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Summary NRSG 328 Exam 2 Study Guide
- Course
- NRSG 328
- Institution
- Emory University
Exam 2 Study Guide for Bio 328. *Essential!! * For you,at a price that's fair enough!!
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Exam 2 BlueprintChapter 29
1. Review nursing care of a child undergoing cardiac catheterization including precatheterization,
postcatheterization, and home care.
**Catheterization Notes
Purpose: Can be diagnostic or therapeutic
To assess oxygen saturation and pressure in chambers, cardiac output, blood flow, anatomic
abnormalities
Interventional
o Closures
o Balloon catheters open narrow vessels/valves
o Insertion of valves
o Insertion of stents
Procedure:
o Radiopaque catheter inserted through a peripheral blood vessel into the heart
o Catheter is introduced through the vein in which a catheter is threaded over a guide wire
inserted through a large-born needle
**Pre-catheterization
Child will be NPO
IV fluid
Assess pedal pulses
Document allergy to radiopaque dye or shellfish
Sedation
Educate mother and child
**post-catheterization/home care
Child must lay still supine, with affected leg straight for 4-6 hours
Vital signs, insertion site observed
distal pulses checked q15 minutes x 1st hour, then q30 minutes
Observe for bleeding at site, pallor, loss of pulses, coolness in extremity distal to site
If bleeding occurs at insertion site, apply continuous pressure 1 inch above insertion
Push fluids to help flush dye out of the body
Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)
Avoid baths for 3 days after catheterization
, 2. Identify clinical manifestations and management of heart failure in an infant and child.
CLASSIFICATION OF CONGENITAL HEART DISEASE
A c y a n o tic C y a n o tic
In c re a s e d O b s t r u c t io n o f D e c re a s e d M i x e d B l o o d F lo w
P u lm o n a r y B lo o d B l o o d F lo w P u l m o n a r y B lo o d
F lo w F lo w
Atrial Septal Defect Coarctation of the
Aorta Tetrologyof Fallot Transposition of
the Great Arteries
Ventricular Septal Pulmonic Stenosis
Defect Tricuspid atresia Hypoplastic Left
Heart Syndrome
Patent Ductus Aortic Stenosis
Arteriosus
Clinical manifestations: four types
o Impaired myocardial function
Tachycardia; fatigue; weakness; restlessness; pale, cool extremities; decreased
BP; decreased urine output
o Pulmonary congestion
Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
o Systemic venous congestion
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein
distention
Management/Medication Management
o Improve cardiac function: Digoxin (improves contractility)
Measure apical pulse (for 1 minute!) prior to administrating digoxin
Drug order usually specifies at what heart rate the drug is withheld
Narrow therapeutic index
Do not repeat a dose if the child vomits after administering drug
Signs of toxicity
Bradycardia
Anorexia
Nausea and vomiting
Visual disturbances
o Decrease preload:
Diuretics- Furosemide (Lasix)
Low sodium diet
o Decrease afterload
ACE Inhibitors-Vasodilation
Captopril, Vasotec
3. Review the following cardiac defects in terms of pathophysiology, clinical manifestations, treatment,
and nursing care: atrial septal defect, ventricular septal defect, patent ductus arteriosus, coarctation of the
aorta, Tetralogy of Fallot, and Hypoplastic Left Heart Syndrome.
4.
Clinical
Pathophysiology Treatment Nursing Care
Manifestations
Atrial Septal Asymptomatic Asymptomatic May close
Defect Undiagnosed spontaneously (<3
Left to right shunt; ASD: mm)
, right atrial and o Heart failure If large (>8 mm),
ventricular dilation and in 3rd and 4th close in cardiac
enlargement; right decade of life cath lab or open
ventricular volume o Atrial heart surgery
enlargement
overload; increased
o Atrial
pulmonary blood flow Arrhythmias
Increased PVR o Emboli
Decreased systemic
blood flow = decreased
CO
Ventricular Abnormal opening Most Surgical-Dacron
Septal between the left and asymptomatic patch
Defect right ventricle Murmur may not Closure during
Most common CHD be heard until 2-8 cardiac
occurs anywhere along weeks of life catherization
ventricular septum Loud harsh
Blood flows through murmur left
the defect to the sternal border
pulmonary artery Large defects
Increased PVR result in dyspnea,
Common in preterm poor feeding,
infants poor growth
Patent normal opening Machinery-like Medical
Ductus between the (machine hum) management:
Arteriosus pulmonary artery and murmur o Administration
aorta in the developing Bounding pulses of
fetus Indomethacin
Allows most of the IV:
blood from the right prostaglandin
ventricle to bypass the inhibitor
fluid-filled non- o (first 10-14 days
functioning lungs and of life)
flow into the aorta. Surgical
functionally closes at 12- management”
72 hours o PDA ligation
Common in preterm o Coils
infants
Left to right shunt
(Aorta to Pulmonary
Artery)
Increased pulmonary
blood flow
Decreased systemic
blood flow
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