Chapter 19: Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder

The pediatric nurse has digoxin ordered for each of five children. The nurse should withhold digoxin for which children? • 5-year-old child who developed vomiting and diarrhea, and is difficult to arouse • 16-year-old child with a heart rate of 54 beats per minute • 2-year-old child whose digoxin level was 2.4 ng/mL from a blood draw this morning The nurse should not administer digoxin to children with the following issues: The adolescent with an apical pulse under 60 beats per minute, the child with a digoxin level above 2 ng/mL, and the child who exhibiting signs of digoxin toxicity. The nurse is assessing the heart rate of a healthy 6-month-old. In which range should the nurse expect the infant's heart rate? 90 to 160 bpm The normal infant heart rate averages 90 to 160 beats per minute (bpm); the toddler's or preschooler's is 80 to 115, the school-age child's is 60 to 100 bpm. 00:59 01:23 The nurse is assessing the blood pressure of an adolescent. In which range should the nurse expect the blood pressure measurement for a healthy 13-year-old boy? 100 to 120/70 to 80 mm Hg The normal adolescent's blood pressure averages 100 to 120/70 to 80 mm Hg. The average infant's blood pressure is about 80/55 mm Hg. The toddler or preschooler's blood pressure averages 90 to 110/55 to 75 mm Hg. The normal school-ager's blood pressure averages 100 to 120/60 to 75 mm Hg Which nursing diagnosis would best apply to a child with rheumatic fever? Activity intolerance related to inability of heart to sustain extra workload Children with rheumatic fever need to reduce activity to relieve stress during the course of the illness A 5-year-old is being prepared for diagnostic cardiac catheterization, in which the catheter will be inserted in the right femoral vein. What intervention should the nurse take to prevent infection? Avoid drawing a blood specimen from the right femoral vein before the procedure Because the vessel site chosen for catheterization must not be infected at the time of catheterization (or obscured by a hematoma), never draw blood specimens from the projected catheterization entry site before the procedure (generally a femoral vein). The other interventions listed are performed for reasons other than prevention of infection. Children scheduled for the procedure are usually kept NPO for 2 to 4 hours beforehand to reduce the danger of vomiting and aspiration during the procedure. Be certain to record pedal pulses for a baseline assessment. The site for catheter insertion is locally anesthetized with EMLA cream or intradermal lidocaine. The nurse is caring for a child with heart failure related to a congenital heart defect. One of the nursing diagnoses identified includes "Excess fluid volume." During a family care planning conference. the parents ask why this diagnosis applies to their child. What is the best response by the nurse? • "Cardiac problems cause the heart to not pump effectively, which causes swelling in the body and fluid in the lungs." This response best explains the meaning of the nursing diagnosis and it's cause. Although there are standardized care plans as a guide, each care plan must be individualized to the client. Stating, "The heart is a pump and it isn't pumping effectively" does not explain the nursing diagnosis. Telling the parents not to worry does not help in educating them. The nurse is caring for a child diagnosed with rheumatic fever. The nurse would do all of the following nursing interventions. Which two interventions would be the priority for the nurse? • Carefully handle the child's knees, ankles, elbows and wrists when moving the child. • Administer salicylates after meals or with milk Pain control and relief are the highest priorities for the child with rheumatic fever. Position the child to relieve joint pain. Large joints, including the knees, ankles, wrists, and elbows, are usually involved. Carefully handle the joints when moving the child to help minimize pain. Salicylates are administered in the form of aspirin to reduce fever and relieve joint inflammation and pain The nurse is reviewing the laboratory test results of several children who have come to the clinic for evaluation. Which child would the nurse identify as having the least risk for hyperlipidemia? Child A with a total cholesterol of 150 mg/dL and low-density lipoprotein (LDL) of 80 mg/dL. Total cholesterol levels below 170 mg/dL and LDL levels less than 100 mg/dL are considered within the acceptable range. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels between 170 and 199 mg/dL and LDL levels between 100 and 129 mg/dL are considered borderline. Total cholesterol levels greater than or equal to 200 mg/dL and LDL levels greater than or equal to 130 mg/dL are considered elevated and place this child at greatest risk The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with rheumatic fever. The nurses in the group make the following statements. Which statement is most accurate regarding the diagnosis of rheumatic fever? "Children who have this diagnosis may have had strep throat." Rheumatic fever is precipitated by a streptococcal infection, such as strep throat, tonsillitis, scarlet fever, or pharyngitis, which may be undiagnosed or untreated. Rheumatic fever is a chronic disease of childhood, affecting the connective tissue of the heart, joints, lungs, and brain. There is no immunization to prevent rheumatic fever. The onset of rheumatic fever is often slow and subtle When a child is scheduled for a cardiac catheterization, an important health teaching point for parents is that the: Child will return with a bulky pressure dressing over the catheter insertion area. Cardiac catheterization is typically performed with the child awake but using conscious sedation. A dressing will be placed on the catheter insertion site After assessing a child, the nurse suspects coarctation of the aorta based on a finding of: Femoral pulse weaker than brachial pulse. A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with coarctation of the aorta. Bounding pulse is characteristic of patent ductus arteriosus or aortic regurgitation. A narrow or thread pulse is associated with heart failure or severe aortic stenosis. Hepatomegaly is a sign of right-sided heart failure. The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells? "He likes to stop and squat wherever he walks." The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance. Constant movement and quick walking are normal for a toddler. Activity level with a daily nap is typical of a toddler. Difficulty breathing would suggest a problem.