CU9

Question 1

• abnormal opening between the atria.
• foramen ovale failed to close.
• increased O2 blood into the right side of heart
• RA & RV enlargement

Answer 1

ATRIAL SEPTAL DEFECT

Question 2

• dyspnea
• fatigue with poor growth
• SOFT SYSTOLIC MURMUR IN PULMONIC AREA (splitting S2)
• asymptomatic if small
• may develop chf

Answer 2

SIGNS AND SYMPTOMS OF ATRIAL SEPTAL DEFECT

Question 3

• 2D echo = enlarged right side of heart, increased pulmonary circulation
• cardiac catheterization = separation of RA, increased O2 sat in RA

Answer 3

LABORATORY / DIAGNOSTIC EXAMS OF ASD

Question 4

• septal occluder (AMPLATZER SEPTAL OCCLUDER)
• ASPIRIN, 81mg/day prescribed for 6 months
• pericardial patch / Dacron patch
• open repair with cardiopulmonary bypass usually performed before school age

Answer 4

TREATMENT FOR ASD

Question 5

as the nurse on duty, what may develop in the postoperative period of ASD surgery?

Answer 5

arrhythmias

Question 6

spontaneous closure of small ASDs occur within?

Answer 6

first 4 years of life

Question 7

• explain to the parents purpose of test and procedures
• educate parents about s/s of CHF & infection
• prepare older child for post-operatice experience, including coughing and deep breathing and need for movement.
• teach need for ANTIBIOTIC PROPHYLAXIS TO PREVENT SUBACUTE BACTERIAL ENDOCARDITIS

Answer 7

NURSING MANAGEMENT FOR ASD

Question 8

• abnormal opening between right and left ventricles
• error in early fetal development
• increased pulmonary blood flow
• most common CHD
• RV becomes enlarged, RA may also be distended

Answer 8

VENTRICULAR SEPTAL DEFECT

Question 9

• tachypnea, dyspnea
• poor growth, reduced fluid intake
• decreased exercise tolerance
• palpable thrills
• SYSTOLIC MURMUR AT LOWER STERNAL BORDER
• may develop chf

Answer 9

SIGNS AND SYMPTOMS OF VSD

Question 10

• furosemide = diuretic
• digoxin = help heart pump more forcefully
• ACEI = relaxes blood vessels, help heart pump more easily

Answer 10

medications for VSD

Question 11

• pulmonary artery banding
• knitted Dacron patch
• surgical repair with cardiopulmonary bypass

Answer 11

surgical treatment for VSD

Question 11

small VSDs close spontaneously within?

Answer 11

first 6 months of life - 1 year

Question 12

when is the highest risk associated with surgical repair?

Answer 12

first 2 months of life

Question 13

• arrhythmias
• right bundle branch block
• complete heart block

Answer 13

possible complications of VSD surgical repair

Question 14

• failure of fetal ductus arteriosus to close within first weeks of life
• allows blood to flow from high pressure aorta to low pressure pulmonary artery, causes left-to-right shunt.
• common in preterms with RDS or hypoxemia
• left ventricular hypertrophy

Answer 14

PATENT DUCTUS ARTERIOSUS

Question 15

when should ductus arteriosus close?

Answer 15

about 15 hours after birth

Question 16

how does ductus arteriosus close?

Answer 16

• increase in arterial oxygen con.
• initiation of pulmonary function

Question 17

what leads to closure of PDA?

Answer 17

prostaglandin E

Question 18

• dyspnea, tachypnea, tachycardia
• full, bounding peripheral pulses
• widened pulse pressure
• hypotension ( if CO is low )
• intercostal retractions
• hepatomegaly
• poor growth
• loud MACHINE-LIKE MURMUR AT UPPER LEFT STERNAL BORDER (left intraclavicular area)
• thrill in pulmonic area
• may develop chf
• asymp. if small

Answer 18

SIGNS AND SYMPTOMS OF PDA

Question 19

• indomethacin
• surgical ligation
• prophylactic antibiotics

Answer 19

TREATMENT FOR PDA

Question 20

it often stimulates closure of ductus arteriosus in preterms but cannot be used if CHF is present.

Answer 20

IV ibuprofen or indomethacin