Peds Exam 2 - Cardiac Flashcards
Pre procedural care for child going to cath lab
-NPO for 4-6 hours, clarify morning meds
-assessment (includes ht & wt)
-assess skin do not bring if diaper rash or lots of ache
mark pedal pulses
what pedal pulse will be weaker after cath
the effect side so if they went in on the right side, right pedal pulse will be weaker
if a child has a diaper rash, can they go to the cath lab
no, could introduce bacteria
post opt care for cardiac catheterization
observe:
-color & LOC
-VS & res status
-distal extremities
-dressing for bleeding
-fluids
-BS, esp hyper
-keep flat for 4-6 hrs
if you think there is bleeding under the dressing, what should you do
circle the dressing to see if the bleeding spreads out
if bleeding put pressure 1in above the insertion site & then call for help
when a baby is born, how many fetal openings are there
three
1) ductus venosus
2) foramen ovale (hole between the atrium)
3) patent ductus arteriosus
general clinical finding for cardiac defects
-dyspnea
-FTT
-res infections
-high HR
-sweating
-choking & blue
-murmur
heart anatomy - flow of blood
blood flows from right atrium -> right ventricle -> into the lungs -> to the left atrium -> left ventricle -> aorta
what side of the heart has more pressure
left side
if there is a hole then more blood will flow into the right side which just receives blood and sends it into the lungs causing less oxygenated blood going to the body & lots of blood to the lungs
congestive heart failure is
the failure of the heart to supply enough blood to meet needs
clinical manifestations of CHF:
-sweating
-tachy
-decreased blood flow to kidneys
-low urine output
-Na & water retention
-cyanosis & clubbing of finger
-res excretion
-SOB
- wt gain from edema
->cap refill
-high HR
what are our 4 main goals of CHF (ther mgt)
-improve cardiac function
-remove accumulated fluid & Na
-decrease cardiac demands
-improve tissue oxygenation & decrease oxygen consumption
meds
-furosemide (lasix)
-ACE inhibitors
-Digoxin, allows to contract harder
digoxin: rules for administrations
-1 hr before or 2 hr after eating
-check apical HR for 1min before giving
-do not mix with food or fluid
-put behind teeth & then oral care
contraindications for digoxin
- apical pulse hold if <90-110 for infants & young kids & <70 for older kids
-low potassium bc will make digoxin work too much
if you miss a dose of digoxin, what do you do
if within 4 hr you can give the missed dose, if >4 hr then hold
if 2 doses missed then notify provider
signs of digoxin toxicity
-vomiting (do not give repeat dose)
-nausea
-bradycardia
-anorexia
-neurologic & visional dysfunction
with digoxin toxicity, what should be monitored
dysrhythmias bc digoxin toxicity can cause hyperK+
digibind
can bind & then excrete it by kidneys if digoxin levels are too hgih
watch for drop on K+
nursing considerations for CHF: activity intolerance
-promote adequate rest
-prevent crying
-group activities
-short intervals of play, cuddling
-provide neutral thermal environment
~sup ox (pt normal stat might just be 70 so based on orders)
nursing considerations for CHF: altered nutrition
-SFM, anticipate hunger
-feeds no longer than 30min
-semi erect position
-burb before, during & after
-increased kcal formulas
-soft preemie nipple w/ moderately large opening
nursing considerations for CHF: ineffective breathing pattern
-assess RR, effort & O2 stat
-position to encourage maximum chest expansion (for older child)
-avoid constriction (tight clothes)
-humidified sup ox during stressful periods