Chapter 26 Flashcards
1
Q
Nursing Care: CHF
A
- keep child comfortable
- implement oxygenation nursing interventions
- ensure good skin care
- Positive inotropes (digoxin) used in cases of poor contractility
- Diuretics (Lasix) for cases of increased preload
- Vasodilators (captopril) used for cases of increased afterload
- All 3 used in conjunction
2
Q
Educate/Discharge: CHF
A
- Educate on how to monitor vitals, recognize s/s, how to use medication, side effects of meds.
- Teach that a good exercise plan may help to make heart muscles stronger and help to prevent CHF, even by moderate walking
3
Q
Nursing Care: Congenital Heart Disease
A
- Monitor and maintain child’s oxygen and nutritional status
- Provide emotional support
- Medical management usually focuses on treating the CHF that may develop due to specific defect
- Preoperative care: take thorough history and physical, provide and support education to family regarding type and process of surgery
- Postoperative care: includes admission into ICU, provide community-based resources to set up home-bound schooling
4
Q
General education/discharge instructions for cardiac conditions in children
A
- Educate parents on: monitoring vital signs, how to recognize s/s of cardiac failure, importance of learning CPR, medication use, effects, and side effects, balance needed between encouraging activity and prohibiting it
- If child need pulse oximeter in home: teach parents to observe for subtle signs of CHF: SOB, decreased appetite, irritability, swelling, weight gain
- Postoperative teaching points: answer questions about diet, exercise and activity, and return to school
- Surgical wound care: keep clean and dry, steri-strips often left in place until they fall off, watch for signs of infection (redness, fever), cradle infant/baby; do not lift child from under arms until sternal bone is healed
5
Q
Nursing Care: Patent Ductus Ateriosus
A
- Closure of PDA may be accomplished surgically, w/transcatheter device, and using medication indomethacin
- Focus on postsurgical measures: wound care, monitor vital signs, ensure adequate hydration and nutrition
- Monitor for signs of mitigation when transcatheter closure device used
6
Q
Nursing Care: Atrioventricular Canal Defect
A
- Prior to surgery optimize cardiac output, ensure adequate weight gain
- After surgery focus on postoperative management and educate on support systems for children w/concomitant Down syndrome
7
Q
Nursing Care: Pulmonic Stenosis
A
- Help pt reduce stressful situations that may cause high BP
- Surgical interventions: balloon angioplasty, valvuloplasty, open-heart surgery; monitor periodically for restenosis
8
Q
Nursing Care: Aortic Stenosis
A
- Based on medical and/or postoperative management
- In critical situations, in pt w/narrow valves, preload and afterload reduction medication is indicated
- Surgical tx: balloon agioplasty or valvuloplasty performed to open narrow area; surgical intervention to repair or replace valve
9
Q
Nursing Care: Coarctation of the Aorta
A
- Focus on postoperative management
- Monitor for evidence of restenosis through proper evaluation of upper and lower BPs
- Control severe rebound hypertension w/antihypertensives as needed (captopril, enalapril)
10
Q
Nursing Care: Tricuspid Atresia
A
- Admin. prostaglandins to keep PDA from closing
- Focus on postoperative management of multiple surgeries (balloon angioplasty, shunt, Glenn procedure, Definitive Fontan procedure may be needed)
11
Q
Nursing Care: Total Anomalous Pulmonary Venous Return
A
- Requires complete surgical repair
- Focus on postsurgical management
12
Q
Nursing Care: Transposition of the Great Arteries
A
- Focus on postoperative management
- Monitor for signs of stenosis around anastomosis sites
13
Q
Nursing Care: Truncus Arteriosus
A
- Requires palliative and complete surgical repair
- Focus on postoperative management
- Tx for children includes aggressive medical regimen with inotropic medications along with preload and afterload reduction
14
Q
Nursing Care: Tetralogy of Fallot
A
- Prior to surgery: prevent and minimize symptoms associated with defect
- After surgery: focus on postoperative management
15
Q
Nursing Care: Subacute Bacterial Endocarditis
A
- Teach preventative measures
- Monitor vital signs
- Support family emotionally
- Provide info. about future outcomes (full recovery vs. valve replacement)
- Edu./Discharge: teach parents how to prevent future infections, how to recognize when infection may occur, to report febrile illness asap; instruct families that if child sustained any vulvar damage, follow-up visits should be made at regular intervals
16
Q
Nursing Care: Kawasaki Disease
A
- Treat symptoms
- Admin. prescribed meds (IV immunoglobulin and aspirin, steroids, plasma exchange, or cytotoxic agents may be used if initial therapy is ineffective)
- Provide emotional care if child suffers sequelae of aneurysms and family faces lifetime of tx and monitoring
- Pre/postoperative care will be required only if child undergoes surgery for aneurysm repair
- Tell parents that follow-up visits are essential
- If child on anticoagulant therapy, teach appropriate blood testing and monitoring
- Inform about activity restrictions if aneurysms are involved
17
Q
Nursing Care: Cardiomyopathy
A
- Alleviate symptoms
- Admin. prescribed meds (ACE inhibitors or angiotensin receptor blockers, beta blocker therapy, nutritional supplementation, diuretic and inotropic therapy recommended)
- Monitor for worsening signs and complications
- Communicate to family that frequent echocardiograms are warranted to assess size and fxn of ventricular wall, as well as to note improvement or deterioration of condition
18
Q
Education/Discharge: Cardiomyopathy
A
- Stress importance of adhering to medications and follow-up regimen
- Teach medication effects, side effects, and proper diet
- Teach proper vital sign monitoring and to recognize symptoms of CHF
- Encourage parents to learn CPR
- Educate about pulse oximeter if child discharged home with oxygen
- Teach parent to observe for subtle signs of CHF
19
Q
Nursing Care: Cardiac Trauma
A
- Based on extent and exact type of injury
- Promote bedrest
- enforce activity restrictions
- Admin. antiarrhythmias, inotropic agents, and pericardiocentesis as required
- Facilitate cardiac rehab program as recommended
- Teach families to recognize complications and prevent further injury
- Educate on exercise restrictions based on specific injury
20
Q
Nursing Care: Hypertension
A
- Ensure more frequent BP checks
- Focused education topics: condition, diet, exercise, lifestyle modification, medications (beta blockers, ACE inhibitors)
- Admin. meds on time, do not skip doses to prevent rebound effect
21
Q
Nursing Care: Pulmonary Arterial Hypertension
A
- Provide education and support for family
- Focus care on reducing respiratory sequelae
- Provide for frequent rest periods
- Monitor respiratory status carefully through vital signs and pulse oximetery
- Provide oxygen and adjust according to need
- Admin. essential meds. (calcium-channel blockers that relax blood vessels, diuretics that decrease volume in vessels)
- Educate on diet: higher calories, exercise: limited abilities, may need specialized cardiac rehab program, medication
22
Q
Nursing Care: Neurally Mediated Syncope
A
- Monitor for frequency, severity, and precipitating factors of syncope
- Increase child’s sodium and water intake
- Medical management: adrenocorticosteroids (fludrocorisone), may be given to encourage fluid retention, beta blocker can regulate exaggerated response
- Tilt test: lay supine then up to 45 degree then to 90 (standing upright). May/may not have fainting but will see remarkable drop in BP or HR. Child will experience lightheaded/dizziness may syncopize. If negative test, lain flat, given chemical stimulant to simulate fast heart rate. – mimics fight/flight response that may occur before syncope. Then table tilted again to see if elicit syncope or drop in BP/HR. If no change – test is considered negative and then start to consider other causes of syncope.
- Encourage family to learn to recognize activities that put child at greatest risk for syncopal event
- Emphasize importance of adequate hydration
- Instruct pt not to stand in one place for a long time and to bend knees or sit down if a syncopal event is imminent
23
Q
Nursing Care: Long GT Syndrome
A
- Primary tx is medication (beta blockers)
- Tx also includes pacemaker-defibrillator (insertion) or left cardiac sympathetic denervation
- Emphasize importance of medication compliance
24
Q
Nursing Care: Rhythm Disturbances
A
- If working in cardiac area w/children who experience dysrrhythmias and require cardiac telemetry, acquire specific knowledge about: ECG and basic dysrrhythmia interpretation
- Determine baseline rhythm and recognize changes
- Know ramifications of these changes
