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Summary NRSG 328 Exam 2 Study Guide

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Exam 2 Study Guide for Bio 328. *Essential!! * For you,at a price that's fair enough!!

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  • August 30, 2024
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Exam 2 Blueprint

Chapter 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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