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- CO=HR X SV
- the volume of blood ejected by the heart in 1 min
- Preload, afterload, and contractility
- amount of blood ejected by the heart in any one contraction
Volume of blood returning to the heart or circulating blood volume
resistance against which the ventricles must push to pump blood out
efficiency of the myocardial fiber shortening or the ability to pump
- heart size and configuration
- pulmonary blood flow
Preop for cardiac cath
- teach child about procedure
- -what they will feel, hear, and see
- -videos, picture books, tour of cath lab
- may need to withhold morn meds
Cardiac Cath complications
Pulses distal to site may be weaker for the first couple of hours but will gradually increase in strength and then be equal and symmetric
If a postop cardiac cath pt has a soaked bandage, what do you do?
direct continuous pressure 1 inch above the site
What is CHF most likely related to?
Most commonly related to defects (VSD is the mosti common)
Why would you see CHF in kids?
- related to defects
- increased risk with maternal chronic illness like diabetes, poorly controlled phenylketonuria, alcohol consumption, exposure to environmental toxins or infections
- highly related to trisomy 21,13,18
What is the normal heart rate for a newborn?
- Awake- 100-180
- Sleep- 80-160
What is the normal HR for 1 wk- 3 month?
- 100-220- awake
- 80-200- sleep
What is the normal HR for 2 month - 2yr?
- 80-150 awake
- 70-120 asleep
What is the normal HR for 2yr-10yr?
- Awake- 70-110
- Asleep- 60-90
What is the normal HR for 10 yr- adult?
What are examples of ACE inhibitors?
Catopril, enalapril, lisonopril
What is the apical pulse that you would withhold dig?
- Infants and young children >90-110
- Older children > 70
- bradycardia, nausea, freq vominting
- visual and neuro disturbances
What parents need to know about administering dig:
- regular intervals
- administer to the side back of the mouth
- do not mix with food or fluid
- if child has teeth- rinse with water or brush teeth
- if dose is missed or vomited do not repeat dose
- if more than 2 doses are missed call HCP
- keep in safe place- pref locked cabinet
- if OD suspected call nearest poison control
Nutrition for child with CHF
- Increased calories
- feed immediately after awakening
- ensure good rest before feeding
What should you monitor with an infant with CHF?
Weight- same scale same time of day
How would you decrease risk of CVA in a child in a hypoxic state?
What position should you put a child in during a hypercyanotic spell?
Knee to chest- reduces the venous return from th elegs and increases systemic vascular resistance wich diverts more blood into pulm artery
What can a left to right shunt lead to?
increased pressure to the pulmonary artery which leads to pulm edeam which leads to CHF
VSD and ASD are categorized as:
increased pulmonary blood flow
PDA- Patent Ductus Arteriosus is surgically closed to prevent what?
increased pulm blood flow--> CHF
Increased Pulmonary Blood Flow
- Atrioventricular canal
Decreased pulmonary blood flow
- tetralogy of fallot
- tricuspid atresia
Mixed blood flow
- transposition of great arteries
- total anomalous pulmonary venous return
- truncus arteriosus
- hypoplastic left heart syndrome
obstruction of blood flow from ventricles
- coartation of aorta
- aortic stenosis
- pulmonic stenosis
Tetralogy of fallot
- ventricular septal defect
- pulmonic stenosis
- overriding aorta
- right ventricular hypertrophy
A mother of a child with congenital heart disease is worried about letting him play with other kids?
- most do not need to restrict activity
- treat child normally and allow self limited activity
- decide which sports need to be restricted with cardiologist
Prepping kid for heart surgery
- Educate on procedure and what to expect before after and during
- reduce anxiery, improve pt cooperation
- ICU tour may be wanted- avoid frightening sights
- review importance of deep breathing, ambulation, drinking and eating after surgery
What do you do if a kid has a fever after surgery?
Suctioning with a child after heart surgery
provide oxygen before and after
What is a worrisome amount of chest drainage?
- more than 3ml/kg/hr
- 5-10ml in any 1 hr
If a child with VSD is not feeling well and has been having fevers, what should the nurse tell the parents
Tell them to bring them in
Who is at a high risk for infective (bacterial) endocarditis?
- congenital anomalies, previous heart surgery, indwelling catheters
- artificial heart valves
- previous Dx of IE
- cardiac transplant with cardiac valvulopathy
What are the clinical manifestations of rheumatic fever?
- erythema maginatum
- subcutaneous nodules
- arthralgia, fever
- elevated ESR & C reactive
- positive strep test
Why do you typically get rheumatic fever?
a previous infection of groub A beta hemolytic streptococci
- TX penicillin
- children who have had it are at risk to have again
What is the therapeutic management of kawasaki's disease?
- Salicylates like aspirin to reduce inflammation and fever
- IVIG- early intervention to reducve fever and incidence of coronary artery abnmormalities
How do you get an accurate measurement of BP to dx HTN?
- Sitting postition on at least 3 diff occasions
- make sure child is quiet and relaxed
- make sure cuff fits
What is the HTN drug related to angiotensin II?
Cholestoral screening- when do you want to check
- Family Hx of elevated cholesterol or early heart disease
- cigarrete smoking
- diabetes type I or II
What is the leading cause of death after cardiac transplant?
- Initially rejection
- long term CAD
What are the discharge instructions for cardiac cath?
- Remove pressure dressing 1 day after cath
- cover site with a bandaid, change daily for 2 days
- keep site clean and dry
- avoid tub bath for 3 days
- older children may shower 1st day after
- observe for signs of redness, swelling, drainage, bleeding, fever
- monitor cardiac cath leg for coolness
- notify HCP if any are observed
- child should avoid strenuous activity for several days
- may attend school
- may resume reg diet without restrictions
- use acetaminophen or ibuprofen for pain
- keep follow up appts per practitioner instructions