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Questions and Answers
What is a characteristic sign of a Patent Ductus Arteriosus (PDA)?
What is a characteristic sign of a Patent Ductus Arteriosus (PDA)?
Patients with Tetralogy of Fallot typically experience increased pulmonary blood flow.
Patients with Tetralogy of Fallot typically experience increased pulmonary blood flow.
False
Name the four heart anomalies associated with Tetralogy of Fallot.
Name the four heart anomalies associated with Tetralogy of Fallot.
Pulmonic stenosis, Right ventricular hypertrophy, Ventricular septal defect, Overriding aorta
Increased preload is caused by _____ of blood from one ventricle to another.
Increased preload is caused by _____ of blood from one ventricle to another.
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Match the following terms with their definitions:
Match the following terms with their definitions:
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What is a common surgical treatment for Patent Ductus Arteriosus?
What is a common surgical treatment for Patent Ductus Arteriosus?
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Surgical and non-surgical procedures for managing PDA have a 0% mortality rate.
Surgical and non-surgical procedures for managing PDA have a 0% mortality rate.
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What is the relationship between increased blood pressure and afterload?
What is the relationship between increased blood pressure and afterload?
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What is a primary reason for shock in children?
What is a primary reason for shock in children?
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Decompensated shock is characterized by normal organ function.
Decompensated shock is characterized by normal organ function.
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What are two observable signs of compensated shock in children?
What are two observable signs of compensated shock in children?
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PDA stands for Patent ________ Arteriosus.
PDA stands for Patent ________ Arteriosus.
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Match the type of shock to its primary characteristics:
Match the type of shock to its primary characteristics:
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Which of these is NOT a focus of therapeutic management in shock?
Which of these is NOT a focus of therapeutic management in shock?
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Prior to birth, screening for critical congenital heart disease is done through physical examination.
Prior to birth, screening for critical congenital heart disease is done through physical examination.
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What type of fluid administration is crucial during the therapeutic management of shock?
What type of fluid administration is crucial during the therapeutic management of shock?
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In the case of PDA, blood flows from high pressure aorta to low pressure ________ artery.
In the case of PDA, blood flows from high pressure aorta to low pressure ________ artery.
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Which of these conditions is not characterized by increased pulmonary blood flow?
Which of these conditions is not characterized by increased pulmonary blood flow?
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What factors determine cardiac output?
What factors determine cardiac output?
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Cardiac contractility is the force a muscle can generate dependent on stretch or load.
Cardiac contractility is the force a muscle can generate dependent on stretch or load.
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List two manifestations of pulmonary congestion.
List two manifestations of pulmonary congestion.
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Prolonged hypertrophy leads to loss of effective __________ contraction.
Prolonged hypertrophy leads to loss of effective __________ contraction.
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Which of the following is NOT a medication used to improve cardiac function?
Which of the following is NOT a medication used to improve cardiac function?
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Gallop rhythm is a sign of impaired myocardial function.
Gallop rhythm is a sign of impaired myocardial function.
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What is the purpose of elevated head positioning in cardiac care?
What is the purpose of elevated head positioning in cardiac care?
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In systemic venous congestion, one possible manifestation is __________ edema.
In systemic venous congestion, one possible manifestation is __________ edema.
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Match the following signs/symptoms with their corresponding conditions.
Match the following signs/symptoms with their corresponding conditions.
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Which nursing action is critical in the management of a child with heart failure?
Which nursing action is critical in the management of a child with heart failure?
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Blalock-Taussig Shunt is a type of elective repair for heart defects.
Blalock-Taussig Shunt is a type of elective repair for heart defects.
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Identify one therapeutic goal for the management of cardiac dysfunction.
Identify one therapeutic goal for the management of cardiac dysfunction.
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One implication for children born with Tetralogy of Fallot is the transition to __________ care.
One implication for children born with Tetralogy of Fallot is the transition to __________ care.
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Which of the following is a symptom of impaired myocardial function?
Which of the following is a symptom of impaired myocardial function?
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Daily weights are unnecessary in the care of a child with cardiac issues.
Daily weights are unnecessary in the care of a child with cardiac issues.
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Study Notes
Circulation Concerns of a Pediatric Client
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Learning Outcomes: Apply core principles of family-centered care and relational care in pediatric nursing practice and teaching; Apply evidence-informed knowledge, critical inquiry, and clinical judgment to pediatric clients and families; Describe a holistic approach to assessment, planning, implementation, and evaluation in pediatric care; Discuss common political, ethical, and economic issues in pediatric care.
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Goals of the Class: Describe immediate interventions for children experiencing circulatory concerns; Explore nursing roles and responsibilities in caring for children with shock, congenital heart disease (PDA or Tetralogy of Fallot); Discuss the Pediatric Cardiac Inquest's impact on nursing.
Shock in Children
- Shock (circulatory failure) is a complex presentation.
- Characterized by inadequate tissue perfusion (not enough blood flow to tissues) that leads to metabolic demands and eventual organ failure.
- Causes in children include hypovolemia (low blood volume), altered peripheral vascular resistance, and pump failure.
Types of Shock
- Compensated Shock: Vital organ function is maintained by compensatory mechanisms. Blood flow is normal or increased, and fluids may shift. Signs include apprehension, irritability, unexplained tachycardia, and normal blood pressure.
- Decompensated Shock: Characterized by tissue hypoxia, metabolic acidosis, and eventually dysfunction of all organ systems. Confusion, somnolence and tachypnea are common.
- Irreversible/Terminal Shock: Thready pulse, hypotension, periodic breathing, apnea, anuria, and stupor/coma.
Compensated Shock
- Thirst, pallor, diminished urine output, reduced perfusion to extremities.
Decompensated Shock
- Oliguria, cool pale extremities, decreased skin turgor, poor capillary refill
Therapeutic Management
- Ventilation: Establish airway and intubate; administer oxygen.
- Fluid Administration: Obtain vascular access (intraosseous in emergency), restore fluid volume.
- Cardiovascular Support: Administer vasopressors (e.g., epinephrine). Provide continuous ECG monitoring, monitor pulse oximetry. Maintain positioning (flat/legs raised), keep child calm and warm.
Review of the Heart Structures
- Screening for Critical Congenital Heart Disease: Prenatal ultrasound, physical examination, oximetry screening (right hand and one foot).
- Congenital Heart Conditions in Children: Information on different congenital heart conditions such as increased/decreased pulmonary blood flow, obstruction of blood flow out of the heart and mixed blood flow.
Congenital Heart Disease (Examples)
- Patent Ductus Arteriosus (PDA): A defect where a fetal artery connecting the aorta and pulmonary artery does not close. This leads to increased pulmonary blood flow.
- Tetralogy of Fallot: Four heart anomalies, including pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta. This leads to decreased pulmonary blood flow.
Presentation of PDA
- Patients may be asymptomatic or show symptoms like heart failure, a machinery-like murmur, widening pulse pressure and bounding pulses.
Management and Treatment of PDA
- Intravenous administration of prostaglandins; Surgical division or ligation of the parent vessel; Surgical coils to occlude the PDA; Surgical and non-surgical procedures have a 0% mortality rate.
Tetralogy of Fallot
- Characterized by four heart anomalies (pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta). This leads to decreased pulmonary blood flow.
Side-by-Side Heart Comparison
- Includes various factors including Preload, Afterload, Cardiac Output, and Contractility
Diagnostic Tests
- Chest X-ray, electrocardiogram, echocardiography, cardiac catheterization, cardiac MRI.
Signs of Heart Failure
- Impaired myocardial function; pulmonary congestion; systemic venous congestion
Impaired Myocardial Function
- Tachycardia, Sweating/inappropriate, decreased urine output, fatigue, weakness, restlessness, Anorexia, Pale/Cool extremities, weak/peripheral pulses, Decreased blood pressure.
Pulmonary Congestion Manifestations
- Symptoms include increased breathing rate, shortness of breath, retractions, flared nostrils, exercise intolerance, and orthopnea.
Systemic Venous Congestion Manifestations
- Weight gain, hepatomegaly, peripheral edema (especially periorbital), ascites, neck vein distention
Therapeutic Management
- Improve cardiac function; Remove accumulated fluid and sodium; Decrease cardiac demands; Improve tissue oxygenation and decrease oxygen consumption.
Medications to Improve Cardiac Function
- Ace inhibitors, digitalis, beta blockers, diuretics.
Nursing Actions and Interventions
- Assess the infant/child, administer oxygen, elevate the head of the bed, offer feeds, and encourage family participation.
Treating Hyper Cyanotic Spells
- Place infant in knees/chest position, provide calm approach, administer oxygen, and potentially give morphine and fluid replacement..
Surgical Interventions
Surgical interventions such as palliative shunts like Blalock-Taussig or complete repair may be necessary.
Care of Child Preoperatively/Postoperatively
- Preoperative care includes frequent cardiorespiratory assessment, daily weights, and preparing the family; Postoperative care includes monitoring, positioning, oxygenation, nutrition, and fluid status.
Diagnosis and Complications for Tetralogy of Fallot
- The congenital heart condition might have varied symptoms from healthy to severe; The condition could lead to additional family fears and the loss of normal routines and expectations; Pediatric cardiac inquest.
Recommendations
- Recommendations on structuring the nursing council; how to report patient concerns related to risks; and potential whistleblower legislation to protect nurses.
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Description
Explore the critical aspects of pediatric care concerning circulatory concerns. This quiz covers the application of family-centered care, holistic assessment, and immediate interventions for children experiencing shock and other circulatory issues. Gain insights into the roles of nurses in managing congenital heart diseases and ethical challenges in pediatric care.
