Saunders peds cardiovascular

A 1-year-old infant with a diagnosis of heart failure is prescribed digoxin. The nurse takes the apical pulse for 1 minute before administering the medication and obtains a result of 102 beats/minute. What is the nurse's best action?

Admin the med

Assessment findings of an infant admitted to the hospital reveal a *machinery-like murmur* on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? Refer to the figure (circled area) to determine the condition.

patent ductus arteriosus

tet spells occur in

tetralogy of Fallot

HF is

the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body.

If the apical rate is low and the digoxin blood level is elevated, indicating toxicity,

the nurse would withhold the medication and notify the health care provider.

The therapeutic digoxin level ranges from

0.5 to 0.8 ng/dL (0.64 to 1.02 mmol/L).

In the presence of rheumatic fever, the child will exhibit an

1. elevated antistreptolysin O titer 2. elevated erythrocyte sedimentation rate 3. leukocytosis 4. positive result on C-reactive protein determination 5. positive result on antinuclear antibody testing

The early signs of HF include

1. tachycardia 2. tachypnea 3. profuse scalp sweating 4. fatigue and irritability 5. sudden weight gain 6. respiratory distress. A cough may occur in HF as a result of mucosal swelling and irritation, but is not an early sign. Pallor may be noted in an infant with HF, but is not an early sign.

Tetralogy of Fallot includes four defects-

1. ventricular septal defect 2. pulmonary stenosis 3. overriding aorta 4. right ventricular hypertrophy.

The apical pulse rate for a newborn is

120 to 160 beats/min.

The apical pulse rate for a 1-year-old infant is

90 to 130 beats/min.

failure of the fetal ductus arteriosus (artery connecting the aorta and the pulmonary artery) to close. A characteristic machinery-like murmur is present, and the infant may show signs of heart failure.

A patent ductus arteriosus is

is a narrowing or stricture of the aortic valve, causing *resistance to blood flow* in the *left ventricle*, decreased cardiac output left ventricular hypertrophy pulmonary vascular congestion.

Aortic stenosis

is a narrowing or stricture of the aortic valve.

Aortic stenosis

Rheumatic fever usually develops after a group A beta-hemolytic streptococcal infection, particularly pharyngitis. Initial diagnosis is made by noting the presence of

Aschoff's bodies, or hemorrhagic bullous lesions, in the heart, joints, skin, and central nervous system; an elevated C-reactive protein level; an elevated antistreptolysin O titer; and an elevated erythrocyte sedimentation rate.

is an abnormal opening between the atria.

Atrial septal defect

The nurse is caring for a child with a diagnosis of a right-to-left cardiac shunt. On review of the child's record, the nurse should expect to note documentation of which most common assessment finding?

Bluish discoloration. Of skin

The nurse is caring for an infant with a diagnosis of congenital heart disease. Which finding, on physical assessment, does the nurse attribute to chronic hypoxia?

Clubbing of fingers

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?

Conjunctival hyperemia

The nurse is reviewing the health care provider's prescriptions for a child with rheumatic fever who is suspected of having a viral infection. The nurse notes that aspirin is prescribed for the child. Which nursing action is most appropriate?

Consult with the health care provider to verify the prescription. Antiinflammatory agents, including aspirin, may be prescribed for the child with rheumatic fever.

The nurse is caring for an infant with congenital heart disease. Which, if noted in the infant, should alert the nurse to the early development of heart failure?

Diaphoresis during feeding The early symptoms of heart failure (HF) include tachypnea, poor feeding, and diaphoresis during feeding. Tachycardia would occur during feeding. Paleness of the skin, pallor, may be noted in the infant with HF, but it is not an early symptom. A strong sucking reflex is unrelated to the development of HF.

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?

Did the child have a sore throat or fever within the last 2 months?" *Rheumatic fever* is an *inflammatory autoimmune disease *that affects the *connective tissues* of the heart, joints, skin (subcutaneous tissues), blood vessels, and central nervous system. Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A β-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months.

A child has been tentatively diagnosed with rheumatic fever. The nurse interprets that this diagnosis is consistent with which laboratory result obtained for this child?

Elevated antistreptolysin O titer In the presence of rheumatic fever, the child will exhibit an elevated antistreptolysin O titer, an elevated erythrocyte sedimentation rate, leukocytosis, and a positive result on C-reactive protein determination. A positive result on antinuclear antibody testing is used to diagnose a wide variety of connective-tissue, vascular, and immune complex disorders and also will be positive with rheumatic fever.

The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

Exercise intolerance Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. A child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone. Options 2 and 4 are not related to this disorder.

The nurse is creating a plan of care for a child admitted with a diagnosis of Kawasaki disease. In developing the initial plan of care, the nurse should include monitoring the child for signs of which condition?

HF

Reed-Sternberg cells are found in

Hodgkin's disease.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction?

If my child vomits after medication administration, I will repeat the dose."

Tetralogy of Fallot includes four defects- 1. ventricular septal defect 2. pulmonary stenosis 3. overriding aorta 4. right ventricular hypertrophy. If pulmonary vascular resistance is higher than systemic resistance,

the shunt is from right to left; (V Higher S)

Kawasaki disease, also known as *mucocutaneous lymph node syndrome*, is an *acute systemic inflammatory illness* .

In the acute stage, the child has a - fever - conjunctival hyperemia - red throat - swollen hands - rash - enlargement of the cervical lymph nodes. In the subacute stage, - cracking lips and fissures - desquamation of the skin on the tips of the fingers and toes - joint pain - cardiac manifestations - thrombocytosis In the convalescent stage, the child appears normal, but signs of inflammation may be present.

Jones criteria for rheumatic fever

JONES (JO)int Pain (often migrates) (N)odules (E)rythyma Marginatum (S)yndenham's Chorea

The nurse is caring for an infant with a diagnosis of *tetralogy of Fallot. The infant suddenly becomes cyanotic, and the nurse recognizes that the infant is experiencing a hypercyanotic spell (blue or tet spell). The nurse immediately places the infant in what position?

Knee-chest

Heart failure (HF) is the inability of the heart to pump a sufficient amount of blood to meet the oxygen and metabolic needs of the body. Crying exhausts the limited energy supply, increases the workload of the heart, and increases the oxygen demands. Oxygen administration may be prescribed for stressful periods, especially during bouts of crying or invasive procedures.

Like —> drawing blood

The nurse is assigned to care for an infant with tetralogy of Fallot. The mother of the infant calls the nurse to the room because the infant suddenly seems to be having difficulty breathing. The nurse enters the room and notes that the infant is experiencing a hypercyanotic episode. What is the priority action by the nurse?

Place the infant in a knee-chest position. If a hypercyanotic episode occurs, the infant is placed in a knee-chest position. The knee-chest position is thought to increase pulmonary blood flow by increasing systemic vascular resistance. This position also improves systemic arterial oxygen saturation by decreasing venous return, so that smaller amounts of highly saturated blood reach the heart. Toddlers and children squat to obtain this position and relieve chronic hypoxia. Therefore, the remaining options are not the best initial or priority actions.

Aspirin should not be given to a child who has chickenpox or other viral infections because of the risk of

Reye's syndrome.

The child with a right-to-left shunt will be considerably sicker than a child with a left-to-right shunt. Many of these children will present with symptoms in the first week of life. The most common assessment finding in these children is bluish discoloration of the skin, known as cyanosis.

The child may also become dyspneic after feeding, crying, and other exertional activities.

The mother of a child being discharged after heart surgery asks the nurse when the child will be able to return to school. Which is the most appropriate response to the mother?

The child may return to school in 3 weeks but needs to go half-days for the first few days."

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 indicates a need for further instruction?

The mother should be instructed that lotions and powders should not be applied to the incision site after cardiac surgery. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site.

is an abnormal opening between the right and left ventricles.

Ventricular septal defect

A child is being discharged from the hospital following heart surgery. Prior to discharge, the nurse reviews the discharge instructions with the mother.

Visitors without signs of any infection are allowed to visit the child. The mother should be instructed, however, that the child needs to avoid large crowds of people for 1 week following discharge.

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?

Weighing the diapers

The nurse is assessing a newborn with heart failure before administering the prescribed digoxin. In reviewing the laboratory data, the nurse notes that the newborn has a digoxin blood level of 1.6 ng/mL (2.05 mmol/L) and an apical heart rate of 90 beats/min. The mother also tells the nurse that the newborn just vomited her formula. Which intervention should the nurse take?

Withhold the medication and notify the health care provider. The apical pulse rate for a newborn is 120 to 160 beats/min. The therapeutic digoxin level ranges from 0.5 to 0.8 ng/dL (0.64 to 1.02 mmol/L). Because the apical rate is low and the digoxin blood level is elevated, indicating toxicity, the nurse would withhold the medication and notify the health care provider. Therefore, the remaining options are incorrect.

Heart failure (HF) is the inability of the heart to pump a sufficient amount of oxygen to meet the metabolic needs of the body. A weight gain of 1 lb (0.5 kg ) in 1 day is caused by the accumulation of fluid. The nurse should assess

urine output evidence of facial peripheral edema auscultate lung sounds report the weight gain to the health care provider. Tachypnea and increased blood pressure occur with fluid accumulation. Diaphoresis is a sign of HF, but it is not specific to fluid accumulation and usually occurs with exertional activities.

The nurse is preparing to administer digoxin to an infant with heart failure. Before administering the medication, the nurse double-checks the dose, counts the apical heart rate for 1 full minute, and obtains a rate of 80 beats/minute. Based on this finding, which is the appropriate nursing action?

Withold

Tachypnea and tachycardia are signs of

acute hypoxia.

*Rheumatic fever* is

an *inflammatory autoimmune disease* that affects the *connective tissues* of the 1. heart 2. joints 3. skin (subcutaneous tissues) 4. blood vessels 5. central nervous system.

Rheumatic fever characteristically manifests 2 to 6 weeks after

an untreated or partially treated group A β-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months.

The child with congenital heart disease may develop clubbing of the fingers. Clubbing of the fingers is thought to be caused by

anoxia or poor oxygenation.

Many children with a left-to-right shunt may remain

asymptomatic.

Digoxin is a

cardiac glycoside. (Positive inotropic drug) Used in the treatment of heart failure

antinuclear antibody testing is used to

diagnose a wide variety of connective-tissue, vascular, and immune complex disorders and also will be positive with rheumatic fever.

A *diagnosis* of *rheumatic fever* is confirmed by the presence of *2 major manifestations* or 1 major and 2 minor manifestations from the *Jones criteria* . In addition,

evidence of a recent streptococcal infection is confirmed by a positive anti-streptolysin O titer, Streptozyme assay, or anti-DNase B assay.

A child with aortic stenosis shows signs of

exercise intolerance, chest pain, and dizziness when standing for long periods. Pallor may be noted, but is not specific to this type of disorder alone.

child with a diagnosis of tetralogy of Fallot exhibits an increased depth and rate of respirations. On further assessment, the nurse notes increased hypoxemia. The nurse interprets these findings as indicating which situation?

hypercyanotic episode

Children with tetralogy of Fallot or similar physiology may experience

hypercyanotic episodes, or tet spells. These episodes are characterized by increased respiratory rate and depth and increased hypoxia. Immediate health care provider (HCP) notification is not required unless other appropriate nursing interventions are unsuccessful.

With digoxin therapy, The parents need to be instructed that

if the child vomits after digoxin is administered, they are not to repeat the dose.

The knee chest position

improves systemic arterial oxygen saturation.

child with *transposition of the great arteries* may receive prostaglandin E1 temporarily to

increase blood mixing if systemic and pulmonary mixing is inadequate to maintain adequate cardiac output.

positive inotropic agents

increase cardiac contractility

Nursing care initially centers on observing for signs of heart failure. The nurse monitors for

increased respiratory rate, increased heart rate, dyspnea, crackles, and abdominal distension. The remaining options are not conditions directly associated with this disorder.

If a hypercyanotic spell occurs, the nurse immediately places the infant in a

knee-chest position.

if systemic resistance is higher than pulmonary resistance, the shunt is

left to right.