case study mod 5 Flashcards
The provider suspects a persistent patent ductus arteriosus (PDA). What would the nurse expect the provider to order to confirm this diagnosis?
C. Echocardiogram.
- Describe the location and function of the ductus arteriosus in-utero.
Opening between pulmonary artery and aorta- gives lungs blood while they develop and are not used in utero
- How, and when, does the ductus arteriosus usually close?
Systemic pressures rising after birth (lungs being used) and lowering of pulmonary pressure. Low levels of oxygen keep it open (artery dilation).
- What are some of the initial interventions and/or treatments used to attempt nonsurgical closure of a PDA?
Inhibit prostaglandin-give NSAIDs,
- A.J.’s mother asks if cardiopulmonary bypass is needed during surgery to close the PDA. How should the nurse respond?
No- bypass is mainly for intracardiac issues, this is extracardiac
- While completing a physical assessment, the nurse finds diaphoresis, cool extremities, weak and rapid peripheral pulses, and a 4 – 5 second capillary refill. His heart rate is too rapid to count but appears to be over 200 bpm. The nurse suspects supraventricular tachycardia (SVT) and calls 911 to report her findings. The nurse also calls Ryan’s father, instructing him to meet Ryan at the hospital. While waiting for the ambulance to arrive, what are some nonpharmacologic interventions for SVT that the school nurse can attempt?
Vagal maneuvers (hold breath, bear down, take bag of ice and cover child’ face, coughing)
- What medication might be used by emergency medical services (EMS) to slow HR upon their arrival, or at the emergency room if nonpharmacologic interventions fail?
Adenosine
- How is this adenosine administered?
Rapid IV push
- What is the most common medication that Jennifer may be prescribed to help manage CHF? Why?
Digoxin: helps improve contractility
- What should the nurse teach Jennifer’s mother about the signs of toxicity associated with Digoxin?
N/V/D, visual changes, tachycardia, irregular pulse
- What are the most common side effects associated with Prostoglandin drip?
Hyperthermia
Apnea
- What differences would the nurse expect to see in blood pressure regarding coarctation of the aorta?
High/normal arm BP with bounding pulses, low LE BP and faint pulse
- Jack is a 3-week-old who presents to the emergency room in respiratory distress. He is cyanotic and limp, and eventually becomes apneic. He is intubated and placed on a ventilator. After performing a physical exam, the provider suspects a congenital heart defect and orders an echocardiogram, which confirms a diagnosis of tetralogy of Fallot (ToF). Jack’s father asks the nurse, “what does this all mean?” The nurse explains that there are four defects associated with this condition, including:
- Pulmonic stenosis
- Ventricular septal defect (hole between ventricles)
- Overriding aorta (giant aorta takes over both ventricles)
- Right ventricular hypertrophy
- James is a 4-year-old who presents to the clinic with a fever of 104.8 degrees Fahrenheit, red lips, and a “strawberry” tongue. The provider orders a rapid strep test, which is negative. Based on these findings, what condition does the nurse suspect?
Kawasaki disease
- Liam is a 10-year-old who presents to the clinic with red, swollen joints. He is also tachycardic with muffled heart sounds. A chest radiograph is performed, which reveals cardiomegaly. An electrocardiogram (ECG) is performed, which reveals a long PR interval. The provider suspects rheumatic fever and orders an antistreptolysin (ASO) titer. The nurse understands that the provider suspects this diagnosis due to which factor in the child’s medical history?
B. Untreated pharyngitis two weeks ago.
