Cardiac Dysfunction

Question 1

Inspection of a child with cardiac problems

Answer 1

nutritional state
color
chest deformities
unusual pulsations
respiratory excursion
digital clubbing

Question 2

is FTT associated with heart problems?

Answer 2

yes

Question 3

historical assessment of a child with cardiac problems

Answer 3

parental concerns
mothers health and pregnancy (DM, ETOH, Drugs?)
family history

Question 4

what is a late sign of something going on cardiac in infants?

Answer 4

cyanosis

Question 5

what is a cardinal sign of something going on cardiac in infants?

Answer 5

poor weight

tachycardia

Question 6

assessment of a child with possible cardiac disorders

Answer 6

palpation and percussion

auscultation

Question 7

what do you look for on a cxr for cardiac?

Answer 7

any abnormalities

increased heart size

Question 8

what do you look for on an abdominal assessment for cardiac?

Answer 8

hepatomegaly

enlarged spleen

Question 9

what do you look for in peripheral pulses for cardiac?

Answer 9

are they even?
bounding?
faint?
unilateral?

Question 10

what diagnostic tests do you use for cardiac evaluation?

Answer 10

chest xray - do 1st
ECG- 15 lead
CBC- check for polycythemia
echo- can be done fetally if needed
ABG
cardiac cath- to visualize heart structure

Question 11

cardiac catheterization

Answer 11

can do diagnostically or interventional (know what is wrong and fix it)
electrophysiology (check impulse of heart, irritate specific part of heart)

Question 12

which side of the heart is commonly used in peds for cardiac catheterization?

Answer 12

Right side

it is safer and structural defects allow access to left side of heart

Question 13

pre procedural care of cardiac catheterization

Answer 13

assess skin ( diaper rash, any skin breaks)
NPO 4-6 hours, clarify AM needs
IV fluids if indicated (polycythemia start fluids to prevent dehydration)
developmentally appropriate psychological prep (let them know what to expect)
sedation?
mark pulses in both feet

Question 14

post procedural care of cardiac catherterization

Answer 14

observe for skin color
LOC
VS
respiratory status
pulses
dressings
fluid intake, IV and PO
hypoglycemia

Question 15

what is important to know about distal pulses following a cardiac cath?

Answer 15

distal pulses to the site can be weaker for the first few hours post procedure

Question 16

how long must a child maintain a flat lying position with legs not bent following a cardiac cath?

Answer 16

Venous 4-6 hours

Arterial 6-8 hours

Question 17

if you suspect bleeding following a cardiac cath what do you do?

Answer 17

circle drainage, time and date
if you suspect a bleed occlude the area 1 inch above insertion site.
CALL FOR HELP, do not leave patient.

Question 18

discharge planning following cardiac catheterization

Answer 18

pressure dressing x 24 hours
no tub baths for 48 hours
rest that night but resume normal activities afterwards
teach for s/s of infection

Question 19

can infants hearts pump harder? why

Answer 19

no, they can only pump faster
because in infancy muscle fibers of the heart are less developed and less organized resulting in limited functional capacity

Question 20

anatomy developmental considerations

Answer 20

heart size- ventricles are equal size at birth
normal O2- 95-100%
infants and small children have thin chest walls with little to no sub-q fat and muscle

Question 21

ductus venosus

Answer 21

helps blood bypass lungs

blood bypasses liver

Question 22

ductus arteriosis

Answer 22

blood escapes through here to avoid lungs, blood is shunted to descending aorta
blood bypasses lung
this closes in presence of increased oxygen concentration in blood

Question 23

fetal blood flow

Answer 23

O2 rich blood enters fetal body through umbilical vein to liver where it divides 1/2 to liver, 1/2 to inferior vena cava via ductus venosus (1st fetal opening) after birth it closes, then to RT atrium to LT atrium through foramen ovale (2nd opening), then LT ventricle, then aorta to head and extremities, then returned to placenta via descending aorta through umbilical arteries

Question 24

foramen ovale

Answer 24

between RT atrium

since lungs are not working blood bypasses the lungs

Question 25

when does foramen ovale close?

Answer 25

when infant takes 1st breath and air fills lungs causing pulmonary vasodilation allows for vascular resistance to decrease.

Question 26

fetal shunts

Answer 26

all close at birth or shortly after

Question 27

why do fetal shunts close?

Answer 27

decreased maternal hormone prostaglandin E increased O2 saturations pressure changes within the heart

Question 28

general clinical findings for cardiac defects

Answer 28

``` dyspnea on exertion feeding difficulty - FTT HR over 200, RR about 60 in infants recurrent respiratory infections cyanosis and clubbing fingers squatting/ knee to chest position heart murmurs excessive sweating signs of HF ```

Question 29

types of cardiovascular disorders in children

Answer 29

congenital heart defects (CHF) | acquired cardiac disorders

Question 30

if there is a hole in the LT side of heart how does blood flow?

Answer 30

increased pressure between atrium and ventricles, blood flows from high pressure to low pressure causing a LT to RT sided shunt

Question 31

blood flow of heart

Answer 31

``` RT atrium tricuspid valve RT ventricle pulmonic valve to lungs, blood becomes oxygenated enters LT atrium mitral (bicuspid) valve LT Ventricle Aortic valve Aorta ```

Question 32

2 classifications of heart defects

Answer 32

acyanotic and cyanotic

Question 33

the severity of congenital heart defects depends on the severity of these two principle consequences

Answer 33

defects that result in LT to RT shunting of blood | Defects that result in decreased pulmonary blood flow

Question 34

acynotic heart defects with increased pulmonary blood flow can indiate

Answer 34

atrial septal defect ventricular septal defect patent ductus arteriosis

Question 35

acyanotic heart defects with obstructive lesions, decreased blood flow to areas of the body can indicate

Answer 35

coarctation of aorta aortic stenosis pulmonic stenosis

Question 36

cyanotic heart defects with decreased pulmonary blood flow can indicate

Answer 36

tetralogy of Fallot | tricuspid atresia

Question 37

cyanotic heart defects with mixed blood flow

Answer 37

transposition of the great vessels hypoplastic left heart truncus arteriosus

Question 38

clinical consequences of defects with increased pulmonary blood flow

Answer 38

left to right shunting occurs increased blood volume on the right side of heart increases pulmonary blood flow at the expense of systemic blood flow *blood that should be returning to the lungs is going back to the heart

Question 39

clinical signs and symptoms of increased pulmonary blood flow

Answer 39

s/s of HF

Question 40

what is CHF?

Answer 40

inability of the heart to pump enough blood enough blood to meet the bodies demand

Question 41

CHF can be caused by

Answer 41

volume overload pressure overload decreased contractility (cardiomyopathy) high cardiac output demands

Question 42

clinical manifestations of pulmonary venous congestion

Answer 42

``` tachypnea wheezing crackles retractions cough dyspnea on exertion feeding difficulties irritability fatigue with play ```

Question 43

clinical manifestations of systemic venous congestion

Answer 43

``` hepatomegaly ascites edema weight gain neck vein distention ```

Question 44

clinical manifestations of impaired myocardial function (cardiac output)

Answer 44

``` tachycardia weak peripheral pulses hypotension gallop rhythm longer capillary refills pallor cool extremities oliguira fatigue restlessness enlarged heart sweating ```

Question 45

clinical manifestations of high metabolic rate

Answer 45

FTT or slow weight gain, perspiration

Question 46

therapeutic management of CHF

Answer 46

improve cardiac function remove accumulated fluid and sodium decrease cardiac demands improve tissue oxygenation and decrease oxygen consumption

Question 47

medications for CHF

Answer 47

Lasix (furosemide)- monitor K+ Ace inhibitors ( PRILS) stops vasoconstriction and decreases afterload, decreased BP Digitalis (digoxin)- only oral inotropic agent works very rapid, causes heart to pump harder, increased contractility

Question 48

rules for administering digitalis

Answer 48

regular intervals 1 hour before eating or 2 hours after apical heart rate for 1 min(hold if <90-110 for infants/children, <70 older kids) do not mix with food/liquids give behind teeth or brush after administering (stains teeth)

Question 49

if a child misses a dose of digitalis what do you do?

Answer 49

if <4 hours give the missed dose >4 hours withhold med if 2 doses are missed contact provider

Question 50

if the child vomits after administering digitalis what do you do?

Answer 50

do not repeat dose

Question 51

if the child is hospitalized and receiving digitalis what do you monitor?

Answer 51

potassium levels prior to giving digitalis | digitalis levels

Question 52

when do you hold digitalis?

Answer 52

if potassium levels are low

Question 53

s/s of digitalis toxicity

Answer 53

``` nausea vomiting bradycardia anorexia neurologic and visual disturbances *monitor child closely for dysrhythmias b/c digoxin toxicity can cause hyperkalemia ```

Question 54

what is the antidote for digitalis toxicity?

Answer 54

digibind (digoxin immune fab fragments) | * monitor for rapidly falling potassium levels

Question 55

nursing considerations for activity intolerance r/t CHF

Answer 55

``` promote adequate rest prevent crying small frequent feedings (don't want to exhaust from eating) short intervals of play prevent shivering supplemental oxygen if needed ```

Question 56

nursing considerations for altered nutrition r/t CHF

Answer 56

anticipate hunger (small, frequent meals) feed no longer than 30 min at a time and give rest through NG non-stimulating environment semi-erect position for feeding burp before starting and frequently formula with increased calories per ounce soft preemie nipple with moderately large opening encourage mom to pump and feed through bottle

Question 57

nursing considerations for ineffective breathing pattern

Answer 57

assess RR, effort and O2 sats position to encourage maximum chest expansion avoid constriction humidified supplemental oxygen during stressful periods such as bouts of crying or invasive procedures

Question 58

1 oz of weight gain = how many grams

Answer 58

28.35 grams

Question 59

weight gain of how many grams can indicate fluid overload?

Answer 59

50 grams

Question 60

nursing considerations for fluid volume excess of CHF

Answer 60

``` accurate I and O daily weight (same time and clothes) assess for edema maintain fluid restriction if ordered good skin care change positions frequently ```