FN 2 test 4 ch 48[1].txt

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abrisson05
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FN 2 test 4 ch 48[1].txt
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2012-05-01 09:12:48
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FN2 48
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    • author "me"
    • fileName "FN 2 test 4 ch 48"
    • tags "11?"
    • description ""
    • Pedatric differences for cardiovascular
    • More sensitive to volume or pressure overload
    • Less compliance-amt of distention or expansion of the ventricles
    • Resluts in dec ability to change stroke vol-amt of blood ejected each contractoin
    • HR is highest at birth becuz of infant metabolic rate
  1. Assessment of cardio.
    • History-mothers health history, pregnancy, and birth history
    • Inspection-nutritional staus, color, chest deformities, unusual pulsations, respiratory excursion, clubbing
    • Palpation- chest, abdomen, peripheral pulses
    • Auscultation- heart rate and rhythm, character of sounds
  2. Cardiac catheterization
    • Potential complications: hemorrhage, fever, N/V, loss of pulse in the catheterized extremity
    • *cannot do if diaper rash in that area
  3. Congenital heart disease
    Cause
    Classifications
    • C- unknown
    • C- inc pulmonary blood flow
    • Dec pulmonary blood flow
    • Obstruction to blood flow out of the heart
    • Mixed blood flow
  4. Inc pulm. Blood flow
    Nursing diagnosis
    • Excess fluid volume r/t heart failure
    • Ineffective infant feeding pattern r/t SOB and fatigue
    • Risk for infection r/t pulmonary vascular congestion and chronic illness
    • Interrupted family processes r/t crisis of child's serious illness
  5. Inc pulm blood flow
    Def
    Signs
    Cuases
    • D- most common congenital heart defect; lt to rt side of heart(blood is shunted)
    • S-poor wt gain, pulmonary artery hypertension
    • --**tachycardia, tachypnea, crackles, fatigue
    • C-pda, asd, vsd
  6. Planning, implementation inc pulm b.f.
    • Pain management
    • Promote resp fnctn
    • Manage fluid and nutrition-adminster oral fluids
    • Encourage child to inc activity gradually
    • Discharge: children at more risk to develop endocarditis
  7. Obstructing blood flow
    • CHF will develop with significant stenosis
    • Most children asymptomatic
    • Aortic vavle dilation or replacement when significant regurgitation occurs
    • Vigorous exercise should be avoided
    • Child is allowed to grow until regurgitation and stenosis becomes symptomatic
  8. Obstructing systemic b.f.
    S/s
    Cause
    Tx
    • S/s- dec blood flow, diminishe pulses, poor color, delay cap refill, dec urinary output
    • Aortic or pulmonary stenosis(obstruction)
    • Tx-same as inc pulm b.f.
  9. Dec pulm.b.f.
    • Cyanosis quickly after birth
    • Does not respond to oxygen administration
    • Pulmonic stenosis- narrowing causes dec blood flow into pulmonary which inc preload
    • Dyspnea on exertion, chf
    • Loud systolic murmur and thrill
    • Dilation of stenosis under cardiac cath to correct narrowing
  10. Dec pulm b.f.
    Problems
    Signs
    Tx
    • Problems-tetralogy of fallot, pulmonary or tricuspid atresia
    • S- cyanosis, edema on periphery, murmurs or thrills, inappropriate tissue perfusion(o2 sats)
    • Squat to help return blood flow
    • Tx-surgery
  11. Nursing diagnosis dec pulm b.f.
    • dec cardiac output r/t ventricular restriction and an obstructed outflow tract
    • Risk for infection r/t unfiltered bacteria in blood and sites of blood shunting that promote bact growth
    • Caregiver role strain r/t care of child with chronic illness
    • Activity intolerance r/t cyanosis and dyspnea on exertion
    • Delayed growth and development r/t congential anomaly and hypoxemia
  12. Planning, implementation dec pulm b.f.
    • Promoting development- delayed gross motor skills
    • Caring for hypercyanotic episode - teaching signs of worsening cyanosis
    • Fluid electrolyte status- report vomiting, diarrhea, and fever prevent dehyration
    • Monitor for infection - systemic and endocarditis
  13. Mixed defects
    • Anomalies needed for survival in the postnatal period as mixing of blood from the pulm and systemic circulations w/in th eheart chambers
    • Includes- transposition of great vessels, total anomalous pulm venous connection, truncus arteriosus, hypoplastic left heart
    • These defects are rare, but critical
  14. Congestive heart failure
    Def
    Acqured by
    • Cardiac output is inadequate to support body needs
    • A-cardiomyopathy or kawasaki disease or congential problems that inc pulmonary pressure
  15. Management goals CHF
    • Improve cardiac fnctn by administering digitalis(digoxin)
    • Remoce accumulated fluid and sodium by administering diuresis along with possible fluid or sodium restriction
    • Dec cardiac demands by limiting activity, maintaining body temp, treating infections, reducing the effort of breathing, and sedation
    • Improve oxygen consumption by providing cool, humidified oxygen
  16. Nursing diagnosis CHF
    • Dec cardiac output r/t cardiac anomaly
    • Excess fluid volume r/t heart failure
    • Risk for impaired skin integrity r/t latered fluid status
    • Imbalanced nutrition: lass than body requirements
    • Compromised family coping
  17. Plnning implementation chf
    • Administer and monitor meds as ordered
    • Maintain oxygenation and myocardial fnctn
    • Promote rest
    • Foster development
    • Provide adequate nutrition
    • Provide emotional support
    • Educate regarding home care
  18. Nursing care congential heart disease
    • Supprt family in their loss
    • Assess the familys level of understanding
    • Supplying information as needed
    • Communicate with members of the interdisciplinary team
  19. Post cardiac surgery nursing care
    • HR and resp rate for full min
    • Breath sounds for atelectasis or pleural effusion
    • Temp changes, particularly cold
    • Freq turning, deep breathing
    • Monitor chest tube output
    • Closely track intake and output
    • Pain control
    • Watch for tachycardia, dyspnea, cyanosis, fatigue, dysrythmias
    • Monitor for depression
  20. Heart transplant
    • Becaue of immunosupprestion, risk for infection is cause of mortality and morbidity
    • Post surgery children have near normal function
    • Renal problems and htn are frq problems requiring treatment
  21. Htn
    • 3 readings over 95th% for gender, age, ht
    • Need: wt reduction, dec sodium fiet...first line tx
    • Medications are used for secondary htn or poor response to non-pharm management
  22. Primary/secondary htn
    • Primary- essnetial body needs it; tx=wt loss, exercise before meds
    • Secondary- due to disease process; tx=underlying cause
  23. Kawasaki disease
    • Acute systemic inflammatory illness leading to acquired heart disease
    • Most prominent in asian children
    • Most often present in children under 5y/o
    • Three stages, acute, subacute, convalescent
  24. Phases of kawasaki
    • Acute- fever, irritability, redness as onset of inflammation, lymph nores, in diaphoresis....self limiting
    • Subacute- skin comes off, cracked lips, finger, and toes that were inflammed start to peel, child appear norml 6-8wks out, but takes some time to resolve
    • Convalescent- 6-8wks after onset, appears normal, some symptoms can flare up
  25. Tx kawasaki
    • Iv immunoglogulin, aspririn
    • Hospitalized 3-4 days, may recover fully, but may have lasting results of aneurysms
  26. Nursing diagnosis kawasaki
    • Risk for imbalanced body tem r/t inflammatory process
    • Impaired oral mucous membranes r/t inflammation and dec intake
    • Inpaired skin integrity due to edema, diaphoresis, and skin desquamation
    • Interrupted family processes due to childs acute and potentially life threatening illness
  27. Nursing care during kawasaki tx
    • Moisturize sking, liks
    • Keep skin clean and dry
    • Passive ROM
    • Support the parents
    • Discharge teach: heart muscle irritable for 6-8wks, hands and feet will peel, become stiff-do rom

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