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
nursing considerations for CHF: prevention of infection
-avoid crowded public places
-good hand washing
-screen visitors
nursing considerations for CHF: fluid volume excess
-I&Os
-daily wts w/ everything the same
-assess for edema
-maintain fluid restriction if ordered
-provide skin care
-change position frequently
family education & support for a child w/ CHF or
-vaccines
-promote G&D
-make sure they know how to give meds
increased pulmonary blood flow: arterial septal defect
know there is a hole between the atrium & more blood on right side
-may be asym, hear a murmur, CHF & increased risk for dysrhythmias
-usually resolves on own or surgery
increased pulmonary blood flow: ventricular septal defect
More series than ASD
the septum fails to completely form between the right & left ventricles
increased pulmonary blood flow: patent ductus arteriosus
the fetal structure fails to close, blood is shunted from the aorta to the pulmonary artery blood is going to lungs not body
PDA treatments
-indomethacin (prostaglandin E inhibitor)
-interventional heart cath w/ coil
-left thoracotomy or VATS (3 small incisions on left side of chest to place a clip on the ductus)
with a coarctation of the aorta, what exterminates will been more effect and symptoms
the lower exterminates bc the structure is past the branches of the aorta that go to your head
may be increased blood flow to upper causing headaches, nose bleeds, bounding pulses
obstruction of blood flow: coarctation of the aorta
a narrowing of the aortic arch, usually distal to the ductus arteriosus and beyond the right subclavian artery
obstruction of blood flow: aortic stenosis
narrowing or fusion of aortic valves which interfers with left ventricle outflow. blood backs up into right side of heart and right side of heart enlarges
results in decreased cardiac output, LVH & pulmonary vascular congestion
obstruction of blood flow: pulmonic stenosis
defect involves narrowing or constriction of valves of the pulmonary artery interfering w/ right outflow
cyanotic defects & symptoms
caused by defects result in decreased pulmonary blood flow causing cyanosis, polycythemia (thick blood), digital clubbing & altered ABGs
pressure greater on pulmonic side so blood shunts from right to left
nursing considerations for cyanotic defects
-prevent polycythemia to avoid clots & assess for clots
-do not let child get dehydrated
-good skin care
-oxygen
-prep for procedures
decreased pulmonary blood flow: tetralogy of fallot
4 parts
1) palmonic stenosis
2) overriding aortic arch (aorta is over the middle of heart & not over the left ventricle)
3) VSD
4) right ventricular hypertrophy (ventricle becomes smaller bc muscle thickens)
what position do we usually see children in who have tetralogy of fallot and why
squatting position
guidelines for hypercyanotic spell
employ calm, comforting approach
-knee to chest position
-100% oxygen by face mask
-give morphine
-IV fluid replacement & volume expansion if needed
-repeat morphine if needed
be able to list, do this one at a time and only continue if needed
decreased pulmonary blood flow: tricuspid atresia
failure of the tricuspid valve to develop resulting in no communication between right atrium and ventricle resulting in severe right hypoplasia or absense of the right ventricle
how do you keep the foramen ovale open
give prostaglandin E to maintain foreman ovale need open for mixing of blood, will result in death if not then digoxin, diuretics & palliative surgery will help
mixed blood flow: transposition of the great arteries
pulmonary artery arises from left ventricle and the aorta arises from the right ventricle. No communication between the systemic & pulmonary circulations
the artery & aorta are switched
mixed blood flow: truncus arteriosus
pulmonary artery and aorta fail to divide during embryonic development. one single large vessel empties both ventricles
truncus arteriosus clinical manifestations
-cyanosis
-CHF
-heart murmur
mixed blood flow: hypoplastic left heart syndrome
aortic valve atresia, mitral atresia or stenosis, small or absent left ventricle, severe hypoplasia of the ascending aorta and aortic arch
very sick & usually ends in death
discharge planning post cardiac cath
-pressure dressing x24 hr
-no tub baths for 48hrs
-rest 1 night then can resume activities
-teach S/s of infections
how do the fetal shunts close at or shortly after birth
-decreased maternal hormone prostaglandin E
-increased O2 sat
-pressure changes within the heart
clinical manifestations of VSD
-CHF & cyanosis
-murmur
-right vent hypertrophy
-FTT
-fatigue
-res infections
treatment of VSD
able to patch it or more intense surgery
therapeutic mgt of VSD
-pulmonary artery banding
-may close on own by 3yr
-interventional heart cath w/ septal occluder or
-surgical correct w/ patch
therapeutic mgt of coarctation of the aorta
-prostaglandin E to maintain PDA
-balloon angioplasty
-surgery within the first 2 years
aortic stenosis serious side effect
-obstruction tends to be progressive
-sudden episodes of MI or low cardiac output, can result in sudden death
activity is limited but not bed rest
how to treat aortic stenosis
try to fix the valve w/ surgery
clinical manifestations of tetralogy of fallot
the kids are very sick
-murmur w/ thrill
-polycythemia
-hypoxic episodes
-metabolic acidosis
-poor growth
-clubbing
-exercise intolerance
treatment for tetralogy of fallot
multiple rounds of surgery
treatment for transposition of great vessels
once we discover d/t cyanotic spell, we will give prostaglandin E to keep the foramen ovale open until they can have surgery to switch the artery and the aorta
treatment of truncus arteriosus
-surgical repair during the first few months of life
-digoxin & diuretics
treatment of hypoplastic left heart syndrome
multiple surgeries that usually do not go well
-> most end up on the transplant list
