Concept Perfusion: Congential Heart Defects

Question 1

Volume of blood ejected from ventricles depends entirely on heart rate until age _____ years.

Answer 1

5

Question 2

Why do infants have a greater risk of heart failure then older children?

Answer 2

Because of the abnormal formation of the heart during fetal development. At birth the right ventricle is bigger than the left because in utero the right ventricle is responsible for pumping the blood throughout the body.

Question 3

What is the normal pulse ox reading in pediatric perfusion ?

Answer 3

95-98%

Question 4

_____ issues occur first before a cardiac event.

Answer 4

respiratory

Question 5

_____% quiet child abnormal. < 85% is a hypoxic event.

Answer 5

94%

Question 6

With neonates cyanosis may not be seen until arterial saturation is < ____%

Answer 6

79%

Question 7

How do children respond to hypoxemia?

Answer 7

with BRADYCARDIA

Question 8

How many different types of documented congenital heart defects are there?

Answer 8

more than 35

Question 9

What % of infants born with a congenital heart defect have critical heart defect that requires surgery or interventional catheterization in first 6 months of life.

Answer 9

40 %

Question 10

one quarter of all children born with a congenital heart defect ___.

Answer 10

die

Question 11

one third that do not survive are less than ___ year or age.

Answer 11

one

Question 12

what are the risk factors for congenital heart defects?

Answer 12

• fetal exposure to drugs, alcohol, cigarette smoke
• maternal viral infections
• maternal metabolic disorders (diabetes mellitus)
• increased maternal age
• genetic factors
• chromosomal abnormalities

Question 13

What should be covered in the assessment of a child with a cardiac condition?

Answer 13

• respirations
• pulse characteristics
• blood pressure
• color
• chest
• heart auscultation
• fluid status
• activity and behavior
• general

Question 14

What diagnostic test are done for congenital heart defects?

Answer 14

• chest x ray
• computerized tomography (CT)
• magnetic resonance imaging (MRI)
• electrocardiogram (ECG)
• Echocardiogram
• Cardiac catheterization

Question 15

What should be done pre-cardiac catheterization?

Answer 15

• NPO except for medications
• arrive 1 to 2 hours prior to procedure if coming from home
• oral sedative
• have void
• baseline vitals
• color, skin temperature, and cap refill
• hemoglobin and hematocrit
• pedal and popliteal pulses

Question 16

What should the nurse assess for and manage post cardiac catheterization ?

Answer 16

• continuous cardiac monitor
• apply pressure to site x 15 minutes. pressure dressing for several hours
• monitor pressure dressing for bleeding q5 minx3 then q15min left in place for several hours.
• assess perfusion lower extremities, compare precath to postcath
• frequent vitals
• monitor I&Os, encourage fluids
• bedrest. DO NOT raise head of bed for 4-6 hours
• quiet activities for 24 hours

Question 17

what is the pathophysiology of a ventricular septal defect?

Answer 17

• increased pulmonary flow
• increased pulmonary vascular resistance
• depending on size of opening and amount of blood may develop CHF.
• right ventricular hypertrophy may develop to compensate.

Question 18

small ______ may close spontaneously within the first 6 moths of life.

Answer 18

VSD

Question 19

___ to ____% VSD cases close within the first two years of life.

Answer 19

75 to 80 %

Question 20

one should wait until the child is _____ or _______ to repair unless worsening complications occur.

Answer 20

symptomatic or older

Question 21

What is the main goal of treatment for VSD?

Answer 21

prevent long term effects of pulmonary hypertension and irreversible pulmonary vascular disease until heart is repaired.

Question 22

What are the clinical manifestations of VSD?

Answer 22

• increased heart rate
• increased respirations
• increased metabolic rate
• diaphoresis during sucking
• poor growth and weight gain
• major complications: pulmonary artery hypertension

Question 23

A diuretic inhibits chloride transport of sodium into circulation. Na and water are lost with K, Ca, and Mg.

Answer 23

Furosemide (Lasix) – Loop diuretic

Question 24

Acts on distal renal tubules to promote sodium and water excretion and potassium retention.

Answer 24

Spironolactone (Aldactone) – Potassium Sparing diuretic

Question 25

dilates the arterioles (vasodilation) and promotes sodium chloride and H2O excretion.

Answer 25

Hydrochlorothiazide (HCTZ) – Thiazide and thiazide like diuretic