Peds Exam 2 - Cardiac Flashcards by Jane Daum

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

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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

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if a child has a diaper rash, can they go to the cath lab

no, could introduce bacteria

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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

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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

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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

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general clinical finding for cardiac defects

-dyspnea
-FTT
-res infections
-high HR
-sweating
-choking & blue
-murmur

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heart anatomy - flow of blood

blood flows from right atrium -> right ventricle -> into the lungs -> to the left atrium -> left ventricle -> aorta

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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

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congestive heart failure is

the failure of the heart to supply enough blood to meet needs

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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

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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

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meds

-furosemide (lasix)
-ACE inhibitors
-Digoxin, allows to contract harder

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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

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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

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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

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signs of digoxin toxicity

-vomiting (do not give repeat dose)
-nausea
-bradycardia
-anorexia
-neurologic & visional dysfunction

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with digoxin toxicity, what should be monitored

dysrhythmias bc digoxin toxicity can cause hyperK+

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digibind

can bind & then excrete it by kidneys if digoxin levels are too hgih
watch for drop on K+

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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)

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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

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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

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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