CHapter 41

Question 1

what are types of cardiac defects?

Answer 1

1. congenital
2. acquired - infection, autoimmune response
3. Vascular dysfunction - kawasaki disease

Question 2

what are some risk factors for cardiac conditions

Answer 2

1. maternal factors - infection (rubella), alcohol and substance abuse during pregnancy, DM
2. genetic factors - congenital conditions, down syndrome, and other chromosomal diseases

Question 3

what are indicators of cardiac dysfunction?

Answer 3

1. poor feeding
2. tachycardia and tachypnea
3. failure to thrive/ poor weight gain/ activity intolerance
4. developmental delays
5. prenatal and/ or family history of cardiac disease

Question 4

manifestations of heart failure

Answer 4

1. impaired cardiac function
   
   • sweating, tachycardia, fatigue, pallor, cool extremities with weak pulse, hypotension, cardiomegaly
2. pulmonary congestion
   
   • tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, exercise intolerance
3. systemic venous congestion
   
   • hepatomegaly, peripheral edema, ascites, neck vein distention, periorbital edema, weight gain

Question 5

hypoxemia manifestation

Answer 5

• Cyanosis
• Poor weight
• Tachypnea
• Dyspnea
• Clubbing
• Polycythemia
• Weight gain
• Hypercyanotic spells (blue or Tet spells)

Question 6

diagnostic tests for cardiac dysfunction

Answer 6

1. chest xray
2. ecg
3. echocardiogram
4. cardiac catheterzation
5. lab test (Hgb, Hct, electrolytes)

Question 7

pre-pocedure nursing considerations for cardiac catheterization

Answer 7

• Perform a nursing history and physical exam
• Check for allergies (iodine)
• Age appropriate teaching
• NPO 4-6 hours prior
• Obtain baseline vitals, including oxygen saturation
• Mark the location and quality dorsalis pedis and posterior tibial
pulses on both extremities.
• Administer pre-sedation

Question 8

post procedure considerations for cardiac catheterization

Answer 8

• Provide continuous cardiac monitoring and oxygen saturation to
assess for bradycardia, dysrhythmias, hypotension, hypoxemia.
• Assess heart rate and respiratory rate for 1 full minute.
• Assess pulses for equality and symmetry
• Assess the temperature and color of the affected extremity:
• Assess insertion site for bleeding or hematoma.
• Maintain a clean dressing
• Prevent bleeding:
• Monitor I & O for hypovolemia or dehydration
• Monitor for hypoglycemia.

Question 9

1. what can cause an increase in pulmonary blood flow?

2. what are examples of defects that increase pulmonary blood flow?

Answer 9

1. -abnormal connection between both sides of the heart
   
   • increased blood volume in right side of heart
   • decreased systemic blood flow
2. Atrial septal defects, ventricular septal defects, patent ductus arteriosus

Question 10

what can cause a decrease in pulmonary blood flow

Answer 10

decreased blood volume on right side of heart

increase systemic blood flow

Question 11

What are some obstruction defects?

Answer 11

1. coarctation of the aorta

2. aortic stenosis and pulmonary stenosis

Question 12

Decreased Pulmonary Blood

Flow Defects

Answer 12

• Tetralogy of Fallot

* Tricuspid atresia - abnormal narrowing

Question 13

patient centered care

1. VSD
2. ASD
3. PDA

Answer 13

1. -Cardiac Catheterization
   -diuretics
2. Cardiac Catheterization (careful observation)
   • Diuretics
   • Low dose aspirin 6 months after procedure
3. Administration of indomethacin
   • Administration of diuretics
   • Protective extra clothes for infants

Question 14

patient centered care:

1. pulmonary stenosis
2. aortic stenosis
3. coarctation f the aorta

Answer 14

1. balloon angioplasty with cardiac catheterization
2. balloon dilation, beta blockers and calcium channel blockers
3. surgical repair on children less than6 years of age, balloon angioplasty and stent placement for adolescents

Question 15

patient centered care

1. tricuspid
2. tetralogy of fallout
3. transposition of great arteries
4. truncus areteriosis
5. hypoplastic left heart syndrome

Answer 15

1. surgical repair
2. surgical repair in first year of life, with shunt placement until undergo surgery
3. surgery switching arteries in first 2 weeks of life, IV prostaglandin E, stent placement in adolescents
4. surgical repair in first month of life
5. repair shortly after birth

Question 16

Infective endocarditis

1. what causes this?
2. what are risk factors
3. Expected findings?
4. how is it diagnosed
5. complications

Answer 16

1. Bacterial : Strep. virdians, Candida albicans, and Staph aureus
2. indwelling catheters
3. fever, malaise, new murmurs
   
   • diaphoresis
   • feeding problems
   • tachycardia
   • septicemia
4. CBC ESR, Blood cultures, ECG
5. Myocardial Infarction, heart failure, embolism

Question 17

what are nursing responsibilities for Infective endocarditis?

Answer 17

• Administer antibiotics parenterally for up to 8 weeks via
peripherally inserted central catheter (PICC)
• Oral care - Preventative oral care for children with existing cardiac problems
• Education: Advise dentist of need for prophylactic antibiotics prior to
dental and surgical procedures, observe for signs of infection.

Question 18

Rheumatic fever

1. Pathophysiology
2. where is it common
3. what does it affect

Answer 18

1. • Inflammatory disease occurs after group A β-hemolytic streptococcal
   pharyngitis
2. • Infrequently seen in U.S.; big problem in Third World
3. • Self-limiting
   • Affects joints, skin, brain, serous surfaces, and heart

Question 19

talk about rheumatic heart disease and what it affects

3. what are some clinical manifestations
4. what are some diagnostic procedures

Answer 19

1. most common complication of rheumatic fever
2. damage to valves
   3.• Carditis
   • Polyarthritis
   • Erythema marginatum (Rash)
   • Subcutaneous nodules
   • Chorea
   • Fever
3. Chest xray, ECG, echocardiogram

Question 20

1. treatment of RHD

2. this is the same as

Answer 20

1. • Penicillin G—IM x 1
   • Penicillin V—oral BID x 10 days
   • Sulfa—oral QD x 10 days
   • Erythromycin (if allergic to above)—oral x 10 days
2. Treatment of streptococcal tonsillitis/pharyngitis

Question 21

how is Kawasaki disease treated

Answer 21

1. IV igG and ASA

Question 22

systemic hypertension

1. what is the difference between primary and secondary
2. what are some causes in pediatrics

Answer 22

1. primary is no known cause, and secondary is a known cause

2. renal disease, CV disease, endocrine or neurologic disorder

Question 23

pulmonary artery hypertension

1. Risk
2. Expected findings
3. How is this diagnosed
4. Nursing actions

Answer 23

1. Genetic
2. Dyspnea, chest pain syncope
3. Xray, ECG, echocardiogram, Cardiac catheterization
4. Family support, Oxygen, prostacyclin, and educate about avoiding high altitudes, adhere to medication

Question 24

dyslipidemia

1. patho
2. nursing consideration
3. treatment

Answer 24

1. Abnormally elevated cholesterol or fats (lipids) in the blood.
2. dietary (restrict intake of cholesterol and fat). If no response to diet, use drugs (colestipol, cholestyramine)

Question 25

Cardiomyopathy 1. risk factors 2. expected findings 3. Patient centered care 4. how is this diagnosed

Answer 25

1. genetics, infections, metabolic conditions, drug toxicity, dysrhythmias 2. tachycardia, dysrhythmia, dyspnea, hepatosplenomegaly, fatigue, poor growth and feeding, chest pain, and syncope. 3. beta blockers, Calcium channel blockers ace inhibitors, anticoagulants and heart transplant 4. chest xray, ecg echo, cardiac catheterization

Question 26

cardiogenic shock 1. Patho 2. risk 3. expected findings 4. diagnosed through?

Answer 26

1. impaired cardiac function that leads to decrease in cardiac output 2. recent cardiovascular surgery, dysrhythmias, anaphylaxis 3. Dyspnea, crackles, grunting, hypotension, tachycardia, weak peripheral pulses 4. similar to others

Question 27

care for cardiogenic shock

Answer 27

• Remain calm • Increase tissue oxygenation: • Decrease workload of heart: • Keep the child well-hydrated/Maintain fluid and electrolyte imbalance: • Conserve the child’s energy • Provide adequate nutrition: • Perform daily weight and I & O to minor fluid status and nutritional status • Monitor heart rate, blood pressure, serum electrolytes, renal function to assess for complications • Administer prescribed medications

Question 28

what are some drugs used for CV disorders

Answer 28

* IV IgG * Digoxin (Lanoxin) * ACE inhibitors (Captopril Enalapril) * ASA, NSAIDs * Beta-Blockers (Metoprolol Carvedilol) * Potassium wasting diuretics (Furosemide, Chlorothiazide) * Spironolactone (Aldactone)

Question 29

Cardiac dysrhythmias and how it is diagnosed

Answer 29

- ECG - Holter Monitoring - Electrophysiologic cardiac catheter - Transesophageal recording

Question 30

1. how is bradydysrhythmias treated

Answer 30

1. AV block, and may use pace maker

Question 31

Postoperative Care for the Child

Answer 31

* Monitor vital signs and A/V pressures * Intra-arterial monitoring of BP * Intra-cardiac monitoring * Respiratory needs * Rest, comfort, and pain management * Fluid management * Progression of activity