week 3 : cardiac care peds Flashcards
what can go wrong ?
name the 2 things that could go wrong ?
congenital heart effect ( CHD )
acquired heart disorders (AHD)
describe what congenital heart defect means ?
include some examples
anatomical abnormalities present at birth
examples :
ventricular septal defect (VSD )
tetralogy of fallot (4 heart defects)
what undergoes acquired heart disorders ( AHD ) : what is this description
give examples
disease or abnormalities that occur after birth
examples:
infection
autoimmune responses
environmental factors
family tendencies
what is this describing : child is born with a heart has not formed normally in utero
congenital heart defect ( CHD )
what is ventricular septal defect
when the child is born with an opening between the two ventricles, normally these chambers are not connected but with a vsd there is an opening.
true or false. VSD there is an opening and this can be very small opening, so for these children when there’s small opening there wont be alot of abnormalities cardiac functioning
true
true or false. Another kid could be born with a large opening or multiple opening between the ventricles - large opening allows blood move abnormally to the heart , left ventricle is under higher pressure than the right , blood moves from high to low pressure - oxygenated move to deoxygenated - more impact
true
tetralogy of fallot ( 4 heart defects )
what are the 4 defects
overriding aorta
ventricular septal defect
right ventricular hypertrophy
pulmonic stenosis
what is right ventricular hypertrophy
it is thicken - this right ventricle has large volume of blood flow
pump harder to try to keep up with workload
what is pulmonic stenosis
pulmonary vein is more narrow allowing less blood to leave the ventricle with each contraction
and so again that would contribute to increased volume in the right ventricle
when would acquired heart disorders ( ADH ) occur ?
during their childhood
recall that infection undergoes acquired heart disorders (AHD)
cardiac infection for example : after covid infection myocardititis , inflammation in the heart muscle
what undergoes environmental factors for ahd
exposure to environment that could be harmful to the heart pollution or chemicals or toxins
whats an example of autoimmune responses for ahd
strep infection can lead into rheumatic fever fever this usually involves endocardial or the inner lining of the heart - target heart valves
what is overriding aorta
in a normal heart, the left ventricle empties into the aorta now in tetralogy of fallot the aorta is actually open over the top of the vsd and so whenever the ventricles contract we get the blood from left and right ventricle entering the aorta - the issue with that deoxy blood is going to enter the into systemic circulation
CHD : what are the symptoms ?
vary between the asymptomatic and severe symptoms
what are the two major symptoms of CHD
cyanosis and heart failure
what is this describing : slight blue or purple tinged in membranes around the mouth, tips of finger, abdomen and chest
cyanosis
name the symptoms of CHD :
abnormality in vital signs - lower cardaic output- pulses weak heart and decreased in bp
tatchycardia
weak peripheral pulses - decreased bp
lack perfusion on the other parts of the body for infants CHD
usually incontinent - check their diapers working harder than normal - sweating
anorexia
decreased u/o
sweating ( inappropriate )
weakness/fatigue
chd : symptoms ( respiratory )
tatchypnea
dyspnea
flaring nares
wheezing
grunting
this is more common in babies and not adults
nose flarring
this is unique to babies - sound when they have hard time breathing
grunting
true or false. usually babies do not make any noises, grunting, usually not making noises but resp distress usually will make sounds
true
chd :the blue symptoms
wt gain
peripheral edema ( esp perioribital )
neck vein distention ( children )
ascites
all signs of fluid overload, when fluid is being retained when heart cannot keep up ( fluid leave blood vessels and go into third spacing )
weight gain and ascites
CHD - diagnostic tests
procedures for cardiac diagnosis
chest xray
ecg
encho
exercise test
cardaic mri
cardaic catherization ( angio )
what are the important points to remember
stressful ( for child and parent )
important to communicate information at an age appropriate level for child and parent/care giver
child must stay still or most tests (what do we utilize)
immobilizers
mild sedative
psychological preparation
distraction ( movie, music )
the child is going to stay still in that time
immobilizers with cloths and velcro they do not hurt the infants ( keep the limbs still ) need still so clearer image
true or false?
true
one of the complications of congenital heart defects is cyanosis or when the child suddenly turns blue due to lack of oxygen . Why is this occurring ?
this tends to happen when there are defects that reduce blood flow to the lungs or defects that cause a mixing
of deoxygenated and oxygenated blood.
what is this describing : hyper cyanotic spells or tet spells can occur suddenly . Is this true or false
true
true or false. teralogy of the fallot happens when the baby is in distress?
true
what is cyanotic episode referred to ?
hypercyanotic spells
CHD - cyanosis when does this often occur ?
often occur during blood draw or iv insertion ( child is upset )
how will the nurses manage chd - cyanosis management
( nursing intervention )
place infant in knee chest position
administer 100 percent oxygen
giver morphine
remain calm
why is the baby placed in a knee chest position during CHD - cyanosis
to reduce venous return to the leg which is desaturated
this helps to keep the baby relax , its sedative and also causes significant vasodilation both the venous and arterial beds
morphine
CHD : heart failure management
goal of care : improve cardiac function
what are the 3 meds
ace
beta blockers
digoxin
improve cardiac function : when it comes to heart failure management : this is done primarily in the use of cardiac medication
slows the heart rate and lower the blood pressure and together decrease the cardiac workload
true
nursing care for chd : heart failure management : improve cardia function
dose calculation
assess vital signs pre and post med admin
monitor for digoxin toxicity
assess patient response
why would we check for dig toxicity?
because of the narrow theurepetic index
what are the symptoms of dig toxicity
nausea, vomitting, as well as bradycardia and dysrthimias
just read : it is important to watch the kids activity and energy level
true
CHD: Heart failure management
goals of care : remove excess fluid
what are the interventions ?
diuretics
fluid restriction
na restricted diet
what are the nursing care that undergoes removing excess fluid
dose calculation
vital signs
monitor ins and outs
monitor weight
CHD : Heart failure management goals of care : decrease cardiac demands
when the heart is weak , we do not want to stress it: interventions and nursing care
keep infant temp normal
treat infections
reduce breathing effort ( semi fowlers )
sedate irritable child
provide restful environment
true or false. we do not want the baby to get cold, why is that ?
because babies will be using a lot of energy ( starts shivering ) more clothing and blanket and room is good temp
it is important to treat infections when it comes to decreasing cardiac demands, why
as they occur, this is stressful for their system, more energy and co diligent - swelling, redness, this should be reportedly immediately
why would we want the baby to be in a semi fowlers position to decrease cardiac demands
working hard to breathe- allow expansion - allows fluid to go at the bottom of the lungs instead of spread out on the back of the lung an reducing oxygen exchange
how does sedation help for babies?
could help them relax and decrease workload on the heart
chd : heart failure management
goals of care : improve tissue oxygenation
interventions and nursing care
monitor oxygen saturation
administer supplemental oxygen as ordered ( cool humidity )
assess pt’s response to oxygen
reduce resp distress
true or false. maintain mucous membrane by adding cool humidity when administering supplemental oxygen
true
true or false. nutrition is often challenging -they lack energy an difficult time breathing , suck and usually starts crying- cant breathe
true
what are the interventions for maintaining nutritional status
feed when well rested ( feed as soon as they wake up so they are well rested )
true or false. frequent shorter feeds is recommended for babies. BONUS : WHY?
yes , because no longer than 30 minutes, harder to breathe if longer, give them breaks
supplemental gavage feedings if required, when it comes to maintaining nutritional status
using ng tube into the stomach, and adminsitering formula that way
why would we use calorie dense formula for babies when we want to maintain their nutritional status ?
because these babies have high metabolic rate, increase hr and resp rate
CHD : surgical management. Is it true that Approximately 50% of children with a CHD will require some type of surgery.
similar to adults what are we assesing for ?
this is true.
bleeding and arthymias
CHD : family education
nurses will teach families how to manage at home
what is it ?
medication ( esp signs of toxicity )
activity tolerance/rest
nutrition ( high calorie needs )
signs of deterioration ( what to do )
just read this :
working or not working
important to recognize : dig toxicity
just like with adults : parents have to recongize too much and interventions to sit down for a while adn let heart recover
balance diet and eduate calories ( hgih metbaollic needs ) what to do whentehh are not eating or dinrking who to contanct
when to bring the child back further assesments :
activity tolerance getting worse
seeing more
sob more
coughing more
any sign cardiac output is detrorating
