Nursing Care of the Child with Cardiac Alteration

Match the following drugs to their actions, use and description.
a. Digoxin
b. Angiotensin- convertin enzyme(ACE) inhibitors
c. Lisinopirl, capropril, enalpril
d. Furosemide
e. Chlorothiazide
f. Spironolactone
g. Carvedilol
H. Prostaglandin
—— Coreg; beta blocker; locks alpha and beta – adrenergic receptors, causing decreased heart rate, decrease blood pressure and vasolidation; used selectively in children; improves symptoms and left ventricular function
—— Aldactone; blocks action of adlostrone to produce dieresis; allows retention of potassium
—— Diuril; Acts directly on distal tubules and possibly proximal tubules to decrease sodium, water, potassium, chloride, bicarbonate absorption, decreases urinary diluting capacity; may need to supplement potassium
—– Causes vasodilation that decreases pulmonary and systemic vascular resistance; decreased blood pressure, reduce afterload, and decrease right and left atrial pressures
—– Lasix; blocks reabsorption of sodium and water to produce diuresis
—— Lanoxin: used because of its rapid onset and decreased risk for toxicity; increases the force of contraction (positive intropic effect); decreases the heart rate (negative chronotropic effect), slows the conduction of impluses through the AV node (negative dromotropic effect), and indirectly enhances diuresis
—— ACE inhibitor that are frequently used in pediatrics
—– A drug administered to the newborn with a congenital heart defect to keep the ductus arteriosus open

From your reading, add medications used to treat hypertension and high cholesterol in the pediatric population. What pertinent patient teaching information would you share with the child and family?

What are signs and symptoms of digoxin toxicity? How could they manifest in a young infant or child?

What labs would the nurse monitor and for what specific reason? In other words, state the rationale for this nursing intervention.

What developmental consideration might there be for the older child and adolescent with a cardiac anomaly?

The infant and the young child who is taking digoxin, at what pulse range would the nurse withhold the dose and notify the practitioner?

What is the relationship between potassium level and the success of digoxin therapy?

What nutritional issues would the nurse anticipate when caring for a young infant born with a heart defect?
Complete the table below:
Condition Hemodynamics
And pathophysiology Medications Nursing management Patient teaching
1. PDA, ASD, and VSD
2. Tetralogy of Fallot
3. Coarctation of the aorta
4. Transposition of the great vessels
5. Aortic and pulmonic stenosis
6. Hypoplastic left heart.

It’s 0700 and you are assigned to care for a 2 year old female was admitted overnight after being seen in the ED. Her parents said she has had a runny nose and cough for four (4) days. Child exhibited rapid and noisy breathing so the parents brought her to the ED. She has refused her food and drinks. She is only taking sips of her parents’ drinks. She was admitted to the unit at 3:00AM.
You assess her status and notes: temperature of 102.6 F, RR. 38, O2 Sat 91%, HR 72, BP is 118/76 and she weighs 28lbs.Upon auscultation of her lungs, coarse breath sounds in the left field and wheezes heard bilaterally. During the initial nursing assessment she is observed sitting on her parents lap, appears listless and frightful of you. Her parents state she talks but she does not answer your questions and looks away from you.
She has a 6 year old brother who is in the 1st grade. She attends daycare. Her brother attends their local public elementary school. Both parents work outside of the home. There are no immunizations included in patient’s medical record. She has NKDA.
She has a PIV on her left forearm running D5 1/3 NS @ 65 ml/hr. Her mother says she has voided but she cannot remember her last “pullup” change nor has she been changed since admission to the unit. She has an order for Tylenol 160 mg PO, PRN q 4h for temperature greater than 101.6 F. She can have a regular diet for age.

1. What additional assessment data would the nurse need?

2. Are the medication and fluid orders safe for this child?

3. List and prioritize 3 Nursing Diagnosis/problems.

4. What pertinent information would be included in a teaching plan for this child and family?

5. Pick one of the top 2 and create a concept map.

6. Discuss the medical and nursing management for the child with a respiratory alteration.

7. Analyze implication for the use of corticosteroids in the care of the child with asthma.

8. Apply family- centered care and atraumatic care concepts and explain the rationale for application to the care of the pediatric patient.

A 10– month – old female infant is the pediatric outpatient clinic for a well child visit. The infant weighed 7 lbs at birth. Today the baby weighs 32 lbs. The baby’s parents often refers to her as “fat beautiful girl” and comments on her as a “good baby and a good eater”.
The nurse notes the infant is sitting unsupported on her father’s laps. The infant has been healthy from birth and appears appropriately development. As a part of the visit a routine lab including a CBC was drawn. On assessment, the infant’s vital signs and height were within normal limits, except her weight and hemoglobin level which is 7.5 g/dl.
The baby is quietly watching the nurse, does not reach for a toy when offered. The nurse notes that when the baby placed seated on a mat on the floor the infant remains seated. When placed in a prone position on the mat, she lays down and looks; does not move or make any attempts to reach several brightly colored toys in her line of sight on the mat.
Her parent’s states” she is too lazy and therefore is a good baby”. She likes to be held. They can count on her remaining where ever she is left and therefore are not worried about her falling or getting injured.
a. Discuss expected normal development of a 10 month old infant.
b. What medical diagnosis should the nurse suspect?
c. What contributing factors are noted in the scenario that supports the expected diagnosis?
d. Based on the Nursing assessment, list 3 prioritized nursing problems.
e. Create a Nursing care and teaching plan for the parents. Include:
1. Treatment/ management
2. Prevention strategies and anticipatory guidance
4. Watch the hemophilia video in the content folder, review the hematological presentation and complete the reading assignment in your text and ATI. Take notes. Use your notes to complete the following learning application activity

2. From the information learned, answer the following:
a. What is hemophilia?

b. How is it diagnosed?

c. How is it treated?

d. What are potential complications?

e. Design a Nursing teaching plan for the child with hemophilia and their family.

5. A 14-year-old male diagnosed with Sickle Cell Anemia at age 2 years is admitted to the pediatric unit. The adolescent reported to the emergency department 6 hours prior to admission with complains of abdominal and joint pain, fever and 1 day history of vomiting. He also reports 4 loose stools at home and one in the ED. His vital signs are on admission to the floor are T. 39.2, P. 98, R. 38 had a B/P 134/91. He weighs 72 lbs and height 68 inches.
Preliminary lab report reveals a serum WBC 19,000 and Hgb. 8. Admitting Diagnoses include R/O gastroenteritis and sickle cell vasoocclusive crisis. The child recently travelled to Denver Colorado from his home in Prince George’s County MD to attend a NFL football game with his father.
He is alert, lying in bed with his cell phone, watching TV. He rates his pain a 9/10 on the numeric pain scale. He requests access to a computer with internet to play his video games. He refuses to drink for fear of more vomiting.
a. What is Sickle Cell Anemia (SCA)?

b. How is it transmitted?

c. What is vasoocclusive crisis?

d. What are the implications of newborn screening? Why is it the law?

e. Discuss the medical management of SCA.

f. Discuss the patient risk for strokes, splenic sequestration and chest syndrome. Are these complications of Sickle Cell Anemia? Why?
g. Create a Nursing plan of care for this child and family
7 . What are the complications Aplastic Anemia and how is treated ?

8. Design a Nursing teaching plan for the child with Aplastic Anemia and their family.
9. What are the complications of Idiopathic Thrombocytopenia Purpura (ITP) and how is treated?

e. Design a Nursing teaching plan for the child with ITP and their family.




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