# Chapter 27: The Child with Cardiovascular Dysfunction

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José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

A. directed at his parents because he is too young to understand.
B. detailed in regard to the actual procedures so he will know what to expect.
C. done several days before the procedure so that he will be prepared.
D. adapted to his level of development so that he can understand.
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José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:

A. directed at his parents because he is too young to understand.
B. detailed in regard to the actual procedures so he will know what to expect.
C. done several days before the procedure so that he will be prepared.
D. adapted to his level of development so that he can understand.
ANS: D

Preoperative teaching should always be directed at the child's stage of development. The caregivers also benefit from the same explanations. The parents may ask additional questions, which should be answered, but the child needs to receive the information based on developmental level. Preschoolers will not understand in-depth descriptions and should be prepared close to the time of the cardiac catheterization.
ANS: A

Because a catheter is introduced into the heart, a risk exists of catheter-induced dysrhythmias occurring during the procedure. These are usually transient. Hypostatic pneumonia, heart failure, and rapidly increasing blood pressure are not risks usually associated with cardiac catheterization.
Which explanation regarding cardiac catheterization is appropriate for a preschool child?

A. Postural drainage will be performed every 4 to 6 hours after the test.
B. It is necessary to be completely "asleep" during the test.
C. The test is short, usually taking less than 1 hour.
D. When the procedure is done, you will have to keep your leg straight for at least 4 hours.
ANS: D
The child's leg will have to be maintained in a straight position for approximately 4 hours. Younger children can be held in the parent's lap with the leg maintained in the correct position. Postural drainage will not be performed unless the child has corresponding pulmonary problems. The child should be sedated to lie still, but being completely asleep is not necessary. The test will vary in length of time from start to finish.
The nurse is caring for a school-age child who has had a cardiac catheterization. The child tells the nurse that the bandage is "too wet." The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:

A. notify physician.
B. apply new bandage with more pressure.
C. place the child in Trendelenburg position.
D. apply direct pressure above catheterization site.
ANS: D
If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture. Notifying a physician and applying a new bandage can be done after pressure is applied. The nurse can have someone else notify the physician while the pressure is being maintained. It is not a helpful intervention to place the girl in the Trendelenburg position. It would increase the drainage from the lower extremities.
The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?

A. "I should avoid tub baths but may shower."
B. "I have to stay on strict bed rest for 3 days."
C. "I should remove the pressure dressing the day after the procedure."
D. "I may attend school but should avoid exercise for several days."
ANS: B

The child does not need to be on strict bed rest for 3 days. Showers are recommended; children should avoid a tub bath. The pressure dressing is removed the day after the catheterization and replaced by an adhesive bandage to keep the area clean. Strenuous activity must be avoided for several days, but the child can return to school.