Chapter 26: Congestive Heart Failure (Children)

Question 1

When does Heart Failure Occur?

Answer 1

when the heart can no longer full accomplish its intended purpose

Question 2

Congestive Heart Failure (CHF)

Answer 2

heart failure
-characterized by the inability of the cardiac muscle to perform its proper function of moving blood forward
-blood is “congested” in a backward direction
-the hearts pumping action is lost so the blood backs up into other areas of the body such as the lungs or the liver
>this backward congestion of fluid eventually fills into the periphery

Question 3

What can lead to CHF

Answer 3

• congenital heart disease (CHD)
• dysrhythmias
• cardiomyopathy
• Kawasaki’s Disease

Question 4

How The Child Presents

Answer 4

signs and symptoms vary with age and whether the fluid is more congested on the right or left side

Question 5

Signs and Symptoms of the Infant

Answer 5

• poor feeding
• poor growth
• irritability
• shortness of breath or excessive sweating
• in advanced stages, an enlarged liver or edema

Question 6

Signs and Symptoms of older children

Answer 6

• poor growth

- shortness of breath and exercise intolerance

Question 7

Signs and Symptoms in babies and toddlers

Answer 7

• puffy eyelids
• swelling of the hands and feet
• bulging fontanelle

Question 8

Diagnosis

Answer 8

• patient history
• physical examination findings: vital signs (blood pressure and pulses may be diminished), weight gain, changes in breath sounds
• B-type natriuretic peptide
• chest x-ray
• exercise test
• echocardiogram
• magnetic resonance imaging (MRI)
• cardiac catheterization

Question 9

Nursing Care

Answer 9

• keep the child comfortable; fluid collections in the brain, periphery, and abdomen make the child irritable
• often restless b/c of an altered breathing pattern r/t fluid in the abdomen and in the pulmonary bed; implement oxygenation nursing interventions to ensure appropriate oxygenation levels
• good skin care
• careful monitoring and follow-up care
• because of the risk of dehydration, fluid restriction not often used

Question 10

Medical Care

Answer 10

-treated with medications b/c of the congenital defects
-digoxin (Lanoxin), or even the stronger dopamine drugs, are used when poor contractility is the cause of CHF
-if increased preload is the cause, diuretics such as furosemide (Lasix) or hydrochlorothiazide (Aquazide) may be used
-Vasodilators such as captopril (Capoten) or enalapril (Vasotec) are prescribed if increased afterload is the causative factor
>all three can be used in conjunction

Question 11

Surgical Care

Answer 11

based on correcting the defect

Question 12

Education/ Discharge

Answer 12

• monitoring vital signs, how to recognize signs and symptoms, and uses and side effects of medications
• good exercise plan may help to make the heart muscle stronger and help to prevent CHF (moderate walking beneficial)

Question 13

What Medication does a Nurse give When poor Contractility is the cause of CHF?

Answer 13

• digoxin (Lanoxin)

- or even a stronger dopamine drug

Question 14

What Medication does the nurse give when increased Preload is the cause of CHF?

Answer 14

diuretics:

• furosemide (Lasix)
• hydrochlorothiazide (Aquazide)

Question 15

What Medication is given when increased afterload (wall stress) is the cause of CHF?

Answer 15

Vasodilators:

• captopril (Capoten)
• enalapril (Vasotec)

Question 16

Preload

Answer 16

amount the ventricles stretch at the end of diastole

-if there is an increased preload, a diuretic is beneficial

Question 17

Afterload

Answer 17

pressure the ventricles must work against to open the semilunar valve to pump blood from out of the heart
-if increased, a vasodilator would be beneficial

Question 18

Contractility

Answer 18

strength of cardiac cells to contract/shorten