Peds Test # 3 Circulation

Question 1

What is the most common cause of CHF in children?

Answer 1

Congenital heart defects

Question 2

When cardiac output is insufficient, the body’s sympathetic response is activated. What is the result of this?

Answer 2

1) Peripheral vasoconstriction
2) ⬇ blood flow to kidneys activates the renin-angiotensin mechanism. Aldosterone is secreted which retains water and salt.

Question 3

In patients with CHF, cardiac output is inadequate to meet the body’s circulatory or metabolic needs. What are the implications of this?

Answer 3

1) Infant tired easily especially during feedings
2) Weight loss or lack of weight gain, Diaphoresis, irritability, Nd frequent infections.
3) Tachypnes, nasal flaring, grunting, retractions, cough, crackles, SOB with minimal exertion.
4) Tachycardia, cardiomegaly, cyanosis, poor peripheral pulses, cool extremities, ⬇ BP, heart murmur.

Question 4

What are the 2 methods used to diagnose CHF?

Answer 4

1) Chest X-ray

2) Echocardiography

Question 5

What is the main medication used to manage CHF?

Answer 5

Digoxin/lanoxin

Question 6

What are the 4 SxS of Digoxin toxicity?

Answer 6

1) N & V
2) Anorexia
3) Bradycardia
4) Dysrhythmias

Question 7

What is the most important nursing Consideration to heed before administering Digoxin.

Answer 7

Check apical pulse for 1 minute before administration and hold if < 100 bpm.

Question 8

What 6 things should you educate your patient on who is taking Digoxin?

Answer 8

1) Give on an empty stomach (1hr before meals)
2) If does missed > 4 hours, don’t give dose
3) If patient vomits, given 2nd dose
4) If missed > 2 consecutive doses, call MD
5) If child has teeth, give water afterwards and brush teeth
6) Call Mad if child is ill or poison control if child overdoses

Question 9

What 2 other types of medication are used in the Tx of CHF management?

Answer 9

1) ACE Inhibitors

2) Loop diuretics

Question 10

What are 5 valuable feeding strategies to use when feeding a child with CHF?

Answer 10

1) Feed the infant smal, frequent feedings in a relaxed environment.
2) Hold the infant in an upright position
3) consider NG tube if unable to feed
4) Onitor for ⬆ Tachypnea, Diaphoresis, and vomiting.
5) Concentrate formula to 27 kcal/oz to increase caloric intake per feeding.

Question 11

What is Coarctation of the Aorta and what are its effects on the upper and lower extremities and the hear?

Answer 11

• COA is a narrowing of the aorta
  1) Upper Extremities - ⬆ BP and bounding pulse
  2) Lower Extremities - ⬇ BP and absent pulse
  3) Cardiac - CHF may be present and ⬇ cardiac output

Question 12

What is the effect of Coarctation of the Aorta (COA) on BP?

Answer 12

COA causes hypertension > headaches, dizziness, epistaxis, and fainting.

Question 13

What is the Tx for COA?

Answer 13

1) Balloon Angioplasty

2) Surgery - resection via thorax otaku incision

Question 14

What is Aortic Stenosis?

Answer 14

Aortic Stenosis is is a narrowing before, at or after the aortic valve.

Question 15

What are the 6 consequences of Aortic Stenosis?

Answer 15

1) Oxygenated blood from the left ventricle into systemic circulation is diminished.
2) Pulmonary edema and ⬇ cardiac output if severe
3) Murmur
4) Chest pain
5) Dizziness if standing too long
6) Exercise intolerance

Question 16

What are the 2 methods used to manage Aortic Stenosis?

Answer 16

1) Cardiac catheter

2) Surgery - Valvotomy or valve replacement

Question 17

What are the 3 characteristics of Acquired Heart Disease Rheumatic Fever?

Answer 17

1) Manifests 2-6 weeks after an untreated beta hemolytic strep infection.
2) It is a collagen disease that injures the heart, blood vessels, joints, an SQ tissue.
3) Usually affects the aortic and mitral heart valves.

Question 18

What 2 methods are used to diagnose Acquired Heart Disease Rheumatic Fever?

Answer 18

1) ⬆ ESR

2) ⬆ ASO titer (antistreptolysin)

Question 19

What are the 7 SxS of Acquired Heart Disease Rheumatic Fever?

Answer 19

1) Carditis: Chest pain and SOB
2) Tachycardia, even in sleep
3) Migratory large joint pain
4) Chorea: Irregular and involuntary movements of the legs (temporary and will disappear).
5) Rash
6) Fever
7) Nodules over bony prominences

Question 20

What are the 5 methods of Tx used to manage Acquired Heart Disease Rheumatic Fever?

Answer 20

1) Bedrest: during febrile phases
2) Assess for cardiac distress
3) Penicillin or Erythromycin
4) Aspirin for anti-inflammatory and anti-coagulation actions
5) Antibiotic prophylaxis

Question 21

How long is Antibiotic Prophylaxis given to a patient with Acquired Heart Disease Rheumatic Fever?

Answer 21

1) Without cardiac symptoms - 5 years or through age 21-25

2) With Rheumatic Heart Disease - 10 years or until 40 years old