C HAPTER 21: A LTERATIONS IN C ARDIAC
F UNCTION
1. Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4
C (101.1 F). What action should the nurse perform?
a. Report findings to the practitioner.
b. Apply a hypothermia blanket.
c. Keep the child warm with blankets.
d. Record the temperature on the assessment flow sheet.
ANS: A
In the first 24 to 48 hours after surgery, the body temperature may increase to
37.8 C (100 F) as part of the inflammatory response to tissue trauma. If the
temperature is higher or fever continues after this period, it is most likely a
sign of an infection, and immediate investigation is indicated. A hypothermia
blanket is not indicated for this level of temperature. Blankets should be
removed from the child to keep the temperature from increasing. The
temperature should be recorded, but the practitioner must be notified for
evaluation.
2. What nursing consideration is important when suctioning a young child who has
had heart surgery?
a. Perform suctioning at least every hour.
b. Suction for no longer than 30 seconds at a time.
c. Expect symptoms of respiratory distress when suctioning.
d. Administer supplemental oxygen before and after suctioning.
, ANS: D
When suctioning is indicated, supplemental oxygen is administered with a
manual resuscitation bag before and after the procedure to prevent hypoxia.
Suctioning should be done only as indicated and very carefully to avoid vagal
stimulation. The child should be suctioned for no more than 5 seconds at a
time. Symptoms of respiratory distress are avoided by using appropriate
technique.
3. The nurse notices that a child is increasingly apprehensi ve and has tachycardia
after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be
the nurses initial intervention?
a. Apply warming blankets.
b. Notify the practitioner of these findings.
c. Give additional pain medication per protocol.
d. Encourage child to cough, turn, and deep breathe.
ANS: B
The practitioner is notified immediately. Increases of chest tube drainage to
more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in
any 1 hour may indicate postoperative hemorrhage. Increased chest tube
drainage with apprehensiveness and tachycardia may indicate cardiac
tamponadeblood or fluid in the pericardial space constricting the heartwhich
is a life- threatening complication. Warming blankets are not indicated at this
time. Additional pain medication can be given before the practitioner drains
the fluid, but the notification is the first action. Encouraging the child to
cough, turn, and deep breathe should be deferred until after evaluation by the
practitioner.
, 4. A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls
the cardiology clinic and reports that the child is just not herself. Her appetite is
decreased, she has had intermittent fevers around 38 C (100.4 F), and now her
muscles and joints ache. Based on this information, how should the nurse advise
the mother?
a. Immediately bring the child to the clinic for evaluation.
b. Come to the clinic next week on a scheduled appointment.
c. Treat the signs and symptoms with acetaminophen and fluids because it is
most likely a viral illness.
d. Recognize that the child is trying to manipulate the parent by complaining
of vague symptoms.
ANS: A
These are the insidious symptoms of bacterial endocarditis. Because the child
is in a high-risk group for this disorder (VSD repair), immediate evaluation
and treatment are indicated to prevent cardiac damage. With appropriate
antibiotic therapy, bacterial endocarditis is successfully treated in
approximately 80% of the cases. The childs complaints should not be
dismissed. The low- grade fever is not a symptom that the child can fabricate.
5. What primary nursing intervention should be implemented to prevent bacterial
endocarditis?
a. Counsel parents of high-risk children.
b. Institute measures to prevent dental procedures.
c. Encourage restricted mobility in susceptible children.
d. Observe children for complications, such as embolism and heart failure.
ANS: A
F UNCTION
1. Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4
C (101.1 F). What action should the nurse perform?
a. Report findings to the practitioner.
b. Apply a hypothermia blanket.
c. Keep the child warm with blankets.
d. Record the temperature on the assessment flow sheet.
ANS: A
In the first 24 to 48 hours after surgery, the body temperature may increase to
37.8 C (100 F) as part of the inflammatory response to tissue trauma. If the
temperature is higher or fever continues after this period, it is most likely a
sign of an infection, and immediate investigation is indicated. A hypothermia
blanket is not indicated for this level of temperature. Blankets should be
removed from the child to keep the temperature from increasing. The
temperature should be recorded, but the practitioner must be notified for
evaluation.
2. What nursing consideration is important when suctioning a young child who has
had heart surgery?
a. Perform suctioning at least every hour.
b. Suction for no longer than 30 seconds at a time.
c. Expect symptoms of respiratory distress when suctioning.
d. Administer supplemental oxygen before and after suctioning.
, ANS: D
When suctioning is indicated, supplemental oxygen is administered with a
manual resuscitation bag before and after the procedure to prevent hypoxia.
Suctioning should be done only as indicated and very carefully to avoid vagal
stimulation. The child should be suctioned for no more than 5 seconds at a
time. Symptoms of respiratory distress are avoided by using appropriate
technique.
3. The nurse notices that a child is increasingly apprehensi ve and has tachycardia
after heart surgery. The chest tube drainage is now 8 ml/kg/hr. What should be
the nurses initial intervention?
a. Apply warming blankets.
b. Notify the practitioner of these findings.
c. Give additional pain medication per protocol.
d. Encourage child to cough, turn, and deep breathe.
ANS: B
The practitioner is notified immediately. Increases of chest tube drainage to
more than 3 ml/kg/hr for more than 3 consecutive hours or 5 to 10 ml/kg in
any 1 hour may indicate postoperative hemorrhage. Increased chest tube
drainage with apprehensiveness and tachycardia may indicate cardiac
tamponadeblood or fluid in the pericardial space constricting the heartwhich
is a life- threatening complication. Warming blankets are not indicated at this
time. Additional pain medication can be given before the practitioner drains
the fluid, but the notification is the first action. Encouraging the child to
cough, turn, and deep breathe should be deferred until after evaluation by the
practitioner.
, 4. A parent of a 7-year-old girl with a repaired ventricular septal defect (VSD) calls
the cardiology clinic and reports that the child is just not herself. Her appetite is
decreased, she has had intermittent fevers around 38 C (100.4 F), and now her
muscles and joints ache. Based on this information, how should the nurse advise
the mother?
a. Immediately bring the child to the clinic for evaluation.
b. Come to the clinic next week on a scheduled appointment.
c. Treat the signs and symptoms with acetaminophen and fluids because it is
most likely a viral illness.
d. Recognize that the child is trying to manipulate the parent by complaining
of vague symptoms.
ANS: A
These are the insidious symptoms of bacterial endocarditis. Because the child
is in a high-risk group for this disorder (VSD repair), immediate evaluation
and treatment are indicated to prevent cardiac damage. With appropriate
antibiotic therapy, bacterial endocarditis is successfully treated in
approximately 80% of the cases. The childs complaints should not be
dismissed. The low- grade fever is not a symptom that the child can fabricate.
5. What primary nursing intervention should be implemented to prevent bacterial
endocarditis?
a. Counsel parents of high-risk children.
b. Institute measures to prevent dental procedures.
c. Encourage restricted mobility in susceptible children.
d. Observe children for complications, such as embolism and heart failure.
ANS: A
