Cong Cardiac pt.1 (Exam 2) Flashcards
(29 cards)
Hallmark Signs of Cardiac Issue
Poor weight
Tachycardia
Cardiac Diagnostic Test
Chest X-ray
15 lead ECG
CBC
Echocardiogram
Arterial Blood Gas
Cardiac Catheterization
Pre-Procedure: Cardiac Cath
Nursing Assessment (height and weight) (for meds and length of cath)
NPO 4-6 hours
IV fluids
Allergies to Shellfish or Iodine
Asses skin for any rash or infection. (Risk of infection)
Developmentally Prep them for the procedure
Post Cardiac Cath: Observe for complications
Color and LOC (will be drowsy)
Vital Signs and RR
-Start every 5 min
-Go to every 15 min
Distal extremities: (pules distal to the site can be weaker for first few hours)
Asses dressing for bleeding
Fluid intake: Both IV and PO
Hypoglycemia
Is a pulse defecit on effected side a expected finding post cardiac cath?
Yes
Post Cardiac Cath Positioning
Leg straight and laying in bed flat for 4-6 hours
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
Discharge education following cardiac catheterization
Pressure dressing x 24 hours
No tub baths for 48 hours
Rest that night then resume normal activities
Teach S/S of infection
Before baby is born, how many fetal opening are there?
Liver and Lungs are bypassed
- Ductus venous (close after birth) (bypass liver) (non heart related)
- Foramen ovale (hole between atrium) (lungs are not functionally so this hole allows blood to bypass them)
- Ductus arteriosus (bypass lungs)
What closes a patent ductus arteriosus?
A dose of ibuprofen
3 Fetal openings close after birth in response to
- Decreased prostaglandin E
- Increased O2 saturations
- Pressure changes within the heart
General Clinical Findings of Cardiac Defects
-Feeding difficulty and failure to thrive
-Respiratory infections
-Dyspnea
-Stridor and choking spells
-Heart Rate over 200: RR over 60
-Cyanosis and clubbing of fingers / toes
-Squatting / knee chest position
-Heart murmur
-Sweating
Clinical Consequences of Defects with increased pulmonary blood follow
They systemic pressure is greater than the pulmonary pressure so left to right shunting occurs
Increased blood volume on the right side of the heart increases pulmonary blood flow at the expense of systemic blood flow
Leading to CHF
What is congestive heart failure?
Inability of the heart to meet the bodies demands
By product of these congenital heart issues
Clinical Manifestations of CHF: Pulmonary Venous Congestion
-Tachypnea
-Wheezing
-Crackles
-Retractions
-Cough
-Dyspnea
-Nasal flaring
-Cyanosis
-Feeding difficulties
Clinical Manifestations of CHF: Systemic Venous Congestion
-Hepatomegaly
-Ascites
-Edema
-Weight gain
-JVD
Clinical Manifestations of CHF: Impaired Myocardial Function
-tachycardia
-weak pulses
-hypotension
-gallop
-poor healing
-enlarged heart
Clinical Manifestations of CHF: Higher Metabolic Rate
Failure to thrive
Child is not gain weight
Therapeutic Management of Congestive Heart Failure
Improve cardiac function
Remove accumulated Fluid and Sodium
Decrease Cardiac Demands
Improve tissue oxygenation and decrease oxygen consumption
Medications used in CHF (Important to Know)
Furosemide (remove fluid)
ACE Inhibitors (decrease pressure the heart pumps against)
Digitalis (only oral inotropic) (heart beat harder)
Digitalis: Rules for administration
Given at regular intervals
Give 1 hour before eating or 2 hours after eating
Check heart
Do not mix with food or fluid
Give behind teeth
Missed dose < 4 hours give,
Missed dose > 4 hours withhold.
If 2 doses are missed contact HCP
If child vomits, do not repeat dose (SIGN OF TOXICITY)
Check potassium levels prior
Hold infants <90
Hold older kids <70
S/S of Digoxin Toxicity (Do not give if the child has any of these)
Nausea
Vomiting
Bradycardia
Anorexia
Neurologic / Visual Disturbances
What do we for digoxin toxicity?
Digibind (Digoxin Immune Fab)
Contraindications for Digoxin
Apical pulse hold if <90 for infants / young kids
Apical pulse hold if <70 in older kids
Low potassium
