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The Child with Cardiovascular Dysfunction Hockenberry Wong's Essentials of Pediatric Nursing
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The Child with Cardiovascular Dysfunction Hockenberry Wong's Essentials of Pediatric Nursing
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Chapter 23 The Child with Cardiovascular Dysfunction Hockenberry Wong's Essentials of Pediatric Nursing, 10th Edition1.An infant with an unrepaired tetralogy of Fallot defect is becoming ex- tremely cyanotic during a routine blood draw. Which interventions should the nurse implement? Place in order from
the highest-priority intervention to the lowest-priority intervention. Select all
that apply:
a.Administer 100% oxygen by blow-by.
b.Place the infant in knee-chest position.
c.Remain calm.
d.Give morphine subcutaneously or by an existing intravenous line.: b. Place the infant in knee-chest position.
a. Administer 100% oxygen by blow-by.
d. Give morphine subcutaneously or by an existing intravenous line.
c. Remain calm. ANS:
b, a, d, c
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants
with tetralogy of Fallot, may occur in any child whose heart defect includes obstruc- tion to pulmonary
blood flow and communication between the ventricles. The infant becomes acutely cyanotic and
hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-
left shunting. Because profound hypoxemia causes cerebral hypoxia, hypercyan- otic spells require prompt
assessment and treatment to prevent brain damage or possibly death. The infant should first be placed in
the knee-chest position to reduce blood returning to the heart. Next 100% oxygen is given to alleviate the
hypoxemia. Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain
calm.
DIF: Cognitive Level: Apply REF: p. 741
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation .A chest radiograph film's ordered for a child with suspected cardiac problems. The child's parent asks the nurse, "What will the radiograph show about the heart?" What knowledge
about the x-ray should the nurse include in the response to the parents?
a.Bones of chest but not the heart.
b.Measurement of electrical potential generated from heart muscle.
c.Permanent record of heart size & configuration.
d.Computerized image of heart vessels & tissues.: c. Permanent record of heart size and configuration
ANS: C
A chest radiograph will provide information on the heart size and pulmonary blood-flow patterns. It will
provide a baseline for future comparisons. The heart will be visible, as well as the sternum and ribs.
Electrocardiography (ECG) measures the electrical potential generated from heart muscle.
Echocardiography will produce a computerized image of the heart
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