Michelle Ricci

Pediatric Nursing
Cardiovascular Dysfunction
6/10/21

1. Mrs. Smith is a primip who is 20 weeks pregnant. Her obstetrician is concern that
her child may be at risk for congenital cardiac disease. Identify five prenatal
assessments which are commonly seen in mothers which increase the suspicion that
the infant may be at risk for a congenital heart defect. (25pts)
- Identifying a strong family history of congenital heart defect, history of a sibling who had
a congenital heart defect or sudden childhood death related to a heart defect.
(Hockenberry & Wilson, 2015)
- Prenatal screening for rubella, cytomegalovirus, and toxoplasmosis could indicate an
increased risk for congenital heart defects. (Hockenberry & Wilson, 2015)
- Fetal ultrasound may indicate structural defects as well as incidence of IUGR, which
could also increase the risk. (Hockenberry & Wilson, 2015)
- Fetal electronic monitoring could contraindicate a vaginal birth and could indicate a
cardiac defect by allowing you to assess heart rate and rhythm.
- Screening the mother for a history of chronic illness, such as diabetes or PKU, may also
indicate further risk for congenital heart defects. (Hockenberry & Wilson, 2015)

2. Baby boy smith was born at 35 weeks gestation, weighing 5lbs 4oz. He is
immediately placed on a cardiac respiratory monitor. Identify five clinical
manifestations that could indicate the presence of congenital heart disease in this
newborn. (25pts)
- Nasal flaring, grunting, and retractions, accompanied by rales that can be seen as
symptoms of respiratory distress. (Hockenberry & Wilson, 2015)
- Pallor, cyanosis, and/or the presence of blue spells that increases in the presence of
crying. (Hockenberry & Wilson, 2015)
- Systolic or diastolic heart murmurs that vary in characteristics depending on the defect.
(Hockenberry & Wilson, 2015)
- Atrial dysrhythmias due to atrial enlargement. (Hockenberry & Wilson, 2015)
- May have asymptomatic or symptomatic mild to severe heart failure. (Hockenberry &
Wilson, 2015)

3. Cameron Smith undergoes cardiac surgery at 2 months of age. Describe how nurses
can advocate and support families when facing home care concerns after a child has
had cardiac surgery. (25pts)
The nurse can begin to advocate and support the families regarding home care after
cardiac surgery by helping to reduce anxiety through preparation and frequent communication
regarding the child’s progress and assist the family with adjusting to the disorder. Family
teaching should include the importance of the medication regimen and teaching like timing,
possible side effects, and when to withhold medication. The parents should also be advised on
when to contact their provider and when to seek emergency medical treatment. Additional
education could be given about what the family can expect as their child grows and what type of
care he may need in the future. Lastly, providing the family with resources and support groups
that are equipped to further educate and help parents should be identified. (Hockenberry &
Wilson, 2015)

4. Cameron is going home after only 1week following cardiac surgery. Identify a
Medication that may be prescribed for a child with cardiac disease upon discharge.
List 4 teaching points you would cover with the parents prior to discharge. (25pts)
One medication that may be given to Cameron as he prepares to go home is digoxin.
Digoxin improves heart contractility and is used for its rapid onset; however initial use must be
monitored to assess for potential dysrhythmias and to obtain therapeutic levels.
Teaching points on this medication could include:
- Checking the child’s apical pulse prior to administering the medication. Do not give if the
pulse rate is below 90-110 beats per minute. (Hockenberry & Wilson, 2015)
- Do not mix the medication with other foods or fluids but give child a glass of water or
brush their teeth after administration to prevent tooth decay. (Hockenberry & Wilson,
2015)
- Do not repeat a dose if the child has vomited and do not give a dose after it has been
missed, continue with the intervals provided. (Hockenberry & Wilson, 2015)
- Monitor the child for signs and symptoms of digoxin toxicity, such as nausea, vomiting,
and bradycardia. (Hockenberry & Wilson, 2015)
References:
Hockenberry, M. J., & Wilson, D. (2015). Wong's nursing care of infants and children (10th ed.).
Elsevier.