Chapter 26

Question 1

Nursing Care: CHF

Answer 1

• keep child comfortable
• implement oxygenation nursing interventions
• ensure good skin care
• Positive inotropes (digoxin) used in cases of poor contractility
• Diuretics (Lasix) for cases of increased preload
• Vasodilators (captopril) used for cases of increased afterload
• All 3 used in conjunction

Question 2

Educate/Discharge: CHF

Answer 2

• Educate on how to monitor vitals, recognize s/s, how to use medication, side effects of meds.
• Teach that a good exercise plan may help to make heart muscles stronger and help to prevent CHF, even by moderate walking

Question 3

Nursing Care: Congenital Heart Disease

Answer 3

• Monitor and maintain child’s oxygen and nutritional status
• Provide emotional support
• Medical management usually focuses on treating the CHF that may develop due to specific defect
• Preoperative care: take thorough history and physical, provide and support education to family regarding type and process of surgery
• Postoperative care: includes admission into ICU, provide community-based resources to set up home-bound schooling

Question 4

General education/discharge instructions for cardiac conditions in children

Answer 4

• Educate parents on: monitoring vital signs, how to recognize s/s of cardiac failure, importance of learning CPR, medication use, effects, and side effects, balance needed between encouraging activity and prohibiting it
• If child need pulse oximeter in home: teach parents to observe for subtle signs of CHF: SOB, decreased appetite, irritability, swelling, weight gain
• Postoperative teaching points: answer questions about diet, exercise and activity, and return to school
• Surgical wound care: keep clean and dry, steri-strips often left in place until they fall off, watch for signs of infection (redness, fever), cradle infant/baby; do not lift child from under arms until sternal bone is healed

Question 5

Nursing Care: Patent Ductus Ateriosus

Answer 5

• Closure of PDA may be accomplished surgically, w/transcatheter device, and using medication indomethacin
• Focus on postsurgical measures: wound care, monitor vital signs, ensure adequate hydration and nutrition
• Monitor for signs of mitigation when transcatheter closure device used

Question 6

Nursing Care: Atrioventricular Canal Defect

Answer 6

• Prior to surgery optimize cardiac output, ensure adequate weight gain
• After surgery focus on postoperative management and educate on support systems for children w/concomitant Down syndrome

Question 7

Nursing Care: Pulmonic Stenosis

Answer 7

• Help pt reduce stressful situations that may cause high BP

- Surgical interventions: balloon angioplasty, valvuloplasty, open-heart surgery; monitor periodically for restenosis

Question 8

Nursing Care: Aortic Stenosis

Answer 8

• Based on medical and/or postoperative management
• In critical situations, in pt w/narrow valves, preload and afterload reduction medication is indicated
• Surgical tx: balloon agioplasty or valvuloplasty performed to open narrow area; surgical intervention to repair or replace valve

Question 9

Nursing Care: Coarctation of the Aorta

Answer 9

• Focus on postoperative management
• Monitor for evidence of restenosis through proper evaluation of upper and lower BPs
• Control severe rebound hypertension w/antihypertensives as needed (captopril, enalapril)

Question 10

Nursing Care: Tricuspid Atresia

Answer 10

• Admin. prostaglandins to keep PDA from closing
• Focus on postoperative management of multiple surgeries (balloon angioplasty, shunt, Glenn procedure, Definitive Fontan procedure may be needed)

Question 11

Nursing Care: Total Anomalous Pulmonary Venous Return

Answer 11

• Requires complete surgical repair

- Focus on postsurgical management

Question 12

Nursing Care: Transposition of the Great Arteries

Answer 12

• Focus on postoperative management

- Monitor for signs of stenosis around anastomosis sites

Question 13

Nursing Care: Truncus Arteriosus

Answer 13

• Requires palliative and complete surgical repair
• Focus on postoperative management
• Tx for children includes aggressive medical regimen with inotropic medications along with preload and afterload reduction

Question 14

Nursing Care: Tetralogy of Fallot

Answer 14

• Prior to surgery: prevent and minimize symptoms associated with defect
• After surgery: focus on postoperative management

Question 15

Nursing Care: Subacute Bacterial Endocarditis

Answer 15

• Teach preventative measures
• Monitor vital signs
• Support family emotionally
• Provide info. about future outcomes (full recovery vs. valve replacement)
• Edu./Discharge: teach parents how to prevent future infections, how to recognize when infection may occur, to report febrile illness asap; instruct families that if child sustained any vulvar damage, follow-up visits should be made at regular intervals

Question 16

Nursing Care: Kawasaki Disease

Answer 16

• Treat symptoms
• Admin. prescribed meds (IV immunoglobulin and aspirin, steroids, plasma exchange, or cytotoxic agents may be used if initial therapy is ineffective)
• Provide emotional care if child suffers sequelae of aneurysms and family faces lifetime of tx and monitoring
• Pre/postoperative care will be required only if child undergoes surgery for aneurysm repair
• Tell parents that follow-up visits are essential
• If child on anticoagulant therapy, teach appropriate blood testing and monitoring
• Inform about activity restrictions if aneurysms are involved

Question 17

Nursing Care: Cardiomyopathy

Answer 17

• Alleviate symptoms
• Admin. prescribed meds (ACE inhibitors or angiotensin receptor blockers, beta blocker therapy, nutritional supplementation, diuretic and inotropic therapy recommended)
• Monitor for worsening signs and complications
• Communicate to family that frequent echocardiograms are warranted to assess size and fxn of ventricular wall, as well as to note improvement or deterioration of condition

Question 18

Education/Discharge: Cardiomyopathy

Answer 18

• Stress importance of adhering to medications and follow-up regimen
• Teach medication effects, side effects, and proper diet
• Teach proper vital sign monitoring and to recognize symptoms of CHF
• Encourage parents to learn CPR
• Educate about pulse oximeter if child discharged home with oxygen
• Teach parent to observe for subtle signs of CHF

Question 19

Nursing Care: Cardiac Trauma

Answer 19

• Based on extent and exact type of injury
• Promote bedrest
• enforce activity restrictions
• Admin. antiarrhythmias, inotropic agents, and pericardiocentesis as required
• Facilitate cardiac rehab program as recommended
• Teach families to recognize complications and prevent further injury
• Educate on exercise restrictions based on specific injury

Question 20

Nursing Care: Hypertension

Answer 20

• Ensure more frequent BP checks
• Focused education topics: condition, diet, exercise, lifestyle modification, medications (beta blockers, ACE inhibitors)
• Admin. meds on time, do not skip doses to prevent rebound effect

Question 21

Nursing Care: Pulmonary Arterial Hypertension

Answer 21

• Provide education and support for family
• Focus care on reducing respiratory sequelae
• Provide for frequent rest periods
• Monitor respiratory status carefully through vital signs and pulse oximetery
• Provide oxygen and adjust according to need
• Admin. essential meds. (calcium-channel blockers that relax blood vessels, diuretics that decrease volume in vessels)
• Educate on diet: higher calories, exercise: limited abilities, may need specialized cardiac rehab program, medication

Question 22

Nursing Care: Neurally Mediated Syncope

Answer 22

• Monitor for frequency, severity, and precipitating factors of syncope
• Increase child’s sodium and water intake
• Medical management: adrenocorticosteroids (fludrocorisone), may be given to encourage fluid retention, beta blocker can regulate exaggerated response
• Tilt test: lay supine then up to 45 degree then to 90 (standing upright). May/may not have fainting but will see remarkable drop in BP or HR. Child will experience lightheaded/dizziness may syncopize. If negative test, lain flat, given chemical stimulant to simulate fast heart rate. – mimics fight/flight response that may occur before syncope. Then table tilted again to see if elicit syncope or drop in BP/HR. If no change – test is considered negative and then start to consider other causes of syncope.
• Encourage family to learn to recognize activities that put child at greatest risk for syncopal event
• Emphasize importance of adequate hydration
• Instruct pt not to stand in one place for a long time and to bend knees or sit down if a syncopal event is imminent

Question 23

Nursing Care: Long GT Syndrome

Answer 23

• Primary tx is medication (beta blockers)
• Tx also includes pacemaker-defibrillator (insertion) or left cardiac sympathetic denervation
• Emphasize importance of medication compliance

Question 24

Nursing Care: Rhythm Disturbances

Answer 24

• If working in cardiac area w/children who experience dysrrhythmias and require cardiac telemetry, acquire specific knowledge about: ECG and basic dysrrhythmia interpretation
• Determine baseline rhythm and recognize changes
• Know ramifications of these changes