Neonatal Cardiovascular Assessment and Care Flashcards

Indomethacin is used in premature neonates primarily for which clinical purpose?

Answer: Pharmacological closure of a hemodynamically significant patent ductus arteriosus

Indomethacin is a prostaglandin synthetase inhibitor (COX inhibitor) that reduces prostaglandin E2 levels, promoting ductal smooth muscle constriction and closure of the PDA.

A 28-week preterm neonate develops increasing oxygen requirements, hypotension, bounding pulses, and a systolic murmur consistent with hemodynamically significant PDA. Which is the first-line pharmacological treatment?

Answer: Indomethacin or ibuprofen to promote ductal closure

COX inhibitors such as indomethacin or ibuprofen are first-line pharmacological agents for hemodynamically significant PDA in preterm neonates when there are no contraindications.

In a post-cardiac surgery neonate, which combination of findings is most consistent with cardiac tamponade (Beck's triad)?

Answer: Hypotension, muffled heart sounds, and elevated central venous pressure

Cardiac tamponade is identified by Beck's triad: hypotension from reduced cardiac output, muffled heart sounds from pericardial fluid, and elevated venous pressure from impaired right heart filling.

A neonate develops supraventricular tachycardia (SVT) with a heart rate of 280 bpm and remains hemodynamically stable. Which intervention should the nurse attempt first?

Answer: Application of ice to the neonate's face to elicit the diving reflex

In stable neonatal SVT, vagal maneuvers such as applying ice to the face (eliciting the diving/oculocardiac reflex) are attempted first before pharmacological cardioversion with adenosine.

A neonate who has undergone the Norwood procedure for HLHS is being monitored postoperatively. What SpO2 range indicates an acceptable balance between pulmonary and systemic blood flow (Qp:Qs ratio of approximately 1:1)?

Answer: 75-85%

After the Norwood procedure, SpO2 of 75-85% reflects a balanced Qp:Qs ratio near 1:1; higher saturations indicate excessive pulmonary blood flow stealing from the systemic circulation.

A postoperative neonate demonstrates signs of low cardiac output including cool mottled extremities, metabolic acidosis (pH 7.20), and urine output less than 0.5 mL/kg/hr. Which medication is most commonly used as first-line inotropic support in neonates?

Answer: Dopamine to improve cardiac output and renal perfusion

Dopamine is the most commonly used first-line inotrope in neonates, with low doses improving renal perfusion and higher doses providing inotropic and vasopressor effects to support cardiac output.

Following open-heart surgery, a neonate's chest tube drainage suddenly decreases from 8 mL/hr to 0 mL/hr while the baby becomes tachycardic, hypotensive, and increasingly agitated. What should the nurse suspect and report immediately?

Answer: Cardiac tamponade from clot obstructing chest tube drainage

Sudden cessation of chest tube output combined with hemodynamic deterioration is a hallmark of cardiac tamponade from clot occlusion of the drain; emergent echocardiography and possible reopening of the sternum may be required.