Learning Guide
Pediatric Cardiovascular Disorders: Chapter 46
Fetal Circulation:
1. What are the routes of blood flow in fetal circulation?
2. What are the changes in circulation from intrauterine to extrauterine? What is the
major stimulus for this change in circulation?
3. What is oxygen saturation? Why is it important for the nurse to know the normal value
for oxygen saturation? At what O2 saturation does cyanosis occur?
Congestive Heart Failure:
4. What is the most common causes for congestive heart failure in infants and children?
5. Explain the pathophysiological basis for the development of CHF in children.
a. How are preload and after-load affected?
b. What compensatory mechanisms does the child exhibit?
6. What are the two earliest clinical manifestations of CHF?
a. What additional symptoms are displayed in an infant and child?
b. Compare and contrast these S&S with those of an adult?
7. How do the various medications assist in treating CHF?
Medication
Action / How do they help
to decrease CHF
Nursing Interventions
Cardiac
glycosides
Digoxin
ACE inhibitors
Diuretics
Beta blockers
**may need to refer to your drug book to complete this chart
8. What are the pulse rate criteria for giving digoxin to an infant, child, and teenager?
9. What are therapeutic levels? What are dosing requirements for digitalization and
maintenance? What are the symptoms of digoxin toxicity? When is digoxin
contraindicated?
10. Why are the potassium levels of importance when giving digoxin?
11. What are nursing specific interventions to decrease cardiac demands and improve
tissue oxygenation?
Cardiac Catheterization:
12. What is the purpose of a cardiac catheterization in children?
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13. Why is it important for the nurse to assess pedal pulses bilaterally prior to a cardiac
catheterization procedure?
14. What are specific nursing interventions for immediate post-cardiac catheterization?
a. Assessment of insertion site
b. Positioning of affected leg
c. Vital signs- which ones are priority?
d. Extremities- what are you assessing?
e. Activityf. Hydration g. Medications h. Comfort –
15. What teaching should the nurse include for discharge instructions for home care after
cardiac catheterization?
Congenital Heart Defects:
16. Cardiac defects are classified by pathophysiology. Discuss the major defects in each
disorder and compare each with normal blood flow in the heart, the clinical
manifestations, and the treatment and nursing care of:
a. Left-to-right shunting lesions
 Patent Ductus Arterious
 Atrial Septal Defect
 Ventricular Septal Defect
- How does insertion of a coil via cardiac catheterization assist in treatment?
b. Obstructive or Stenotic Lesions
 Pulmonic stenosis
 Aortic Stenosis
 Coarctation of the Aorta
- How does balloon valvoplasty assist in treating defects?
- What surgical procedures are performed to correct these defects?
- Why do physicians order take pulse and B/P in all four extremities in
the infant with coarctation of aorta?
c. Cyanotic Lesions with Decreased Pulmonary Flow
 Tetralogy of fallot
- What are the four defects and how do they cause cyanosis?
- Why does dehydration cause concern for this infant?
- What criteria is used in deciding upon surgery?
- What surgery is performed to treat this defect?
d. Cyanotic Lesions with increased pulmonary blood flow
 Truncus arteriosus
 Transposition of the great arteries
17. What is the main complication associated with increased pulmonary blood flow?
18. Explain the rationale for giving indomethacin to a newborn with patent ductus
arteriosus. What is the classification and mechanism of action for this medication?
19. Discuss pre-op and post-op care of the pediatric client regarding open-heart surgery.
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20. Why are prostaglandins administered to the child with an obstructive cardiac disorder,
aortic stenosis?
21. What assessment findings in the newborn and child indicate coarctation of the aorta?
22. How does the nursing care differ for a child with a cyanotic lesion?
23. What is polycythemia, why does it occur in a child with a cardiac disorder? What
specific nursing interventions should the nurse include when planning care for this
client?
24. Which cardiac anomalies represent the greatest risk to survival? What classic
assessment finding would the nurse detect at birth?
Acquired Diseases
Infective Endocarditis:
25. What children are more susceptible to develop bacterial endocarditis?
26. When does the organism enter the body and lodge in the damaged heart tissue?
27. What part of the heart is most affected by the disease?
28. What specific areas of instruction would a nurse include in developing a long-term plan
of care for the child/family with bacterial endocarditis.
29. What specific teaching regarding dental hygiene and dental care must the nurse
include?
Rheumatic Fever:
30. What is the precipitating condition that may develop into rheumatic fever?
31. Compare the major and minor Jones Criteria.
32. What priority teaching would the nurse include related to prevention of rheumatic
fever?
33. Discuss the medication therapy for rheumatic fever:
a. antibioticsb. aspirin
Kawasaki Disease:
34. What does it mean to have multi-system vasculitis?
35. What are the three phases of Kawasaki disease? Describe the clinical manifestations of
each.
36. Why are the erythrocyte sedimentation rate and C-reactive protein elevated?
37. Develop a teaching plan for the family of a child with Kawasaki disease. Include
rationale for each of the following:
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a. Medications:
i. Aspirin (Why is aspirin used in the treatment)ii. Gamma Globulin
b. Activity
c. Comfort
d. Long-term care
e. Psychosocial
38. What is the major complication of Kawasaki disease?
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