NURS 225 Lecture Notes - Lecture 2: Bradycardia, Wolters Kluwer, Circulatory System
University of Pennsylvania School of Nursing
N 225 Pediatric Nursing
Helene Fuld Pavilion for Innovative Learning and Simulation
Faculty Guide
Nursing care of the pediatric patient with alterations in cardiovascular function
As with any activity you must consult the policy and procedure manual of the healthcare
facility you are working at before commencing patient care to determine the specific
requirements of that setting.
Point values for each response to the objectives are in parenthesis
Total number of points: 100
LEARNING OBJECTIVES AND CRITICAL THINKING QUESTIONS
1. Define / explain each of the following as they relate to cardiac function (Ball,
Bindler, and Cowen, Chapter 21, p. 571). 6 points
Compliance
Amount of distension or expansion the ventricles can achieve to
increase stroke volume
Stroke Volume
Amount of blood ejected with each contraction
Cardiac Output
Volume of blood ejected from the left ventricle each minute
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2. Why do infants with fever, activity, stress, or respiratory distress respond with
tachycardia (Ball, Bindler, and Cowen, Chapter 21, p. 571)? 2 points
Infants respond to fever, activity, stress or respiratory distress with tachycardia rather
than increased stroke volume because there is less compliance of the heart muscle. This
means that infants cannot substantially increase their stroke volume to meet increased
oxygen/metabolic demands. The infant’s heart compensates by pumping blood more
frequently. The goal is to increase cardiac output.
3. What is a common chronic precursor to polycythemia (Ball, Bindler and Cowen,
Chapter 21, page 571)? (2pts)
Hypoxemia is a common chronic precursor
4. What is the bone marrow’s role in relation to polycythemia (Ball, Bindler, and
Cowen, Chapter 21, page 571)? 2 points
The child’s bone marrow responds to the chronic hypoxemia by producing more red blood cells.
This increases the amount hemoglobin to be oxygenated.
5. What is a physical assessment finding that can be the first indication suggestive of a
heart defect (Ball, Bindler, and Cowen, Chapter 21, page 568)? 2 points
The presence of a heart murmur
6. List the 4 defects that comprise Tetralogy of Fallot (Ball, Bindler, and Cowen,
Chapter 21, page 582). 4 points
Pulmonic stenosis
Right ventricular hypertrophy
Ventricular septal defect
Overriding of aorta
7. Utilizing the picture below, answer the following questions related to the physiology
of a patient with Tetrology of Fallot (Ball, Bindler, and Cowen, Chapter 21, page
582). 4 points
a. Indicate in the picture where the pressure is higher in a patient with
Tetrology of Fallot
i. Pressure is higher in the right side of the heart (specifically right ventricle)
b. Where does the blood shunt?
i. Blood shunts from right ventricle to the aorta (and therefore to the rest of
the body)
c. Why does the blood shunt in this direction?
i. Since blood is obstructed from entering the pulmonary artery, pressure
rises in the right ventricle of the heart. Since a ventricular septal defect and
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an overriding aorta are present, blood will shunt from the area of higher
pressure (right ventricle) to the area of lower pressure (aorta).
d. What classic sign does the shunting result in?
i. This results in cyanosis
8. An infant, diagnosed with Tetrology of Fallot, is having a hypercyanotic episode.
The nurse places the infant in a knee-chest position. How does this positioning help
this infant’s condition? (Ball, Bindler, and Cowen, Chapter 21, page 585) 2 points
This decreases the return of systemic venous blood to the heart by increasing systemic
vascular resistance.
9. What is the physiology of congestive heart failure in a patient diagnosed with
patient ductus arteriosus (PDA). (Ball, Bindler, and Cowen, Chapter 21, page 575)?
4 points
When a patient has PDA, blood shunts from the aorta to the pulmonary arteries, thus increasing
pressure in the pulmonary circulation and increasing pulmonary vascular resistance. This can
lead to pulmonary artery hypertension, in which the heart muscle hypertrophies to be able to
work harder to pump blood through these vessels. Eventually, the heart muscle will no longer be
able to keep up with this demand and the body’s organs and tissues will receive inadequate
oxygenation.
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Document Summary
Helene fuld pavilion for innovative learning and simulation. Nursing care of the pediatric patient with alterations in cardiovascular function. As with any activity you must consult the policy and procedure manual of the healthcare facility you are working at before commencing patient care to determine the specific requirements of that setting. Point values for each response to the objectives are in parenthesis. Learning objectives and critical thinking questions: define / explain each of the following as they relate to cardiac function (ball, Amount of distension or expansion the ventricles can achieve to increase stroke volume. Infants respond to fever, activity, stress or respiratory distress with tachycardia rather than increased stroke volume because there is less compliance of the heart muscle. This means that infants cannot substantially increase their stroke volume to meet increased oxygen/metabolic demands. The infant"s heart compensates by pumping blood more frequently.
