Final Exam: Chapter 41 (Cardio)

The nurse is providing child and family education prior to discharge following a cardiac catheterization. The nurse is teaching about signs and symptoms of complications. Which statement by the mother indicates a need for further teaching?

"The feeling of the heart skipping a beat is common."

Kawasaki Disease (KD)

Also known as mucocutaneous lymph node syndrome - Leading cause of acquired cardiovascular disease in the U.S

Tetralogy of Fallot → Dextroposition of the aorta

Aorta is displaced to the right and blood from both ventricles enters it

What will the nurse include in the feeding plan for a breastfed infant with congenital heart disease?

Breastfeed with small, frequent meals

Tetralogy of Fallot: Diagnosis

Confirmed by chest x-ray that shows a typical boot-shaped heart - EKG - 3-D echocardiography - Cardiac cath

Restrictive Defect

Contraction of the aorta

_____ heart disease occurs when blood is shunted from the venous to the arterial system as a result of abnormal communication between the two systems.

Cyanotic

Tetralogy of Fallot → Hypertrophy of the right ventricle

Enlarges because it must work harder to pump blood through the narrow pulmonary artery

Atrial Septal Defect (ASD): Treatment

If <5 mm and asymptomatic = no treatment → if symptoms = surgical repair (Dacron patch) - ASA therapy for 6 months post surgical intervention

Tetralogy of Fallot: Treatment

Immediate prevention of brain damage and death - Surgical repair 3-6 months = closure of VSD and repair of stenotic pulmonary valve and any anomalies

_____ are a common complication after pediatric cardiac surgery.

Infections

A 6-year-old girl is diagnosed with aortic stenosis. The mother asks the nurse what the likely treatment for this condition will involve. What should the nurse tell the mother?

Insertion of a catheter with an uninflated balloon tip into the affected area followed by inflation of the balloon to open the narrowing

A child is diagnosed with rheumatic fever. For which medication will the nurse educate the caregivers?

Nonsterioidal anti-inflammatory drugs (NSAIDs)

Assessing capillary refill time of the digits is an acceptable method to assess blood perfusion.

True

Measuring temperature to ensure an infant is rewarmed is a major responsibility after open-heart surgery.

True

Respiratory failure is the most frequent cause of cardiac arrest.

True

Rheumatic fever is an autoimmune response that follows a group A β-hemolytic streptococcal infection.

True

Ventricular septal defect is the most common type of congenital cardiac disorder.

True

Hypoplastic Left Heart Syndrome

Underdevelopment of left side of heart - Usually results in an absent or nonfunctional left ventricle and hypoplasia of the ascending aorta - Heart transplant - Rare disorder (1-3%) - PGE1 infusion to keep DA open until surgery

A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed?

"We can stop th penicillin when her symptoms disappear."

The nurse is caring for a 1-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160, respirations 80, oxygen saturation 92%, retractions, and crackles noted in bilateral lungs. Which nursing actions are appropriate at this time? Select all that apply.

- Administer furosemide - Initiate IV access - Apply oxygen via oxyhood - Begin indomethacin infusion

Acyanotic Defect

- Atrial Septal Defect (ASD) - Ventricular Septal Defect (VCD) - Patent Ductus Arteriosus (PDA)

Atrial Septal Defect (ASD): Diagnosis

- Cadiac cath - EKG - Echo

Tetralogy of Fallot

- Cyanosis increases with age - Clubbing of fingers and toes → due to chronic hypoxia - Child rests in a "squatting" position to breathe more easily by altering systemic venous return

Contraction of the Aorta: Diagnosis

- Echo - X-ray shows cardiac enlargement

Tetralogy of Fallot: Prevalent Symptoms

- Feeding problems - Failure to thrive - Frequent respiratory infections - Severe dyspnea on exertion - Polycythemia develops to compensate for the lack of oxygen

Kawasaki Disease (KD): Treatment

- IV gamma globulin - Salicylate therapy → antithrombus - Warfarin therapy → aneurysms

Acquired Disorders

- Rheumatic fever - Kawasaki disease

Tetralogy of Fallot: Four Defects

- Stenosis or narrowing of the pulmonary artery - Hypertrophy of the right ventricle - Dextroposition of the aorta - Ventricular septal defect (VSD)

Cyanotic Defect

- Transposition of the Great Arteries (TGA) - Tetralogy of Fallot (TOF)

Patent Ductus Arteriousus (PDA): Diagnosis

2-D Echo

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

80 beats per minute

The nurse is caring for a newborn in the hospital. Which assessment finding is most concerning?

A fixed split-S2 heart sound

Which problem-based nursing care plan will the nurse indicate as priority for the child following cardiac surgery for tetralogy of Fallot?

Altered cardiopulmonary tissue perfusion risk

Atrial Septal Defect (ASD)

An abnormal opening between the right and left atria - Oxygenated blood is forced from the left atrium back to the right atrium - Asymptomatic - Detected as murmur

Congenital Heart Defects

Anatomic, resulting in abnormal function

A child presents to the emergency department with a heart rate of 178 bpm, dizziness, and decreased level of consciousness. The nurse places the child on a cardiac monitor and notes a narrow complex rhythm. The nurse initiates intravenous access and assists the child with a vagal maneuver but continues to note the same rhythm on the monitor. Which action will the nurse perform next?

Begin synchronized cardioversion

Patent Ductus Arteriousus (PDA)

DA does not close at birth, blood continues to pass from the aorta, pressure is higher, oxygenated blood is recycled through the heart. Overburdens pulmonary circulation, causing heart to pump harder - Can be asymptomatic when young - Dyspnea, bounding radial pulse, wide pulse pressure, mechanical murmur

Tetralogy of Fallot → Stenosis or narrowing of the pulmonary artery

Decreases blood flow to the lungs

Contraction of the Aorta: Treatment

Dependent upon type and severity of the defect - Best time for surgical intervention is between 2-4 years of age

The nurse is administering medications to the child with congestive heart failure (CHF). Large doses of what medication are used initially in the treatment of CHF to attain a therapeutic level?

Digoxin

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

Digoxin

Aquired Heart Defects

Disease process - Infection - Autoimmune response - Environmental facts - Familial tendencies

Ventricular Septal Defect (VSD): Diagnosis

Echocardiogram

_____ is the primary diagnostic test for congenital heart disease.

Echocardiography

A nurse is reviewing blood work for a child with a cyanotic heart defect. What result would most likely be seen in a client experiencing polycythemia?

Increased RBC

Kawasaki Disease (KD): Pathophysiology

Inflammation of the vessels in the cardiovascular system → weakens the walls of the vessels - Often results in an aneurysm (abnormal dilation of the wall of a blood vessel) - Aneurysm can cause thrombi (blood clots) to form

Ductus Arteriosus (DA)

Is a normal blood vessel that connects two major arteries — the aorta and the pulmonary artery — that carry blood away from the heart in a developing fetus. The DA diverts blood away from the lungs, sending it directly to the body. The DA should close shortly after birth.

Paroxysmal Hypercyanotic Episodes

Known as Tet spells - Occur during first 2 years of life - Spontaneous cyanosis, respiratory distress, weakness, and syncope occur - Can last up to a few hours and are followed by lethargy and sleep - Place child in knee-chest position when Tet spell occurs

Ventricular Septal Defect (VSD)

MOST COMMON HEART ANOMALY - An opening between the right and left ventricles - Increased pressure within the left ventricles forces blood into the right - May be asymptomatic - Loud harsh murmur and systolic thrill

Ventricular Septal Defect (VSD): Treatment

Many close spontaneously, ligation of hole with sutures or synthetic (Dacron) patch may be necessary

Contraction of the Aorta: Characteristic Symptoms

Marked difference in the blood pressure and pulses of the upper and lower extremities - High BP in upper extremities, low BP in lower extremities

The prognosis for the child with rheumatic fever depends on the extent of ___________ involvement.

Myocardial

In congenital heart disease, cyanosis is ____ always a clinical sign.

NOT

Contraction of the Aorta

Narrowing or constriction of the aortic arch of the descending aorta

A nurse suspects a child is experiencing cardiac tamponade after heart surgery. What would be the priority nursing intervention?

Notify the doctor immediately

Kawasaki Disease (KD): Phases

Phase 1 - Fever, conjunctivitis w/o discharge, strawberry tongue, inflamed mouth Phase 2 - Desquamation: peeling of skin on hands and feet often in large sheets Phase 3 - S&S slowly decrease

The nurse is caring for a 6-year-old child with a congenital heart defect. To best relieve a hypercyanotic spell, what action would be the priority?

Place the child in a knee-to-chest position

An infant with tetralogy of Fallot becomes cyanotic. Which nursing intervention would be the first priority?

Place the infant in the knee-chest position

Kawasaki Disease (KD): Nursing Care

Postpone active routine immunizations for several months after admin of immune globulin = immunosuppressant - Long-term, low-dose aspirin therapy

Patent Ductus Arteriousus (PDA): Treatment

Prostaglandin inhibitor sometimes successful in closing of PDA, thoracotomy and ligation, VATS (visually assisted thoroscopic surgery) cardiac cath with coils to occlude PDA

Transposition of Great Arteries: Therapeutic Management

Provide intracardiac mixing → prostaglandin E infusion to keep PDA open - Arterial switch procedure is the procedure of choice in the first weeks of life

An infant with congenital heart disease is not growing and developing adequately. The nurse will institute what feeding strategy?

Raise the caloric density of the feeding beyond 20 calories per ounce

Autoimmune disease occurring as a complication of an untreated group a beta hemolytic streptococcus infection of the throat (strep infection)

Rheumatic fever (RF)

Transposition of Great Arteries

Second most common congenital defect and is reversal of arteries - Aorta = right side - Pulmonary artery = left side - No communication between the systemic and pulmonary circulation - Severe cyanosis - Right arm O2 sat < lower

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry tounge

_____ is necessary to help prevent pooling of secretions in the respiratory tract while a child is receiving ventilatory assistance.

Suctioning

Rheumatic Fever (RF)

Systemic disease involving the joints, heart, CNS, skin, and subcutaneous tissue - Common feature is destruction of connective tissue → scars mitral valve in the heart

A nurse is caring for a child who is experiencing heart failure. Which assessment data was most likely seen when initially examined?

Tachycardia

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. What would most likely explain this assessment finding?

The liver size increases in right-sided heart failure