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1. What is the congenital heart disease? Explain in terms that the lay person can understand. a.

Congenital heart disease involves a defect to a structure of the heart and the great vessels. These abnormalities develop before birth. 2. What symptoms could the child have and how could it affect his/her activity level? a. The child could have structural abnormalities, functional alterations, or both; cyanosis, poor eating and poor weight gain (failure to thrive), rapid breathing or SOB, abnormal cardiac rhythm; periorbital and facial edema, neck vein distention, hepatomegaly, and splenomegaly; and decreased peripheral perfusion, decreased urine output, mottling, and pallor. 3. How is the heart disease diagnosed? a. The diagnosis of heart disease is through diagnostic tests such as pulse oximetry, chest x ray, echocardiogram, electrocardiogram, exercise stress test, holter monitor, MRI, and cardiac catheterization 4. How is the heart disease treated? a. Treatment is not necessary if the regurgitation is trivial or mild, however, in severe cases, surgery is necessary to repair the valve, which usually is open heart surgery before the infant is 2 months old. With conditions such as heart failure doctors aim to treat the underlying problem. Management is aimed at decreasing the cardiac workload and improving cardiac output through the manipulation of the hemodynamics and neurohormonal responses. 5. What can parents expect about follow-up care for the disease? a. Parents can expect regular check-ups and life-long monitoring with a cardiologist. Parents should also be reassured that individuals with heart disease are living into adulthood. o Next, complete the following questions: Chapter 18: The Child with an Immunologic Alteration 1. The immune system is able to distinguish the bodys own cells, or self, from a foreign substance, or non-self. 2. Two classes of lymphocytes involved in the immune response are B lymphocytes, which promote the humoral response, and T lymphocytes, which are responsible for the cellmediated response. 3. IgG comes from prenatal transfer of maternal antibodies, and IgA comes from breast milk transfer. 4. When a body reacts to an antigen, it is developing active immunity. 5. Passive immunity results from antibody transfer from one person to another.

6. Measurement of eosinophilia and IgE levels, along with a radioallergosorbent test and skin testing, is helpful in the diagnosis of allergic reactions. 7. The risk for children acquiring HIV infection through drug abuse exists. 8. Traditional HIV antibody measurement by ELISA or Western blot assays is not accurate in infants and children younger than 18 months because of the persistence of maternal antibodies. 9. If serum cortisol levels do not rise after administration of ACTH, adrenal suppression (cortisone excess) is present. 10. In an allergic reaction, the hypersensitive reaction occurs with a second exposure to an antigen. Chapter 22: The Child with a Cardiovascular Alteration 1. With the neonates first breath, gas exchange is transferred from the placenta to the lungs. 2. Peripheral perfusion is monitored after cardiac catheterization. It is important for the nurse to locate and mark distal pulses. 3. The cardiac catheter insertion site is assessed for healing or the presence of local infection. 4. After cardiac surgery, the childs cardiac output is monitored through assessment of vital signs and peripheral perfusion. 5. Before the administration of digoxin (Lanoxin), the apical heart rate should be counted for 1 minute. In an infant, the drug should be held if the heart rate is less than 50 beats per minute. 6. Polycythemia is a compensatory response to chronic hypoxia. 7. Treatment of a hypercyanotic episode in an infant (tet spell) includes calming the infant, placing the infant in knee-chest position, and administering oxygen. 8. In a child with heart failure, careful monitoring of fluid status is necessary to prevent hemoconcentration. 9. Until cardiac defects are repaired, the child is at greater risk for development of infective endocarditis and may need antibiotics prophylaxis. 10. The four problems that occur in tetralogy of Fallot are ventricular septal defect, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. Chapter 23: The Child with a Hematologic Alteration 1. Iron deficiency is the most common cause of anemia during infancy, childhood, and adolescence. 2. Iron deficiency anemia (IDA) related to inadequate dietary iron intake is rare before age 4 to 6 months because of the presence of maternal iron stores. 3. Adolescents are at risk for iron deficiency anemia because they are experiencing increased growth and often have poor dietary habits. 4. Sickle cell disease (SCD) is an inherited, lifelong disease that affects primarily AfricanAmericans but can also occur in individuals of Mediterranean, Indian, and Middle Eastern descent.

5. Although not a disease in and of itself, the carrier state of SCDsickle cell traitmay produce clinical symptoms in times of extreme stress, during extremely vigorous exercise, and in high altitudes. 6. Hemophilia is an X-linked autosomal recessive disorder; carrier females pass on the defect to affected males. 7. Therapy for hemophilia aims to prevent excessive bleeding and tissue damage by supplying the body with the missing or ineffective factors. 8. Clinical manifestations of immune thrombocytopenic purpura include the sudden onset of bruising and petechiae, with bleeding involving the mucous membranes and gums, in a child who is in otherwise good health. 9. Manifestations of disseminated intravascular coagulation (DIC) involve an insidious onset, corresponding to platelet count and fibrinogen levels. 10. Neonatal hyperbilirubinemia is often a transient benign disorder occurring during the first week of life.