The Child with a Cardiovascular Disorder

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Questions and Answers

What characteristic is specific to ventricular septal defect compared to other heart defects?

It involves a hole between the two ventricles. (correct)

It involves a hole between the two atria.

It is a condition that causes decreased blood flow to the lungs.

It is associated with narrowed blood vessels.

Which of the following is a symptom commonly associated with rheumatic fever?

Joint pain (correct)

Shortness of breath

Skin rash

Chronic cough

What differentiates primary hypertension from secondary hypertension in children?

Primary hypertension is always inherited.

Secondary hypertension results from another medical condition. (correct)

Secondary hypertension is more common in adolescents.

Primary hypertension has more severe symptoms.

Which heart-healthy guideline is essential for children to prevent cardiovascular disorders?

Maintaining a balanced diet rich in fruits and vegetables. Signup and view all the answers

Kawasaki disease is characterized by which of the following manifestations?

Persistent fever and rash. Signup and view all the answers

What is the ideal instructor to student ratio mentioned for effective teaching?

1:30 Signup and view all the answers

Which of the following materials is NOT listed as required for student use?

Instructor Notes Signup and view all the answers

How does the structure of an infant's cardiovascular system differ from that of an adult?

It is less developed and can lead to congenital defects. Signup and view all the answers

What equipment is required for an instructor to present effectively in the classroom?

Classroom w/desks & chairs Signup and view all the answers

Which cardiovascular sign may indicate a critical condition in a child?

Bradycardia Signup and view all the answers

Which factor is NOT identified as a potential cause of congenital heart defects?

High altitude living Signup and view all the answers

The condition described when a child shows visual pulsations in the neck veins is likely related to which of the following?

Cardiovascular pathology Signup and view all the answers

What should an instructor do before presenting a lesson on cardiovascular disorders?

Thoroughly prepare by studying the lesson and reference materials. Signup and view all the answers

When does the cardiovascular system typically begin to develop in a fetus?

Between the third and eighth week of gestation Signup and view all the answers

Which symptom is NOT commonly associated with congenital cardiac problems in infants?

Excessive weight gain Signup and view all the answers

What type of learning approach is recommended for discussing the differences in the cardiovascular system of infants and adults?

Large group discussion Signup and view all the answers

Which of the following best describes why congenital heart defects are not a problem during fetal development?

Fetal circulation compensates for the oxygen needs. Signup and view all the answers

When presenting a lesson, which media type is being used in this format?

Lecture Signup and view all the answers

What is the primary cause of death during the first year of life among congenital anomalies?

Congenital heart defects Signup and view all the answers

Which of the following best describes defects that increase pulmonary blood flow?

They allow for the return of blood to the right ventricle after recirculation through the lungs. Signup and view all the answers

What is the usual treatment approach for ventricular septal defects (VSD) in children?

Surgical closure or spontaneous closure Signup and view all the answers

Atrial septal defect (ASD) generally results in blood flowing from which chamber to which chamber?

From the left atrium to the right atrium Signup and view all the answers

Which type of heart murmur is characteristic of a ventricular septal defect?

A loud, harsh murmur with a systolic thrill Signup and view all the answers

What is hypothermia used for during cardiac surgery?

To minimize blood loss and enhance patient response Signup and view all the answers

What procedure is a common treatment for an atrial septal defect?

Cardiac catheterization Signup and view all the answers

In congenital heart disease, what does a shunt refer to?

Blood flow through an abnormal opening between two heart vessels Signup and view all the answers

What characterizes the treatment of many congenital heart defects?

Most require surgical intervention Signup and view all the answers

Which congenital defect is often associated with a left-to-right shunt?

Atrial septal defect Signup and view all the answers

What is the primary function of the cardiopulmonary bypass machine during surgery?

To provide oxygenation to body tissues while the heart is stopped Signup and view all the answers

What immediate care is usually given after surgical repair of congenital heart defects?

Regular follow-up appointments with cardiology Signup and view all the answers

What condition is characterized by an abnormal connection between the pulmonary artery and the aorta that typically exists in fetuses?

Patent ductus arteriosus Signup and view all the answers

What is a significant consequence of a patent ductus arteriosus (PDA) remaining open after birth?

Overburdening of the pulmonary circulation Signup and view all the answers

What symptom is NOT commonly associated with patent ductus arteriosus (PDA) as the child grows?

Increased weight gain Signup and view all the answers

What is the primary treatment for coarctation of the aorta in older children?

Percutaneous balloon angioplasty Signup and view all the answers

Which of the following is a characteristic sign of coarctation of the aorta?

Marked difference in blood pressure between upper and lower extremities Signup and view all the answers

What condition can develop if coarctation of the aorta is untreated?

Infective endocarditis Signup and view all the answers

Which diagnostic tool is particularly useful for visualizing blood flow across a patent ductus arteriosus?

Two-dimensional echocardiogram Signup and view all the answers

In tetralogy of Fallot, what defect causes primary obstruction to blood flow to the lungs?

Narrowing of the pulmonary artery Signup and view all the answers

What often occurs as a compensatory mechanism in response to hypoxia in conditions with decreased pulmonary blood flow?

Polycythemia Signup and view all the answers

What is a common positioning behavior exhibited by children with tetralogy of Fallot to ease breathing?

Adopting a squatting position Signup and view all the answers

Which of these is a treatment option for premature infants with a patent ductus arteriosus (PDA)?

Intravenous indomethacin or ibuprofen Signup and view all the answers

What is the term for an unusually wide range between systolic and diastolic blood pressures?

Pulse pressure Signup and view all the answers

What complication may arise after coarctation surgery that requires careful monitoring?

Hypertension Signup and view all the answers

What physiological alteration is most likely evident in a child with a significant difference in blood pressure between the arms and legs due to coarctation of the aorta?

Marked difference between upper and lower extremity pressures Signup and view all the answers

What is the term used for paroxysmal hypercyanotic episodes during the first 2 years of life?

Tet spells Signup and view all the answers

Which diagnostic method confirms the diagnosis of tetralogy of Fallot?

Chest X-ray Signup and view all the answers

Which surgical intervention is performed as a temporary measure for newborns with tetralogy of Fallot?

Blalock-Taussig procedure Signup and view all the answers

When managing hypoplastic left heart syndrome, what medication is given to maintain ductus arteriosus patency?

Prostaglandin E1 Signup and view all the answers

What symptom is commonly associated with congestive heart failure in infants with heart defects?

Dyspnea Signup and view all the answers

Why is dental care particularly important for children with congenital heart defects?

To avoid bacteremia and bacterial endocarditis Signup and view all the answers

Which factor does NOT typically contribute to complications in children with tetralogy of Fallot?

Normal hydration Signup and view all the answers

What should parents be advised to monitor for postoperatively after open heart surgery?

Signs of congestive heart failure Signup and view all the answers

Which approach is recommended regarding immunizations for children after cardiac transplantation?

Immunizations should be delayed until after stopping immunosuppressants Signup and view all the answers

What is a common requirement before dental procedures in children with heart defects?

Antibiotics Signup and view all the answers

What characteristic of skin may indicate poor oxygenation in infants with congenital heart defects?

Grayish blue Signup and view all the answers

Which of the following is NOT a defect included in tetralogy of Fallot?

Aortic regurgitation Signup and view all the answers

How should caregivers respond when a child experiences a tet spell?

Place the child in a knee-chest position Signup and view all the answers

What is the recommended approach for children with congenital heart disease regarding physical activity?

Avoid overprotection while promoting participation Signup and view all the answers

What is the primary purpose of using chest tubes postoperatively?

To remove secretions and air from the pleural cavity Signup and view all the answers

Why must drainage systems be kept below the level of the chest?

To avoid backflow of secretions Signup and view all the answers

What is the significance of using padded Kelly clamps with chest tubes?

To prevent accidental dislodgment of the tubes Signup and view all the answers

What is one of the most common causes of death post cardiac transplant?

Infection and rejection of new tissue Signup and view all the answers

Which aspect is NOT a primary goal of care for children after cardiac surgery?

Teaching advanced surgical techniques Signup and view all the answers

What differentiates the circulation of a newborn from that of a fetus?

Fetal circulation bypasses the lungs Signup and view all the answers

What defines acquired heart disease?

A cardiac problem occurring after birth Signup and view all the answers

Which factor does NOT lead to the development of congestive heart failure (CHF)?

Excessive exercise Signup and view all the answers

What manifestation indicates right-sided heart failure?

Backup of blood in the systemic venous system Signup and view all the answers

Which heart condition is characterized by four specific defects?

Tetralogy of Fallot Signup and view all the answers

Which of the following conditions typically leads to a left-to-right shunt?

Atrial septal defect Signup and view all the answers

What characterizes patent ductus arteriosus (PDA)?

Blood bypassing the lungs after birth Signup and view all the answers

What aspect of cardiac function is significantly limited in infants compared to adults?

Stroke volume responsiveness Signup and view all the answers

What is a common complication of rheumatic fever that specifically affects the heart?

Scarring of the mitral valves Signup and view all the answers

Which of the following symptoms may indicate dehydration in children?

Dry mucous membranes Signup and view all the answers

What is one of the guidelines regarding the administration of digoxin?

The resting apical pulse should be checked for one full minute Signup and view all the answers

Which of the following is NOT considered a possible symptom of rheumatic fever?

Hypoglycemia Signup and view all the answers

What dietary recommendation is essential for patients receiving diuretics?

Foods high in potassium Signup and view all the answers

What safe practice is recommended regarding medication administration in a cardiac unit?

Double-check high-risk medications with another nurse Signup and view all the answers

Which should be prioritized for the management of a child with suspected rheumatic fever?

Aggressive diagnosis and treatment of streptococcal throat infection Signup and view all the answers

During which seasons is rheumatic fever believed to have higher incidence rates among school-age children?

Winter and Spring Signup and view all the answers

Which of the following is NOT a method used to monitor a child under diuretic therapy?

Daily blood pressure readings Signup and view all the answers

What vital assessment should be performed on an infant receiving digoxin before administration?

Count the resting apical pulse Signup and view all the answers

What can prompt a worsening of symptoms in rheumatic fever?

Delay in administering antibiotics Signup and view all the answers

Which of the following best describes rheumatic fever?

An autoimmune disease causing joint and heart issues Signup and view all the answers

Which of these health signs should alert a nurse to a child's potential dehydration?

Poor skin turgor Signup and view all the answers

What is critical information for parents of children on diuretics to understand?

Certain fruits are high in potassium Signup and view all the answers

What is the primary role of anti-inflammatory drugs in treatment?

To decrease fever and pain Signup and view all the answers

In which scenario is the use of steroids indicated?

For severe cardiac symptoms Signup and view all the answers

Which observation would indicate an increased risk of CHF in an infant?

Fatigue during feeding Signup and view all the answers

What potential risk is associated with aspirin therapy?

Aspirin toxicity and blood clotting effects Signup and view all the answers

What characteristic of cyanosis should a nurse particularly note?

Duration and location Signup and view all the answers

What is recommended for a patient during the initial attack of rheumatic fever?

Bed rest until ESR returns to normal Signup and view all the answers

What should nursing activities focus on to benefit a fatigued patient?

Minimizing interruptions during care Signup and view all the answers

In what position may an infant with CHF find relief while breathing?

Knee-chest position Signup and view all the answers

What is tachycardia and why is it significant in infants suspected of having CHF?

A rapid pulse reflecting the heart's struggle to maintain output Signup and view all the answers

Which of the following preventive measures is essential for avoiding rheumatic fever?

Prophylactic antibiotic therapy before dental procedures Signup and view all the answers

What is a significant factor in determining an abnormal blood pressure reading in children?

Age, sex, and height correlations Signup and view all the answers

Which of the following is NOT a common sign of CHF in infants?

Excessive eating without fatigue Signup and view all the answers

What should a nurse observe for in terms of skin changes when assessing for CHF?

Pale or mottled skin Signup and view all the answers

What criteria defines normal blood pressure in children?

Blood pressure below the 90th percentile for age, height, and sex Signup and view all the answers

What feeding strategy can help an infant with suspected CHF?

Small, frequent meals Signup and view all the answers

What should a nurse stress after a diagnosis of strep throat?

Complete antibiotic therapy even if symptoms improve Signup and view all the answers

Which symptom may arise from the use of steroids?

Moon face and hirsutism Signup and view all the answers

Why should the nurse monitor the infant's pulse before administering digitalis?

To avoid potential complications from bradycardia Signup and view all the answers

What change in urine output can the nurse anticipate in an infant with CHF?

Decreased urine output Signup and view all the answers

Which sign indicates that an infant with CHF might be experiencing significant respiratory distress?

Nostril flaring and mouth breathing Signup and view all the answers

What is the primary purpose of administering oxygen to an infant with CHF?

To alleviate dyspnea Signup and view all the answers

Which of the following best describes early signs of CHF that should be reported?

Tachycardia at rest and sudden weight gain Signup and view all the answers

What response changes might you expect from an infant exhibiting air hunger?

Irritability and restlessness Signup and view all the answers

What is a common consequence of poor feeding in infants due to CHF?

Failure to gain weight Signup and view all the answers

What distinguishes the polyarthritis associated with rheumatic fever from other forms of arthritis?

Symptoms disappear without treatment. Signup and view all the answers

Which symptom is most indicative of Sydenham’s chorea?

Involuntary muscle movements Signup and view all the answers

During which age group is rheumatic carditis most often observed?

Young children Signup and view all the answers

What is the typical treatment method for Sydenham's chorea?

Symptomatic relief through medication Signup and view all the answers

Which test is NOT useful in diagnosing rheumatic fever?

Pulmonary function tests Signup and view all the answers

What characterizes erythema marginatum observed in rheumatic fever?

Small red circles with wavy lines Signup and view all the answers

Which of the following criteria is NOT considered a major criterion for diagnosing rheumatic fever?

Fever Signup and view all the answers

Which statement regarding the management of rheumatic fever is true?

Antibiotics are administered to eliminate streptococcal infection. Signup and view all the answers

In rheumatic carditis, which heart structure is most commonly affected?

Mitral valve Signup and view all the answers

What is one potential outcome for children with untreated rheumatic carditis?

Permanent heart damage Signup and view all the answers

Which manifestation may occur alongside rheumatic fever indicating central nervous system involvement?

Chorea Signup and view all the answers

What key feature does the Jones criteria emphasize for diagnosing rheumatic fever?

Evidence of recent streptococcal infection Signup and view all the answers

How does migratory polyarthritis typically present?

Pain that moves from one joint to another Signup and view all the answers

What underlying factors contribute to the difficulty of diagnosing rheumatic fever?

No single test definitively confirms it. Signup and view all the answers

Study Notes

Cardiovascular Disorders in Children

Differences in Child vs. Adult CV Systems: Infant and young children have thinner chest walls, varying pulse, respiration, blood pressure, and hematological values compared to adults. Newborn circulation differs from the fetus, and capillary function is less mature. Heart rate is higher in newborns/infants. Children have less capacity to increase stroke volume when cardiac output decreases, and most heart conditions stem from embryonic structural defects.
Signs of Potential Cardiac Issues: Failure to thrive/poor weight gain, cyanosis/pallor, neck vein pulsations, tachypnea/dyspnea, irregular pulse, finger clubbing, feeding/activity fatigue, and excessive perspiration, especially on the forehead. Bradycardia can indicate impending cardiac arrest in hypoxia.
Congenital Heart Defects: Caused by genetic, maternal (drug use, rubella), or environmental factors. Fetal echocardiography helps detect in high-risk pregnancies. Congenital defects impact the infant's circulatory system's ability to meet oxygen demands after birth.
Congenital Defect Classification and Types Defects categorized into increased pulmonary blood flow (left-to-right shunts), restricted blood flow (stenosis), decreased pulmonary blood flow (right-to-left shunts), and mixed oxygenated/unoxygenated blood, with shunts signifying abnormal openings. Specific defects include atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), coarctation of the aorta, and tetralogy of Fallot. Each defect presents unique physiological and clinical characteristics.
Atrial Septal Defect (ASD): Abnormal opening between atria, allowing oxygen-rich blood to flow back to the right atrium. Usually asymptomatic, murmur often detected during routine checks. Can sometimes close spontaneously; surgical repair may involve patches or catheterization.
Ventricular Septal Defect (VSD): Most common heart anomaly; opening between ventricles, leading to blood shunting from the higher-pressure left ventricle to the right (left-to-right shunt). Loud, harsh murmur detected. Many resolve spontaneously; surgical interventions performed for persistent or serious cases.
Patent Ductus Arteriosus (PDA): Failure of the fetal ductus arteriosus to close after birth. Allows blood flow from higher-pressure aorta to lower-pressure pulmonary artery. Symptoms generally evident later in infancy. Diagnosis aided by 2D echocardiogram; potentially treated with medication (indomethacin, ibuprofen) or surgery.
Coarctation of the Aorta: Narrowing of the aorta. Results in high blood pressure proximal to the defect and low pressure distally, with significant difference in upper/lower extremity blood pressure and pulse. Untreated, may lead to hypertension, CHF, and endocarditis. Treatment dependent on defect severity often involves surgical repair or percutaneous interventions.
Tetralogy of Fallot: Four defects (pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy). Results in decreased pulmonary blood flow, causing cyanosis. Symptoms worsen with age, including tet spells (paroxysmal hypercyanotic episodes). Treatment primarily involves surgery to increase pulmonary blood flow.
Hypoplastic Left Heart Syndrome: Underdevelopment of the left side of the heart. Infants often require multiple staged surgeries or heart transplants.

Acquired Heart Disease

Acquired Heart Disease Definition: Occurs after birth. Can arise from complications of congenital heart disease, respiratory infections, sepsis, hypertension, or severe anemia.
Congestive Heart Failure (CHF): Inadequate cardiac output to meet the body's metabolic needs. Right-sided failure involves systemic venous system backup, and left-sided failure concerns lung backup. Symptoms subtle in infants. Manifestations include cyanosis, pallor, rapid respiration, pulse, feeding difficulties, fatigue, weak cry, excessive perspiration, failure to gain weight, edema, frequent respiratory infections. Critical signs in infants for CHF include tachycardia at rest, sweating around scalp and forehead, dyspnea, and sudden weight gain.
CHF Treatment and Nursing Care: Aim to reduce heart workload, improve respiration, maintain nutrition, prevent infection, reduce patient anxiety, and support parents. Small, frequent feedings using appropriate nipples. Medications like digitalis (digoxin) may be used. Monitor heart rate closely before administration. ACE inhibitors and diuretics may be used. Daily weight, vital signs, and intake/output monitoring is essential.
Rheumatic Fever (RF): Autoimmune disease complicating untreated group A beta-hemolytic streptococcal throat infections. Symptoms (Jones criteria) include migratory polyarthritis, skin eruptions (erythema marginatum), chorea, and carditis. Treatment focuses on eliminating the infection (penicillin or erythromycin), managing symptoms (aspirin, steroids), and providing rest.
Systemic Hypertension: High blood pressure. Significant causes should be investigated; treatment usually addresses underlying causes and manages blood pressure.

Additional Notes

Medication Safety: Always double-check medication dosages, especially digoxin, in pediatric patients. Avoid complementary and alternative medicine (CAM) therapies that may interact with cardiac medications.
Nursing Considerations: Thorough assessment and monitoring are critical. Emotional support for families is essential. Adapt care to the child's needs, minimizing interruptions, providing appropriate rest. Education crucial for family, including prevention strategies and follow-up care.
Cardiovascular Procedures: Cardiac catheterization and surgery necessitate careful post-procedure monitoring and family education. Discharge planning to include community resources/support.

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Description

Test your knowledge on pediatric cardiovascular health with this quiz. Questions cover conditions such as ventricular septal defect, rheumatic fever symptoms, and primary versus secondary hypertension. It's a great way to understand heart health guidelines for children and the differences in cardiovascular systems between infants and adults.