UNIT 7 CARDIOVASCULAR DISORDERS CHAPTER 42 Flashcards
Fetal circulation
Umbilical vein: During fetal life blood carrying oxygen and nutritive
materials from the placenta enters the fetal system through the
umbilicus via the large umbilical vein
Blood then travels to the inferior vena cava through the ductus
venosus
Foramen ovale: shunts blood from right atrium to left atrium
Ductus arteriosus: connects pulmonary artery to the proximal
descending aorta.
A first time mother has a toddler that has undergone a cardiac cauterization procedure. She insists on giving the toddler a tub bath which is her normal hygiene regimen for the toddler. What is the best nursing action from the nurse?
A. Re-educate the mother, that it is not prohibited to continue tub baths after this invasive procedure. It can lead to further complications.
B. Instruct the mother that tub baths are only prohibited 6 months after the procedure.
C. Sponge baths are the only acceptable hygiene regimen for toddlers after this procedure.
D. Advice the mom that she can only bathe the toddler for a maximum of 4 minutes.
A. Re-educate the mother, that it is not prohibited to continue tub baths after this invasive procedure. It can lead to further complications.
Cover catheter insertion site with an adhesive bandage strip and change daily for 2 days.
Keep site clean and dry. Avoid tub baths and swimming for several days; patient may shower or have a sponge bath.
Observe site for redness, swelling, drainage, and bleeding. Monitor for fever.
Notify the practitioner if these occur.
Encourage rest and quiet activities for the first 3 days and avoid strenuous exercise.
Discuss returning to school and resuming other activities with the practitioner.
Resume regular diet without restrictions.
Use acetaminophen for pain.
Keep follow-up appointments per practitioner’s instruction.
What is the priority nursing action post-op of cardiac catheterization?
A. Assess pulses bilaterally
B. Administer acetominophen
C.
D.
You observe that the cardiac Cath site has site redness, swelling, drainage, and bleeding. You also assess the preschoolers temperature , it is 101.3 degrees Fahrenheit. What is the nurses priority action?
A. Initiate IV fluid
B. Provide therapeutic communication to patients family
C. Call a code
D. Notify the health care provider
D. Notify the health care provider
Observe site for redness, swelling, drainage, and bleeding. Monitor for fever. Notify practitioner if these occur.
Your patient has just had a cardiac catheterization on their left femoral artery. What location should you asses the pulses bilaterally?
A. Carotid pulse
B. Femoral pulse
C. Popliteal pulse
D. Brachial pulse
C. Popliteal pulse
Pulses, especially below the catheterization site, for equality and
symmetry. (Pulse distal to the site may be weaker for the first few
hours after catheterization but should gradually increase in strength.)
Are children ate risk post op Cardiac Catherization for hypovolemia and dehydration
A. Yes
B. No
A. Yes
Fluid intake, both IV and oral, to ensure adequate hydration.
(Blood loss in the catheterization laboratory, the child’s NPO sta- tus, and diuretic actions of dyes used during the procedure put children at risk for hypovolemia and dehydration.)
What is the proper positioning for a pediatric patient op cardiac cath>
A. Legs flexed
B. Trendelenburg positioning
C. right side lying
D. legs extended and straight
D. legs extended and straight
Depending on hospital policy, the child may be kept in bed with the affected extremity maintained straight for 4 to 6 hours after venous catheterization and 6 to 8 hours after arterial catheterization to facilitate healing of the cannulated vessel.
Is coolness of the extremity an expected finding after cardiac Cath site?
A. Yes
B. No
B. No
- Pulses, especially below the catheterization site, for equality and
symmetry. (Pulse distal to the site may be weaker for the first few
hours after catheterization but should gradually increase in strength.) - Temperature and color of the affected extremity because coolness
or blanching may indicate arterial obstruction - Vital signs, which are taken as frequently as every 15 minutes, with
special emphasis on heart rate, which is counted for 1 full minute
for evidence of dysrhythmias or bradycardia - Blood pressure (BP), especially for hypotension, which may indi-
cate hemorrhage from cardiac perforation or bleeding at the site of
initial catheterization - Dressing, for evidence of bleeding or hematoma formation in the
femoral or antecubital area - Fluid intake, both IV and oral, to ensure adequate hydration.
(Blood loss in the catheterization laboratory, the child’s NPO sta- tus, and diuretic actions of dyes used during the procedure put children at risk for hypovolemia and dehydration.) - Blood glucose levels for hypoglycemia, especially in infants, who should receive IV fluids containing dextrose
Your 11-year-old client is on a football team. He is about to undergo a cardiac Cath procedure. He wanted to know if he can go to practice 1 day post op of the cardiac procedure. What statement by the nurse warrants immediate intervention?
A. It is prohibited to start strenuous exercise after a cardiac Cath procedure to to risk of bleeding.
B. After the procedure you should be all set to play football again.
C. I would highly recommend you rest after this procedure so you’ll be strong and recovered when you start playing football again.
D. Every child is different but I personally would not give you the ok due to your health being at risk.
B. After the procedure you should be all set to play football again.
Encourage rest and quiet activities for the first 3 days and avoid strenuous exercise.
What is the difference between acquired and congenital heart defects?
Congenital - you have it at birth
*Anatomic: abnormal function
Acquired- you contract it due to environmental factors, something happened and it damaged your heart
*Infection
*Autoimmune responses
* Environmental factors
*Familial tendencies
Which of the following defects would warrant early Pediatric Indicators of Cardiac Dysfunction?
A. low pitch crying
B. poor feedings
C. rooting reflex is gone at 4 months
D. Spontaneous movements
B. poor feedings
Poor feeding
Tachypnea/ tachycardia
Hypoxia
Failure to thrive/poor weight gain/activity intolerance
Developmental delays
Positive prenatal history
Positive family history
IDENTIFY DIAGNOSTIC TEST
Graphic measure of electrical activity of heart
A. Cardiac catherization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
C. Electrocardiogram
IDENTIFY DIAGNOSTIC TEST
Use of high-frequency sound waves obtained by a transducer to produce an image of cardiac structures
A. Cardiac catherization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
D. Echocardiography
IDENTIFY DIAGNOSTIC TEST
Imaging study using radiopaque catheters placed in a peripheral blood vessel and advanced into heart to measure pressures and oxygen levels in heart chambers and visualize heart structures and blood flow patterns
A. Cardiac catheterization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
A. Cardiac catheterization
function of Electrophysiology studies
Electrophysiology studies: Catheters with tiny electrodes that record the impulses of the heart directly from the conduction system are used to evaluate dysrhythmias. Other catheters can destroy abnor- mal pathways that cause rapid rhythms (called ablation).
function of Interventional catheterizations
Interventional catheterizations (therapeutic catheterizations): A bal- loon catheter or other device is used to alter the cardiac anatomy. Examples include dilating stenotic valves or vessels or closing ab- normal connections (Table 42.2).
function of Diagnostic catheterizations
Diagnostic catheterizations: These studies are used to diagnose con-
genital cardiac defects, particularly in symptomatic infants and before surgical repair. They can include right-sided catheteriza- tions, in which the catheter is introduced through a vein (usually the femoral vein) and threaded to the right atrium, and left-sided catheterizations, in which the catheter is threaded through an ar- tery into the aorta and into the heart.
If the cardiac catheter site is bleeding what is the priority action of the nurse?
A. Apply pressure on the site
B. Apply a warm compress to stop the bleeding
C. Apply direct continues pressure 1 inch above the incision cite to localize pressure over the vessel puncture
D. Call a rapid response
C. Apply direct continues pressure 1 inch above the incision cite to localize pressure over the vessel puncture
If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture.
How would you differentiate acyanotic and cyanotic
cyanotic baby turns blue or has blue mucous membranes with an increase of activity, feeding , or frying
Acyanotic no visible symptoms of respiratory distress
Digoxin Infant vs Digoxin Adolescent heart rate (AMINISTRATION CONTRAINDICATION)
Adolescents BELOW 70 DO NOT GIVE
Infants BELOW 90 DO NOT GIVE
What is the best indicator of the drug furosemide is working?
a patients weight loss
Defects of increased pulmonary blood
flow
Defects of increased pulmonary blood
flow
ASD
VSD
PDA
Obstructive cardiac defects
Coarctation of the aorta
Aortic stenosis
Pulmonic stenosis
What is the best intervention to correct obstructive cardiac defects
Cardiac catheterized balloon
Defects of decreased pulmonary blood
flow
Defects of decreased pulmonary blood
flow
Tetralogy of Fallot
Tricuspid atresia
When would tetralogy of fallot be considered to be a cyanotic defect?
A. positive tet spell
B. negative tet spell
C. crying baby
D. unresponsive baby
A. positive test spell
Cardiac defects in tetralogy of Fallot
-Overriding aorta
-Pulmonic stenosis
-Ventricular septal defect
-Right ventricular hypertrophy
What is a tet spell
At birth, infants may not show the signs of the cyanosis but later may develop episodes of bluish skin from crying or feeding called “Tet spells
Mixed blood flow
Transposition of the great vessels
Hypoplastic left heart syndrome
What causes atrial septal defect
foramen ovale does not close,
opening in the right atrium
opening in the right atrium
A.PDA
B. VSD
C. ASD
Atrial septal defect
Abnormal opening between right and left ventricular chambers?
A. PDA
B. ASD
C. VSD
C. VSD
Ventricular septal defect
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life
A. PDA
B. VSD
C. ASD
Patent ductucterios arteriosus
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, which causes a left-to-right shunt.
narrowing of Aorta artery wall?
A. pulmonary stenosis
B. aortic stenosis
C.Coarctation of aorta
C.Coarctation of aorta
The effect of a narrowing within the aorta is increased pressure proximal to the defect (upper extremities) and decreased pressure distal to it (lower extremities).
The healthcare provider has diagnosed your patron with Coarctation of the aorta, which of the following statements are true about this cardiac defect?
A.B. the patient has a decreasedblood pressure in arms and increased blood pressure in legs
B. the patient has a increased blood pressure in arms and decreased blood pressure in legs
C. the patient has a decreased blood pressure systemically
D. The patient has present petechia on neck and chest
B. the patient has a increased blood pressure in arms and decreased blood pressure in legs
The effect of a narrowing within the aorta is increased pressure proximal to the defect (upper extremities) and decreased pressure distal to it (lower extremities).
There may be high blood pressure and bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure.
Increased pressure to
head and upper
extremities
Decreased pressure to
lower extremities
What is the treatment of choice for obstructive cardiac defects
Treatment of choice:
balloon angioplast
What drug would you suspect the Health Care Provider to order for an infant with Patent Ductus Arteriosus?
A. Digoxin
B. Methotrexate
C. Indomethacin
D. Furosemide
Indomethacin injection works by causing the PDA to constrict, and this closes the blood vessel. turn the opening into a ligament (normal anatomic structure)
Administration of indomethacin (prostaglandin in- hibitor) has proved successful in closing a patent ductus in premature infants and some newborns.
What are the 4 defects of Tetrology of fallout
- Ventricular Septal defect
2 . Overriding aorta
- Right ventricular hypertrophy
- pulmonary stenosis
