Week 6 TUES Flashcards
Peds perfusion
What is important to teach parents about cardiac catheterization
the catheter will be placed in the femoral artery
After a cardiac cath what is the most important intervention?
taking pedal pulses for the first 4 hours after
What apical pulse would warrant nurse w/ holding digoxin on a 6 month old?
80 bpm
explain “excess fluid volume” to families
cardiac problems cause the heart to not pump effectively, which causes swelling in the body
explain what hypoplastic left heart to a family means
problem where the left side of the heart didn’t develop properly
Health hx that makes nurse suspect CV disorder in a 6 wk boy
“he gets sweaty when he eats”
What is the best position for a child to be placed to promote optimal benefits w/ a structural defect while receiving O2 therapy?
Semi- fowlers
A nurse is caring for a child that just returned from cardiac catheterization where the catheter was placed through the left femoral artery. Upon assessment the nurse finds that the dressing is saturated and the patient is bleeding from the site. What is the first thing the nurse should do?
Check the patient’s vital signs
Notify the provider
Apply pressure 1 inch above the site
Change the pressure dressing
C!
Apply pressure 1 inch above the site
- peds lose blood very fast! the other things can be done after bleeding is controlled
The caregiver of a 4-week-old infant is tearful after finding out their child has been diagnosed with a congenital heart defect. Which statement by the caregiver needs further teaching?
“I should not be concerned if my child’s color changes with exertion.”
“My child will need routine follow-up with the cardiology clinic.”
“I will feed my child smaller meals more often.”
“I will notify my child’s provider if I notice my child has difficulty breathing.”
A!
- cyanosis during exertion is a sigh of a cardiac issue
You are preparing to administer IVIG to a 42 lbs. child with Kawasaki Disease. The order is to administer IVIG 2 g/kg/day. Which of the following is the correct total daily dose of IVIG for this patient? Round to the nearest whole number.
38 mg
38 g
84 mg
84 g
B!
38g
- Do the math!
The 4 chambers of the heart are formed in the first ______ weeks of gestation
2-8 wks
T or F the heart initially lies horizontally, then grows more vertically as child gets older
TRUE!
When does the foramen ovale, ductus arteriosus, and ductus venosus close?
at birth when newborns start breathing on their own
The right side of the heart carries what type of blood from the lungs and body
- deoxygenated blood
The left side of the heart carries what type of blood from the lungs and the body
- oxygenated blood
Altered perfusion risk factors in peds
- prematurity
- maternal pregnancy factors
- chromosomal disorders
- family hx of heart disease and CHD
Nurses role in reducing risk factors
- ensuring adequate prenatal care
- assess maternal medications
- education on drugs and alcohol
- education on reducing environmental exposures
Altered perfusion complications
- growth and developmental delay
- failure to thrive
- decreased cognitive ability
- death
T or F inequities don’t have an impact on congenital heart disease
FALSE!
- equalities do factor in
- we as nurses can do things to improve or work against inequities during practice
Altered perfusion assessment
- detailed health hx> PMH, family
- present illness
- vital signs
- physical assessment
- know current medications
extra or unusual sounds made by blood circulating through the heart’s chambers or valves, or through blood vessels near the heart.
Murmurs
what are the characteristics of murmurs
- location
- relation to heart cycle
- intensity> grades> 6 grades
- quality> musical, harsh, blowing
- variation w/ position
Altered perfusion different test and labs
- angiogram
- holter monitor> cardiac monitoring
- chest x-ray
- echo
- ecg
- exercise stress test
- hgb and hct
-PO2
What position is best for a pt after an angiogram?
- flat and bedrest
Common medical treatment for altered perfusion
- oxygen therapy
- chest physio and postural drainage
- chest tube
- pacing
- meds
Passage of oxygenated capillary blood through body tissues
perfusion
What uses angiography to inject contrast dye to monitor the heart and vessels, a catheter is inserted through the vessel
Cardiac cath
What medication increases contractility through lowering conduction and increasing force
- AFib, A Flutter, HF, SVT
Digoxin
Structural issues that exist at birth
Congenital heart disease
Disorders occurring at some point after birth
Acquired heart disease
Congenital heart disease exemplars
- tetralogy of falloy
- coarcation of the aorta
- VSD
- hypoplastic left heart syndrome
Acquired heart disease exemplars
Kawasaki Disease
Tetralogy of fallot has 4 defects which include…..
- VSD
- Pulmonic stenosis
- overriding aorta
- right ventricular hypertrophy
What exempler is the Decrease in oxygenated blood coming from the lungs, putting more work on the heart to get to the pulmonary system for oxygenation
Tetralogy of Fallot
What exemplar is an opening between right and left ventricles, mixing deoxygenated and oxygenated blood together
Ventricular Septal Defect (VSD)
What exemplar is a narrowing of the aorta causes an impact on the ability to adequately provide oxygenated blood to the body
Coarctation of the Aorta
What exemplar includes the left side of the heart is severely under-developed including left ventricle and aorta. nonfunctional left side
Hypoplastic left heart syndrome
Congenital heart defect nursing interventions
- improve oxygen> #1
- promote adequate nutrition
- infection prevention
- child/family education
- child/family coping
What exemplar is an aquired heart disease that is characterized by systemic vasculitis
Kawasaki Disease
Treatment for Kawasaki disease
- aspirin
- IVIG
s/s of Kawasaki disease
- red, bloodshot eyes
- fever lasting 5 days or more
- red, swollen hands
- red, swollen feet
- rash involving entire body
- red, cracked lips and red tongue
Treatment for Hypoplastic left heart
- prostaglandin> keep open PDA
- heart transplant
- multiple surgeries> palliative staged treatment
s/s of Hypoplastic left heart
- may be asymptomatic
- poor feeding and tires easily
- cyanosis/ cool skin
- shock> once PDA closes
- possible gallop, single heart sound, soft murmur
- HIGH RR, Pulse, hypothermia
Treatment of Coarctation of the aorta
- balloon angioplasty
- surgical repair
- administer prostaglandin to help keep ductus arterious open!
s/s of Coarctation of the aorta
- irritable
- dizziness, fainting
- epistaxis> nosebleed
- leg pain w/ activity
- absent/ weak pulses in the lower extremities
- bounding pulses in the upper extremities
- notching on ribs
Treatment of VSD
- surgery> patch and sew holes
- transplantation> if right to left shunt occurs
s/s of VSD
- HF s/s
- tires easily with exertion/ feedings
- poor growth
- pulmonary infections
- SOB, rapid breathing
- color change or diaphoresis w/ feeding
- edema in face/ fontanels
Treatment of tetralogy of fallot
- small frequent meals/ feedings
- surgery to correct defects
- shunt placements
s/s of tetralogy of fallot
- cyanosis w/ feeding, crying,a ctivity
- hypoxemia, increased respirations, increased work of breathing
- clubbing of fingers and toes
- delayed growth and development
- squatting position or fetal position to catch breath
