease causes mitral valve stenosis. d. altered blood flow increases cardiac workload with resulting heart failure.
a
A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? A. Apical heart rate of 60. B. Sweating across the forehead. C. Doesn't suckle well. D. Respiratory rate of 30 breaths per minute
a
The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? A. Weighing the diapers B. Inserting a Foley catheter C. Comparing intake with output D. Measuring the amount of water added to formula
a
Transposition of the great vessels
a congenital abnormallity where the aorta is attached to the righ ventricle and the pulmonary artery to the left ventricle (this is backwards and leads to two separate blood routes) needs immediate dx and surgical intervention-arterial switch procedure prior to surgery-prostaglandins and oxygenation at least 75%
19. How would the nurse caring for an infant with congestive heart failure (CHF) modify feeding techniques to adapt for the child's weakness and fatigue? Select all that apply. a. Feeding more frequently with smaller feedings b. Using a soft nipple with enlarged holes c. Holding and cuddling the child during feeding d. Substituting glucose water for formula e. Offering high-caloric formula
abce
21. What assessment(s) in a child with tetralogy of Fallot would indicate the child is experiencing a paroxysmal hypercyanotic episode? Select all that apply. a. Spontaneous cyanosis b. Dyspnea c. Weakness d. Dry cough e. Syncope
abce
20. The nurse uses a diagram to illustrate what four structural heart anomalies that comprise tetralogy of Fallot? Select the four that apply. a. Hypertrophied right ventricle b. Patent ductus arteriosus c. Ventral septal defect d. Narrowing of pulmonary artery e. Dextroposition of aorta
acde
12. A child has an elevated antistreptolysin O (ASO) titer. Which combination of symptoms, in conjunction with this finding, would confirm a diagnosis of rheumatic fever? a. Subcutaneous nodules and fever b. Painful, tender joints and carditis c. Erythema marginatum and arthralgia d. Chorea and elevated sedimentation rate
b
6. An appropriate nursing action related to the administration of digoxin (Lanoxin) to an infant would be: a. counting the apical rate for 30 seconds before administering the medication. b. withholding a dose if the apical heart rate is less than 100 beats/min. c. repeating a dose if the child vomits within 30 minutes of the previous dose. d. checking respiratory rate and blood pressure before each dose.
b
7. A child develops carditis from rheumatic fever. The nurse knows that the areas of the heart affected by carditis are the: a. coronary arteries. b. heart muscle and the mitral valve. c. aortic and pulmonic valves. d. contractility of the ventricles.
b
8. The comment made by a parent of a 1-month-old that would alert the nurse about the presence of a congenital heart defect is: a. "He is always hungry." b. "He tires out during feedings." c. "He is fussy for several hours every day." d. "He sleeps all the time."
b
The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicate a need for further instruction? a. a balance of rest and exercise is important b. i can apply lotion or powder to the incision if it is itchy c. activities in which my child could fall need to be avoided for 2-4 weeks d. large crowds of people need to be avoided for at least 2 weeks after surgery
b
15. When the child with rheumatic fever begins involuntary, purposeless movements of her limbs, the nurse recognizes that this is an indication of: a. seizure activity. b. hypoxia. c. Sydenham's chorea. d. decreasing level of consciousness.
c
16. The nurse clarifies to the parents of a 4-year-old child recovering from rheumatic fever that the child will need to receive monthly injections of penicillin G for a minimum of _____ year(s). a. 1 b. 2 c. 5 d. 10
c
17. The nurse is aware that the characteristics of high-density lipoproteins (HDLs) are that they: a. have high amounts of triglycerides. b. have only small amounts of protein. c. have little cholesterol. d. aid in steroid production.
c
Assessment findings of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of HF. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? a. aortic stenosis b. atrial septal defect c. patent ductus arteriosus d. ventricular septal defect
c
On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? a. cracked lips b. normal appearance c. conjunctival hyperemia d. desquamation of the skin
c
The clinic nurse reviews the record of a child just seen by HCP and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? a. pallor b. hyperactivity c. exercise intolerance d. gi disturbances
c
The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? a. Reassure the parents that 3-year-olds are cooperative and therefore are less likely to be anxious. b. Obtain a video film of a cardiac catheterization to show to the child prior to the procedure. c. Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. d. Obtain a cardiac catheter and demonstrate the procedure by pretending to put the catheter in a doll or stuffed animal.
c
The nurse is monitoring an infant with congenital heart disease closely for signs of HF. The nurse should assess the infant for which early sign of HF? a. pallor b. cough c. tachycardia d. slow and shallow breathing
c
coarctation of aorta
congenital cardiac condition characterized by a narrowing of the aorta *possible BP difference between bilateral upper and lower extremities* BP higher in upper extremities and lower in lower extremities bounding pulses BUE, weak or absent femoral pulses surgery is tx of choice for < 6 months medication-prostaglandins to keep ductus arteriousus open (temporary fix to equalize pressure) as well as CHF tx
tetralogy of fallot
congenital malformation involving four distinct heart defects (VSD, pulmonic stenosis, overriding aorta, RV hypertrophy) "blue" baby, difficulty feeding, decreased weight, "boot-shaped" heart on x-ray, polycythemia, dyspnea, TET spells, harsh systolic murmur, clubbing of fingernails during TET spells--knee-to-chest position, morphine to suppress respiratory center and decrease degree of hyperpnea, calm the infant, administer oxygen
11. The parent of a 1-year-old child with tetralogy of Fallot asks the nurse, "Why do my child's fingertips look like that?" The nurse bases a response on the understanding that clubbing occurs as a result of: a. untreated congestive heart failure. b. a left-to-right shunting of blood. c. decreased cardiac output. d. chronic hypoxia.
d
13. An infant with congestive heart failure is receiving digoxin (Lanoxin). The nurse recognizes a sign of digoxin toxicity, which is: a. restlessness. b. decreased respiratory rate. c. increased urinary output. d. vomiting.
d
14. The nurse is aware that the infant born with hypoplastic left heart syndrome must acquire his or her oxygenated blood through: a. the patent ductus arteriosus. b. a ventricular septal defect. c. the closure of the foramen ovale. d. an atrial septal defect.
d
18. The school nurse recommends a heart healthy diet that limits fats to no more than ____% of the total dietary intake. a. 10 b. 15 c. 20 d. 30
d
3. The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is blood pressure that is: a. higher on the right side. b. higher on the left side. c. lower in the arms than in the legs. d. lower in the legs than in the arms.
d
A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? a. has the child complained of back pain b. has the child complained of headaches c. has the child had any nausea and vomiting d. did the child have a sore throat or fever within the last two months
d
A health care provider has prescribed oxygen as needed for an infant with HF. In which situation should the nurse administer the oxygen to the infant? a. during sleep b. when changing the infant's diapers c. when the mother is holding the infant d. when drawing blood for electrolyte level testing
d
The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? A. Bradycardia. B. Machinery murmur. C. Weak pedal pulses. D. Clubbed fingers.
d
The nurse provides home care instructions to the parents of a child with HF regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? a. i will not mix the medication with food b. i will take my child's pulse before administering the medication c. if more than 1 dose is missed, i will call HCP d. if my child vomits after the medication administration, i will repeat the dose
d
The nurse reviews the lab results for a child with a suspected diagnosis of rheumatic fever., knowing that which lab study would assist in confirming diagnosis? a. immunoglobulin b. red blood cell count c. white blood cell count d. anti-streptolysin o titer
d
resistence in pulmonary circulation ___________ systemic circulation
decreases
A 3-week-old newborn is brought to the clinic for follow-up after a home birth. The mother reports that her child bottle feeds for 5 minutes only and then falls asleep. The nurse auscultates a loud murmur characteristic of a ventricular septal defect (VSD), and finds the newborn is acyanotic with a respiratory rate of 64 breaths per minute. What instruction should the nurse provide the mother to ensure the infant is receiving adequate intake? A. Monitor the infant's weight and number of wet diapers per day. B. Increase the infant's intake per feeding by 1 to 2 ounces per week C. Mix the dose of prophylactic antibiotic in a full bottle of formula D. Allow the infant to rest and refeed on demand or every 2 hours. E. Use a softer nipple or increase the size of the nipple opening
e
atrial septal defect
flaw in the septum that divides the two atria of the heart (left to right shunt) if pt is asymptomatic, wait for spontaneous closure during 1st year if symptomatic, surgery between age 2-5 years
ventral septal defect
flaw in the septum that divides the two ventricles of the heart (left to right shunt) Accounts for 25% of CHD CHF is common. Can also lead to Nurse should expect to hear dysrhytmias and LOUD holosystolic murmur when assessing the infant Treatment: pulmonary artery banding (temporary fix), complete repair, device closure during cardiac cath
indomethacin
helps close patent ductus arteriosus (vasoconstrictive)
AV canal defect
incomplete fusion of the endocardial cushions (left to right shunt) Most common in pt's with Down's Moderate to severe CHF Loud systolic murmur Mild cyanosis and increases with crying High risk for developing pulmonary vascular obstructive disease Surgical tx: palliative, complete
diaper rash on incontinence increase risk factors for ___________ in infants undergoing cardiac cath
infection
Truncus arteriosus
major trunk arises from left and right ventricle instead of a separate aorta and pulmonary artery Tx: manage CHF pulmonary artery banding (temporary) or corrective surgery
aortic stenosis
narrow stricture of aortic valve exercise intolerance, chest pain and dizziness when standing for long periods murmur Tx: dilation of narrowed valve through cardiac cath-balloon, surgical valvotomy w/ valve replacement later
Tricuspid Atresia
no tricuspid valve cyanosis usually seen in newborn may have tachycardia and dyspnea also chronic hypoxemia with clubbing Prostaglandins may be given immediately after birth to keep ductus arteriousus open until surgical intervention can be arranged
patent ductus arteriosus
passageway between the aorta and the pulmonary artery remains open after birth (left to right shunt) increases workload on left side--because it senses decreased blood flow through the aorta risk for bacterial endocarditis machinery like murmurs widened pulse pressure and bounding pulses Management: indomethacin may be administered to close it in premature infants and some newborns Defect may be closed during cardiac catheterization or may require surgery
