7.3 Heart Failure

Question 1

HF

Answer 1

• Often the result of congenital heart defects (secondary to another defect)
• Defined as inability of heart to pump adequate amount of blood to systemic circulation to meet the bodies metabolic demands

Right Sided Heart Failure
- Inadequate blood being pumped to the blood which causes systemic circulatory issues

Left Sided Heart Failure
- Unable to pump blood through aorta to periphery causing blood to backup to pulmonary system

Symptoms
- Tachycardia at rest (EARLIEST SIGN)
- Tachypnea
- Scalp Sweating (especially in infants when feeding) - VERY COMMON
- Fatigue, poor nutrition, reduction of blood flow to other organs (decreased urinary output in kidneys)
- Weight gain
- Increase vascular tone

Question 2

HF Treatment

Answer 2

GOAL
- Decrease workload of heart and improve cardiac functioning

Treatment
- Decrease environmental stimuli and keep them calm (turn down lights, put on calming music)
- Sitting patients up in a position of comfort to improve ease of breathing
- Uninterrupted sleep to conserve energy
- Oxygen therapy
- Cardiac babies are allowed to have anywhere between 75-85% SPO2 (allowed to be lower oxygen levels than normal)
- Monitor CO, peripheral circulation
- Loosen clothes and diapers to prevent constriction of blood vessels
- Morphine (vasodilator to decrease workload of heart)

Question 3

Nutritional Concerns with HF

Answer 3

• We want them to conserve energy and calories so they can grow
• Keep babies well rested before feedings
• Feed every 3 hours (every 2 hours does not provide enough rest, every 4 hours requires increased food volume need which is tiring)
• Soft nipples with large openings are used to decrease workload
• Breastfed babies may need additional calorie supplement

Question 4

Medication Treatment for HF

Answer 4

Digoxin (most common)
- Cannot give to infant if HR is less than 110
- Cannot give to children if HR is less than 70
- Therapeutic Range - 0.8-2.0 ug
- INFANTS RARELY RECEIVE MORE THAN 0.05 mg PER DOSE. ANY HIGHER THAN THAT IS A RED FLAG

Symptoms of Digoxin Toxicity
- Fatigue, weakness, blurred vision, (early signs)
- Bradycardia vomiting

Interventions
- Do not mix digoxin with food or fluids to make sure children are getting the full dose

ACE Inhibitors (enalapril or captopril)
- Watchout for dry cough, hypotension, and kidney problems.

Lasix
- Formula has more sodium than breastmilk

Question 5

Long Term Observation

Answer 5

• Prolonged hypoxemia
• Polycythemia (hypoxemia stimulates erythropoiesis)
• Clubbing

Question 6

Cyanosis Interventions

Answer 6

• Place infant in knee-chest position to reduce venous return from legs and increase systemic vascular resistance. This shunts organs from periphery and push it to major organs
• Calm/comfort infants
• Administer 100% oxygen
• Give morphine (reduce infundibular spasms)
• Begin IV fluid replacement (dehydration increases risk of stroke)
• Repeat morphine

Question 7

Primary Initial Goal of CHF

Answer 7

• Correct arrhythmias because these are life threatening

Question 8

Highest Priority to Lowest Priority

Answer 8

1 - Monitor O2 Sat (Pulse Ox)
2 - Elevate HOB while sleeping
3 - Monitor Cardiac Output
4 - Weigh diapers and measure urine specific gravity
5 - Maintain calorie count to ensure nutrition is maintained
6 - Involve parents in care