PED'S Chapter 41 - Nursing Care of the Child With an Alteration in Perfusion/ Cardiovascular Disorder

order of changes that occur in cardiopulmonary system immmediately following birth in proper order

1. lung inflate 2. reduction of pulmonary vascular resistance to blood flow 3. drop in pulmonary arterial pressure 4. decreased pressure in right atrium 5. closure of foramen ovale 6. closure ductus arteriosus

most cases of HF in children with congenital heart defects occur by the age of _____

6 months

Toddler or preschooler heart rate

80 to 115

Infant heart rate

90 to 160

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note?

A bounding pulse is characteristic of patent ductus arteriosis or aortic regurgitation.

A nurse is palpating the pulse of a child with suspected aortic regurgitation. Which assessment finding should the nurse expect to note? A. bounding pulse B. preference to resting on right side C. pitting edema

A bounding pulse is characteristic of patent ductus arteriosis or aortic regurgitation. N

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful? A) "This pressure dressing needs to stay on for 5 days from now." B) "He can't eat but he can drink fluids for the next 24 hours." C) "He should avoid taking a bath for about 3 days but he can shower." D) "It's normal if he says he feels like his heart skipped a beat."

Ans: C Feedback: - After a cardiac catheterization, the child should avoid tub baths for about 3 days but he can shower or use sponge baths. - The pressure dressing should be removed the day after the procedure and a dry sterile dressing or adhesive bandage is applied for the next several days. - After the procedure, the child can resume his usual diet. - Any reports of fluttering or the heart skipping a beat should be reported.

A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern? A) 120 mg/dL B) 150 mg/dL C) 180 mg/dL D) 210 mg/dL

D.: A total cholesterol level greater than 200 mg/dL is considered high and would be of the greatest concern.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?

Edema of the lower extremities is characteristic of right ventricular heart failure in older children.

if child vomits digoxin give another dose

FALSE second dose shoul not be given

management of edema associated with heart failure

Furosemide

rheumatic fever symptoms

Signs and symptoms of rheumatic fever include systolic murmur, involuntary limb movement, macular rash on the trunk, tender swollen joints, and subcutaneous nodules.

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 increases in size due to right-sided heart failure. This is one of the cardinal signs of congestive heart failure.

The nurse is caring for a child after a cardiac catheterization. What is the nursing priority? A. Allow early ambulation to encourage activity participation. B. Check pulses above the catheter insertion site for strength and quality. C. Assess extremity distal to the insertion site for temperature and color. D. Change the dressing to evaluate the site for infection.

C. Vessel spasm or hematoma may occur after the catheterization, occluding circulation. The extremity may become pale, feel cool to the touch, and have diminished pulses distal to the insertion site.

Tetralogy of fallot

- pulmonary stenosis - ventricular septal defect (usually large) - dextroposition (overriding) of the aorta - hypertrophy of the right ventricle.

Digoxin Administration

-should be giving every 12 hr - one hr before or two hr after feeding - monitor potassium level

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. Which of the following would the nurse expect the physician to prescribe? Select all answers that apply. A) Intravenous immunoglobulin B) Ibuprofen C) Acetaminophen D) Aspirin E) Alprostadil

A, C, D - In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. - Acetaminophen is used to reduce fever. - Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. - Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.

After assessing a child's blood pressure, the nurse determines the pulse pressure and finds that it is narrowed. Which of the following would the nurse identify as associated with this finding? A) Aortic stenosis B) Patent ductus arteriosus C) Aortic insufficiency D) Complete heart block

A. A narrowed pulse pressure is associated with aortic stenosis.

A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also helps to do which of the following? A) Cause vasodilation B) Increase pulmonary vascular resistance C) Promote diuresis D) Mobilize secretions

A. Oxygen improves oxygen saturation and also functions as a vasodilator and decreases pulmonary vascular resistance.

Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem? A. previous streptococcal throat infection B. history of open heart surgery at 5 years of age C. playing too much soccer and not getting enough rest D. exposure to a sibling with pneumonia

A. Rheumatic fever occurs as a sequela to group A streptococcal infection

The nurse is conducting a physical examination of a child with a suspected cardiovascular disorder. Which of the following findings would the nurse most likely expect to assess if the child had transposition of the great vessels? A) Significant cyanosis without presence of a murmur B) Abrupt cessation of chest output with an increase in heart rate/filling pressure C) Soft systolic ejection D) Holosystolic murmur

A. Significant cyanosis without presence of a murmur is highly indicative of transposition.

The nurse is conducting a physical examination of an infant with a suspected cardiovascular disorder. Which assessment finding is suggestive of sudden ventricular distention? a. decreased BP b. heart murmur c. cool, clammy pale extremities d. Accentuated third heart sound

An accentuated third heart sound is suggestive of sudden ventricular distention.

A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, the nurse would document this murmur as which of the following? A) Loud without a thrill B) Loud with a precordial thrill C) Soft and easily heard D) Loud, audible with a stethoscope

Ans: A Feedback: A grade III murmur is loud without a thrill. Grade II is soft and easily heard. Grade IV is loud with a precordial thrill. Grade V is characterized as loud, audible with a stethoscope.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? A) Tetralogy of Fallot B) Atrial septal defect C) Hypoplastic left heart syndrome D) Transposition of the great vessels

Ans: B Feedback: Atrial septal defect is an example of a disorder involving increased pulmonary blood flow. Tetralogy of Fallot is a defect involving decreased pulmonary blood flow. Transposition of the great vessels and hypoplastic left heart syndrome are examples of mixed disorders.

The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which of the following statements by the mother indicates a need for further teaching? A) "The baby may need as much as 150 calories/kg/day." B) "Small, frequent feedings are best if tolerated." C) "I need to feed him every hour to make sure he eats enough." D) "Gavage feedings may be required for now."

Ans: C Feedback: Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

The nurse is caring for an infant with suspected patent ductus arteriosus. Which of the following assessment findings would the nurse identify as helping to confirm this suspicion? A) Thrill at the base of the heart B) Harsh, continuous, machine-like murmur under the left clavicle C) Faint pulses D) Systolic murmur best heard along the left sternal border

B With patent ductus arteriosus, a harsh, continuous, machine-like murmur (usually loudest under the left clavicle) is heard at the first and second intercostal spaces.

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? A)Right ventricular heave B)Holosystolic harsh murmur along the left sternal border C)Fixed split-second heart sound D)Systolic ejection murmur

B - With ventricular septal defects, there is often a characteristic holosystolic harsh murmur along the left sternal border. - Right ventricular heave, fixed split-second heart sound, and systolic ejection murmur are typically found with atrial septal defects.

The nurse is reviewing the medical record of a child with infective endocarditis. Which of the following would the nurse expect to find? Select all answers that apply. A) White blood cell count revealing leukopenia B) Microscopic hematuria with urinalysis C) Electrocardiogram with prolonged PR interval D) Lungs clear on auscultation E) Petechiae on palpebral conjunctiva

B, C, E With infective endocarditis, leukocytosis, microscopic hematuria, prolonged PR interval, adventitious lung sounds, and petechiae on the palpebral conjunctiva are noted.

The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. Which of the following would the nurse be least likely to include? A) Daily weight assessment B) Maintenance of strict bed rest C)Prevention of infection D) Signs of complications

B. A child with congenital heart disease should be allowed to engage in activity as tolerated, with rest periods frequently throughout the day to prevent overexertion.

After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which of the following as an assessment finding? A) Janeway lesions B) Jerky movements of the face and upper extremities C) Black lines D) Osler nodes

B. Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. Janeway lesions, black lines, and Osler nodes are associated with infective endocarditis.

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which of the following statements by the mother would warrant further investigation? A) "My baby does not make any grunting noises." B) "The baby seems more comfortable over my shoulder." C) "The baby usually drinks all of her bottle." D) "I don't notice any rapid breathing patterns."

B. The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. - Grunting or rapid breathing would be a cause for concern.

The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? a. " his agar score was an 8" b. I am in on a low dose of steroids c. I had flu during pregnancy

B. Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects.

When conducting a physical examination of a child with suspected Kawasaki disease, which of the following would the nurse expect to assess? A) Hirsutism or striae B) Strawberry tongue C) Malar rash D) Café au lait spots

B. Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease.

The nurse is assessing a child with suspected infective endocarditis. Which of the following assessment findings would the nurse interpret as a sign of extracardiac emboli? A) Pruritus B) Roth spots C) Delayed capillary refill D) Erythema marginatum

B: Roth spots are splinter hemorrhages with pale centers on the sclerae, palate, buccal mucosa, chest, fingers, or toes, and are signs of extracardiac emboli. Delayed capillary refill time does not point to extracardiac emboli. Wheezing and pruritus are indicative of a hypersensitivity reaction. Erythema marginatum is a classic rash associated with acute rheumatic fever.

The nurse takes an infant's apical pulse before administering digoxin. What is the usually accepted level of pulse rate considered safe for administering digoxin to an 8-month-old infant?

Because digoxin slows the heart rate, it is important that it is not already beating at a slow rate before administration.

Auscultation of a child's heart reveals a loud murmur with a precordial thrill. The nurse documents this as which of the following? A) Grade II B) Grade III C) Grade IV D) Grade V

C.

A child with a suspected cardiovascular disorder is to undergo diagnostic testing and is scheduled for an echocardiogram. When explaining this test to the child, which of the following would the nurse most likely include? A) "This test will check the pattern of how your heart is beating." B) "They'll take a picture of your chest to look at the heart's size." C) "A special wand that picks up sound is used to check your heart." D) "Small patches are attached to your chest to check the heart rhythm."

C. An echocardiogram is a noninvasive ultrasound procedure using a gel-coated wand that assesses the heart wall thickness, the size of the chambers, valve and septal motion, and the relationship of the great vessels to other cardiac structures. An electrocardiogram reveals the pattern or rhythm of the heart's beating and involves small patches or electrodes attached to the chest.

A nurse is working with an adolescent who is slightly overweight and was recently diagnosed with hypertension. They are discussing nutritional management. Which statement by the adolescent demonstrates understanding of the information? A) "I have to make sure that I don't eat a lot of salty foods." B) "I can eat any amount at a meal as long as I don't eat between meals." C) "I should eat plenty of fresh fruits and vegetables." D) "If I skip breakfast, I can eat a much bigger lunch."

C. Nutritional management includes controlling portion sizes, decreasing the intake of sugary beverages and snacks, eating more fresh fruits and vegetables, and eating a healthy breakfast.

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication? A) Alprostadil B) Heparin C) Indomethacin D) Spironolactone

C. - Indomethacin is the drug typically ordered to close a patent ductus arteriosus. - Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. - Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. - Spironolactone would be used to manage edema due to heart failure and to treat hypertension.

An infant with congenital heart disease is to undergo surgery to correct the defect. The mother states, "I guess I'm going to have to stop breastfeeding her." Which response by the nurse would be most appropriate? A) "That's true, but we'll make sure she gets the best intravenous nutrition." B) "Unfortunately, your baby needs more nutrients than what breast milk can provide." C) "Breast milk may help to boost her immune system, so you can continue to use it." D) "She won't be able to suck, so we have to give her fortified formula through a tube."

C. Breastfeeding a child before and after cardiac surgery may boost the infant's immune system, which can help fight postoperative infection.

During a follow-up visit, the parents of a 5-month-old infant diagnosed with congenital heart disease tell the nurse, "We're just so tired and emotionally spent. All these tests and examinations are overwhelming. We just want to have a normal life. We're so focused on the baby that it seems like our 3-year-old is lost in the shuffle." Which nursing diagnosis would the nurse identify as most appropriate? A) Risk for delayed growth and development related to necessary treatments B) Deficient knowledge related to the care of a child with congenital heart disease C) Interrupted family processes related to demands of caring for the ill child D) Fear related to infant's cardiac condition and need for ongoing care

C. The statements by the parents indicate that there is disruption in the family resulting from the demands of caring for the ill infant and they verbalized concern about their older child.

While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action? A. Provide supplemental oxygen by face mask. B. Administer a dose of IV morphine sulfate. C. Begin cardiopulmonary resuscitation. D. Place the infant in a knee-to-chest position.

D. Hypercyanotic spells are a dangerous event. Placing the infant in a knee-to-chest position increases systemic vascular resistance, thereby improving pulmonary blood flow. It is the first action the nurse should take.

An infant with poor feeding is suspected of having a congenital heart defect. The parents are asking why a chest x-ray is necessary in their infant. What is the best response from the nurse?

Chest x-rays are performed to see if the heart is enlarged. This will determine if the heart muscle is increasing in size.

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A) Contact the physician B) Offer a snack and administer another dose C) Immediately administer another dose D) Administer next dose as ordered in 12 hours

D. Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. - If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. - It is not necessary to contact the physician.

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: A) 140 beats per minute B) 120 beats per minute C) 100 beats per minute D) 80 beats per minute

D. In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the physician should be notified.

A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding? A. gallop and rales B. blood pressure discrepancies in the extremities C. right ventricular hypertrophy on ECG D. heart murmur

D. Typically, children with aortic stenosis have a murmur that is best heard along the left sternal border.

Sydenham chorea

a movement disorder of the face and upper extremities associated with acute rheumatic fever.

atrial septal defect (ASD)

an opening in the septum separating the atria

ventricular septal defect (VSD)

an opening in the septum separating the ventricles

the radiographic study of the heart and coronary vessels after infection of contrast medium

angiography

grade II murmur

audible but quiet and soft

Abrupt cessation of chest output accompanied by an increase in heart rate and filling pressure is indicative of _____________

cardiac tamponade.

Tetralogy of Fallot is a defect involving ______________ blood flow.

decreased pulmonary

___________ is prescribes to increase contractility of the heart muscle by decreasing conduction and increasing tone

digoxin

prophylaxis and treatment of thromboembolic disorders especially after cardiac surgery.

heparin

grade III murmur

is characterized as loud without a thrill

grade IV murmur

is loud with a precordial thrilL

grade V murmur

loud, audible without a stethoscope.

niacin

lower blood cholesterol

hypoplastic left heart syndrome are examples of

mixed disorders.

coarctation of the aorta

narrowing of the aorta

A widened pulse pressure is associated with

patent ductus arteriosus, aortic insufficiency, fever, anemia, or complete heart block.

examples of defects with increased ____ blood flow as patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD).

pulmonary

first sign of clubbing due to chronic hypoxia

softening of nail beds

Alprostadil function

temporary maintenance of ductus arteriosus patency in infants with ductal-dependent congenital heart defects

In infants, peripheral edema occurs first in:

the face, then the presacral region, and the extremitieS

Hypoplastic Left Heart Syndrome

underdevelopment of the left side of the heart, usually resulting in an absent or nonfunctional left ventricle and hypoplasia of the ascending aorta