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Questions and Answers
What is the recommended management for polycythemia in children with congenital heart defects?
What is the recommended management for polycythemia in children with congenital heart defects?
Which of the following cardiac monitoring techniques is most beneficial for assessing patients with congenital heart defects?
Which of the following cardiac monitoring techniques is most beneficial for assessing patients with congenital heart defects?
What nursing intervention is crucial for a child recovering from congenital heart defect surgery?
What nursing intervention is crucial for a child recovering from congenital heart defect surgery?
Which cardiovascular diagnostic test is used to visualize the structure of the heart and blood flows in cases of congenital heart defects?
Which cardiovascular diagnostic test is used to visualize the structure of the heart and blood flows in cases of congenital heart defects?
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What is a common post-operative care concern for patients after repair of a congenital heart defect?
What is a common post-operative care concern for patients after repair of a congenital heart defect?
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In cases of transposition of the great arteries, which condition may patients need to be monitored for during surgical post-operative care?
In cases of transposition of the great arteries, which condition may patients need to be monitored for during surgical post-operative care?
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What is the purpose of administering aspirin after a surgical closure of an atrial septal defect?
What is the purpose of administering aspirin after a surgical closure of an atrial septal defect?
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Which condition typically requires immediate surgical intervention in children with congenital heart defects?
Which condition typically requires immediate surgical intervention in children with congenital heart defects?
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What is the primary purpose of keeping the ductus arteriosus open in newborns immediately after birth?
What is the primary purpose of keeping the ductus arteriosus open in newborns immediately after birth?
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Which symptom would most likely indicate decreased blood flow in the lower extremities due to aortic narrowing?
Which symptom would most likely indicate decreased blood flow in the lower extremities due to aortic narrowing?
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What is a common non-surgical treatment used to close a patent ductus arteriosus (PDA)?
What is a common non-surgical treatment used to close a patent ductus arteriosus (PDA)?
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Which of the following is a key nursing intervention for managing a patient with cyanotic spells from Tetralogy of Fallot?
Which of the following is a key nursing intervention for managing a patient with cyanotic spells from Tetralogy of Fallot?
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Which cardiovascular diagnostic test is not typically utilized for assessing conditions like a patent ductus arteriosus?
Which cardiovascular diagnostic test is not typically utilized for assessing conditions like a patent ductus arteriosus?
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What critical monitoring should occur post-operatively after surgical correction of significant congenital heart defects?
What critical monitoring should occur post-operatively after surgical correction of significant congenital heart defects?
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What is a potential sign of poor cardiac output in a newborn with a congenital heart defect?
What is a potential sign of poor cardiac output in a newborn with a congenital heart defect?
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In managing polycythemia in infants, which approach is commonly used?
In managing polycythemia in infants, which approach is commonly used?
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Which of the following signs indicate hypoxemia in patients with cardiovascular issues?
Which of the following signs indicate hypoxemia in patients with cardiovascular issues?
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What is a critical nursing intervention for managing a child with tachypnea?
What is a critical nursing intervention for managing a child with tachypnea?
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Which factor is essential to monitor when administering digoxin to an infant?
Which factor is essential to monitor when administering digoxin to an infant?
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What is the primary purpose of conducting a chest X-ray in cardiovascular assessments?
What is the primary purpose of conducting a chest X-ray in cardiovascular assessments?
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What medication is commonly used to relieve fluid overload in patients with heart failure?
What medication is commonly used to relieve fluid overload in patients with heart failure?
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Which of the following could be a consequence of poor post-operative care following cardiac catheterization?
Which of the following could be a consequence of poor post-operative care following cardiac catheterization?
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In managing polycythemia, which condition should healthcare providers monitor for its effects on the patient?
In managing polycythemia, which condition should healthcare providers monitor for its effects on the patient?
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What is a common sign of systemic vascular congestion in a child?
What is a common sign of systemic vascular congestion in a child?
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What is a common symptom indicating impaired myocardial function in children with CHF?
What is a common symptom indicating impaired myocardial function in children with CHF?
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Which nursing intervention is most important when caring for a child experiencing tachypnea?
Which nursing intervention is most important when caring for a child experiencing tachypnea?
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What should parents be warned about following cardiac catheterization in children?
What should parents be warned about following cardiac catheterization in children?
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Which symptom might suggest systemic vascular congestion in a pediatric patient?
Which symptom might suggest systemic vascular congestion in a pediatric patient?
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Which congenital heart defect results in increased blood flow to the lungs?
Which congenital heart defect results in increased blood flow to the lungs?
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What is an appropriate nursing measure to promote rest in a child with heart failure?
What is an appropriate nursing measure to promote rest in a child with heart failure?
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What is a common symptom associated with Cyanotic congenital heart defects?
What is a common symptom associated with Cyanotic congenital heart defects?
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What is the typical time frame for the closure of the fetal ductus arteriosus in full-term newborns?
What is the typical time frame for the closure of the fetal ductus arteriosus in full-term newborns?
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When administering digoxin, which vital sign requires careful monitoring?
When administering digoxin, which vital sign requires careful monitoring?
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Which symptom is indicative of aortic narrowing in the lower extremities?
Which symptom is indicative of aortic narrowing in the lower extremities?
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Which of the following findings may indicate hypoxemia in a child?
Which of the following findings may indicate hypoxemia in a child?
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Which surgical procedure is typically performed to close an atrial septal defect?
Which surgical procedure is typically performed to close an atrial septal defect?
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What is a key symptom of pulmonary congestion in pediatric patients with CHF?
What is a key symptom of pulmonary congestion in pediatric patients with CHF?
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What is a potential treatment for preventing the closure of the ductus arteriosus immediately after birth?
What is a potential treatment for preventing the closure of the ductus arteriosus immediately after birth?
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What condition can lead to spontaneous closure in children before the age of three?
What condition can lead to spontaneous closure in children before the age of three?
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What is a primary factor influencing whether or not surgery is needed for a septal defect?
What is a primary factor influencing whether or not surgery is needed for a septal defect?
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What procedure is utilized for non-surgical closure of a patent ductus arteriosus?
What procedure is utilized for non-surgical closure of a patent ductus arteriosus?
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Which congenital heart defect commonly presents with deoxygenated blood circulating through the body?
Which congenital heart defect commonly presents with deoxygenated blood circulating through the body?
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Which of the following is a classic symptom of Tetralogy of Fallot?
Which of the following is a classic symptom of Tetralogy of Fallot?
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What are common observed signs in infants experiencing TET spells?
What are common observed signs in infants experiencing TET spells?
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What type of blood flow is characteristic of a left-to-right shunt?
What type of blood flow is characteristic of a left-to-right shunt?
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What is one of the results of an obstructed flow from the ventricles due to aortic narrowing?
What is one of the results of an obstructed flow from the ventricles due to aortic narrowing?
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Which method is commonly used to repair an atrial septal defect in children?
Which method is commonly used to repair an atrial septal defect in children?
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Which treatment option is utilized if non-surgical efforts to close a PDA fail?
Which treatment option is utilized if non-surgical efforts to close a PDA fail?
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What is the typical age group most affected by widespread inflammation of small and medium-sized blood vessels?
What is the typical age group most affected by widespread inflammation of small and medium-sized blood vessels?
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Which symptom is commonly associated with the acute phase of Kawasaki disease?
Which symptom is commonly associated with the acute phase of Kawasaki disease?
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What is the primary diagnostic method for confirming Kawasaki disease?
What is the primary diagnostic method for confirming Kawasaki disease?
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Which treatment is often administered for Kawasaki disease if strep throat is ruled out?
Which treatment is often administered for Kawasaki disease if strep throat is ruled out?
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What type of lab results might indicate a risk for coronary artery aneurysms during Kawasaki disease's subacute phase?
What type of lab results might indicate a risk for coronary artery aneurysms during Kawasaki disease's subacute phase?
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What is a significant nursing consideration for a child in post-operative care following heart surgery?
What is a significant nursing consideration for a child in post-operative care following heart surgery?
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During which phase of Kawasaki disease do symptoms resolve but lab work remains abnormal?
During which phase of Kawasaki disease do symptoms resolve but lab work remains abnormal?
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In terms of surgical care, what is a vital aspect to manage in pediatric patients post-operative?
In terms of surgical care, what is a vital aspect to manage in pediatric patients post-operative?
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Study Notes
Congenital Heart Disease (CHD)
- Over 35 defects affecting the population
- Can occur alone or with other syndromes (e.g., Down syndrome)
- Classified based on blood flow, not symptoms
Normal Heart Function
- Deoxygenated blood returns to the heart's right atrium.
- Blood is pumped through the tricuspid valve into the right ventricle.
- Blood travels through the pulmonary artery to the lungs.
- Blood is oxygenated and returns to the heart via pulmonary veins.
- Oxygenated blood flows through the bicuspid valve into the left ventricle.
- Blood is pumped out of the heart through the aorta to the body.
Common Pediatric Heart Anomalies
- Atrial septal defect (ASD)
- Atrioventricular canal defect
- Coarctation of the aorta (COA)
- Ebstein anomaly
- Hypoplastic left heart syndrome (HLHS)
- Patent ductus arteriosus (PDA)
- Pulmonary atresia
- Pulmonary valve stenosis
- Tetralogy of Fallot
- Total anomalous pulmonary venous return (TAPVR)
- Transposition of the great arteries (TGA)
- Tricuspid atresia
- Truncus arteriosus
- Ventricular septal defect (VSD)
Classification of Defects
Acyanotic Defects
- Left-to-right shunt
- Increased blood flow to the lungs
- ASD, VSD, PDA
Cyanotic Defects
- Right-to-left shunt
- Decreased blood flow to the lungs
- Transportation of great arteries/vessels
- Tetralogy of Fallot
Atrial Septal Defect (ASD)
- Opening between the atria (failure of foramen ovale to close at birth)
- Often closes spontaneously before 5-6 years of age
- Repair depends on the size of the opening
Ventricular Septal Defect (VSD)
- Opening between the ventricles
- Often seen with other congenital heart defects
- 30-50% close spontaneously by 3 years of age
- 3-4 years old, patch graft or open-heart surgery
- Potential need for ongoing heart surgery
Patent Ductus Arteriosus (PDA)
- Opening between the pulmonary artery and the aorta (normal in utero)
- Failure of the fetal ductus arteriosus to close
- Common in premature infants
- Usually closes within 72 hours or up to 2-3 weeks of life
- Full-term newborns may need intervention to close the PDA
- "Machine-hum" murmur, bounding pulses, wide pulse pressure
Coarctation of the Aorta (COA)
- Narrowing of the aorta beyond the aortic arch
- Obstructed flow from the ventricles
- Symptoms:
- Increased blood pressure and blood flow in upper extremities
- Nosebleeds, headaches, bounding carotids
- Decreased blood pressure and blood flow in lower extremities
- Weak pulses, weak muscle tone
Tetralogy of Fallot
- Four defects:
- Ventricular septal defect (VSD)
- Other defects (not specifically listed but implied from previous information in the notes)
Pulmonic Stenosis
- Narrowing of the pulmonary valve
- Symptoms:
- Cyanosis
- Systolic murmur
- Tet spells/blue spells/hyper-cyanotic spells
Kawasaki Disease
- Mimics strep throat (strep test is negative)
- Inflammation of the small and medium-sized blood vessels, especially coronary arteries
- 80% of children are 5 years old or younger
- Cause is unknown
- Seen late winter-early spring
- Not communicable
Acute, Subacute, and Convalescent Phases of Kawasaki Disease
- Acute phase: Sudden onset of fever that's not responsive to antipyretics, irritability, edema, erythema of palms and soles
- Subacute phase: Begins with fever resolution, high risk of coronary artery aneurysms, continuous baseline ECG and ECHO monitoring.
- Convalescent phase: Symptoms resolve, but lab work may not return to baseline yet.
Treatment for Kawasaki Disease
- Culture is negative for strep.
- Health teaching and monitoring for unresolved strep.
- If strep negative, but Kawasaki disease is present - treatment with IVIG and aspirin.
- Consider antibiotics if strep is present.
ASA Therapy
- Might receive antibiotics (ABX) depending on the clinical situation.
Impaired Myocardial Function (CHF Assessments)
- Tachycardia
- Diaphoresis
- Decreased urine output
- Fatigue
- Pale and cool extremities
- Weak peripheral pulses
- FTT/anorexia
Pulmonary Congestion (CHF Assessments)
- Tachypnea
- Dyspnea
- Retractions and nasal flaring
- Excessive intolerance
- Stridor or grunting
- Recurrent respiratory infections
Systemic Vascular Congestion (CHF Assessments)
- Peripheral edema
- Ascites
- Neck vein distention
Signs and Symptoms of Hypoxemia
- Cyanosis
- Clubbing
- Polycythemia
- TET spells
- CHF
Nursing Interventions
- HOB 30 degrees or nap position
- Cluster care with feedings
- Feed only when awake (alert)
- IV feed when needed
- Morphine to decrease respiratory rate (if tachypneic)
- Oxygen administration (PRN)
- Digoxin use - need to be aware of dosages and holding conditions.
- Monitor oxygen saturation
Diagnostic Tests
- Chest X-ray
- Echocardiogram
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