congenital Cardiac

Question 1

congestive heart failure

Answer 1

Inability of heart to pump enough blood to meet bodies demands

Question 2

sx of pulmonary venous congestion

Answer 2

Increased respiratory rate
Nasal flare
Wheezing , crackles
Grunting
Retractions

Question 3

sx systemic congestion

Answer 3

Hepatomegaly
Ascites
Edema
Weight gain
JVD

Question 4

impaired myocardial function sx

Answer 4

increased heart rate, weak pulses
Decreased blood pressure
Cool extremities
gallop murmur

Question 5

increased metabolic rate sx

Answer 5

FTT
Slow weight gain
Sweating

Question 6

Medications to treat CHF

Answer 6

Furosemide – decrease fluid
Ace inhibitors – decrease BP, afterload
Digoxin – increase contractility, decrease heart rate, increase BP

Question 7

what is the only oral ionotropic medication?

Answer 7

Digoxin

Question 8

when to hold digoxin

Answer 8

Infants-heart rate, less than 90 to 110
Older kids – heart rate less than 70
Vomiting
Low potassium level <3.5

Question 9

other digoxin rules

Answer 9

Give at regular intervals
Give one hour before or two hours after eating
Check apical rate one minute before
Don’t mix with food or water
Brush after – stains

Question 10

What to do if missing a dose of digoxin

Answer 10

less than four hours, give
Greater than four hours skip

Two doses - call HCP

Question 11

Signs of digoxin toxicity

Answer 11

nausea/vomiting
Bradycardia
Anorexia
Vision disturbances
Elevated potassium

Question 12

what is the antidote for digoxin toxicity?

Answer 12

Digibind

Question 13

nursing care for CHF patient

Answer 13

Prevent crying
Anticipate needs
Promote rest
Group activities together
Neutral thermal environment
Avoid construction , crowded places

Question 14

Nutrition for CHF patients

Answer 14

small, frequent meals
Feed less than 30 minutes at a time, remaining NG tube
Calm environment
Semi erect position
Burp before during and after
Increase calories per ounce with formula
Soft premie nipple with large volume

Question 15

arterial septal defect (ASD)

Answer 15

Hole between atrias
Left to right shunting
More blood to the lungs

Question 16

ventricular septal defect (VSD)

Answer 16

hole between ventricles
Left to right shunting
More blood to the lungs

Question 17

T/F it is important to stay up-to-date on vaccines with CHF patients

Answer 17

True, most are eligible for high up vaccines

Question 18

patent ductus arteriosus (PDA)

Answer 18

Fetal structure fails to close
Blood is shunted from aorta to pulmonary artery

Question 19

treatment for PDA

Answer 19

Indomethacin – anti-prostaglandin E promotes closure of PDA

Ibuprofen

Question 20

coarctation of aorta

Answer 20

Narrowing of aorta distal to ductus arteriosus

Question 21

what are the pressure changes with COA?

Answer 21

Increased pressure, proximal to defect
Decreased pressure distal to defect

Question 22

s/sx COA

Answer 22

Headache
Nosebleed
Increased blood pressure in upper extremities
Weak/absent lower extremity pulses
bounding upper extremity pulses
Cool legs

Question 23

Treatment of COA

Answer 23

Prostaglandin E

Question 24

Aortic stenosis

Answer 24

narrowing fusion of aortic valves

Blood backs up into the right side of the heart and enlarges

Hypertrophy of left ventricle

Question 25

s/sx aortic stenosis

Answer 25

Exercise intolerance Poor feeding Faint pulse, increased HR Chest pain

Question 26

what is the level of activity patients with aortic stenosis should be doing?

Answer 26

Limited activity, but not bedrest Example – elevator versus stairs

Question 27

Pulmonic stenosis

Answer 27

Narrowing of valves of pulmonary artery Small left ventricle

Question 28

Atresia

Answer 28

Total fusion no blood flow to the lungs

Question 29

polycythemia

Answer 29

thick blood More RBCs More at risk of clots in stroke Prevented by hydration

Question 30

tetralogy of fallot

Answer 30

right ventricle hypertrophy VSD Pulmonic stenosis Overriding aorta

Question 31

hyper cyanosis

Answer 31

Hyper contractility Tet spell

Question 32

Hypoxic squat

Answer 32

increases vascular resistance Decreases venous return of deoxygenated blood Diverts more blood to the pulmonary artery

Question 33

TET spell guidelines

Answer 33

1- knee to chest position 2- oxygen 3- morphine

Question 34

what is the role of morphine?

Answer 34

Relaxes infundibular muscle Allows more blood to leave right ventricle

Question 35

tricuspid atresia

Answer 35

Failure of tricuspid valve to develop

Question 36

treatment of tricuspid atresia

Answer 36

Prostaglandin E Digoxin Diuretics Surgery

Question 37

transposition of the great arteries

Answer 37

Pulmonary artery connects to the left ventricle Aorta connects to the right ventricle

Question 38

treatment for transposition of great arteries

Answer 38

Arterial switch procedure within the first few weeks of life IV. Prostaglandin E Surgery

Question 39

Truncus arteriosus

Answer 39

Pulmonary artery an aorta fail to divide One single, large vessel, empties both ventricles

Question 40

Hypoplasia left heart syndrome (HLHS)

Answer 40

small/absent left ventricle-severe hypoplasia Mixed blood to the lungs

Question 41

treatment for HLHS

Answer 41

Prostaglandin E Transplant

Question 42

discharge planning for heart surgery

Answer 42

Wound care – sternal incision Prophylaxis antibiotics for bacterial endocarditis When to call HCP Self limit activities Med. Teaching.

Question 43

how should a child be picked up after open heart surgery?

Answer 43

Scooped under their bottom and back Do not pick up under arms for at least two weeks

Question 44

what is the role of prostaglandin E

Answer 44

Keeps PDA open