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What is the 100% Oxygen challange?
- – Helpful in differentiating between cardiac and noncardiac causes of cyanosis
- – After providing 10 minutes of 100% O2:
- • A noncardiac disease would have at least a 10% change in oxygen saturation (pox) and a significant change in measured PO2
- --Or to put it another way, a pulomary problem is going to change O2 sats right away.
- • A cardiac disease would have a minimal change in oxygen saturation (pox) and measured PO2. Lungs are oxygenating blood, so little change in O2 sats, but heart is not perfusing adequately.
How can you tell if a cardiac problem is cyanotic?
- – May not be detected in the newborn nursery dt the patency of the ductus arteriosus (PDA)
- – Requires immediate attention and evaluation
How can you tell if a cardiac problem is acyanotic?
- – Typically presents with s/s of congestive heart failure
- – More gradual clinical decompensation
- – May not present until after the first 2-3 weeks of age
- • Classic symptoms: tachypnea, tachycardia, hepatomegaly
- • History may include: poor or slow feeding, sweating, color change with feeding, and poor weight gain (FTT)
What is right-sided CHF?
- • RV is unable to effectively pump blood
- effectively into the pulmonary artery
- – Results in increased pressure in RA and systemic
- venous circulation
– Hepatosplenomegaly, edema, weight gain occur
What is left-sided CHF?
- • The left ventricle is unable to effectively pump
- blood into the systemic circulation
- – Results in increased pressure in the LA and
- pulmonary veins.
- • Lungs become congested with blood, causing elevated
- pulmonary pressures and pulmonary edema
What are the three groups of cardiac dysfunction?
- Impaired myocardial function
- Pulmonary congestion
- Systemic venous congestion
What are some SnSs of Impaired myocardial function?
- v BP
- Gallop heart rhythm
- v periferal pulses
Theme = weak heart
What are some SnSs of Pulmonary Congestion?
- retractions in infants
- flaring nares
Theme = respiratory distress
What are some SnSs of Systemic Venous Congestion?
- Weight gain
- Periferal edema, esp. periorbital
- Neck vein distention, esp in children
Theme = puffiness
What are the primary nursing priorities with any heart defect?
- Decrease oxygen and cardiac
- Balance oxygen supply and oxygen
What are some things to look for after heart Sx.
- • Congestive heart failure
- • Dysrhythmias: Irregular rhythms
- • Tamponade: Blood or fluid in the pericardial space containing the heart
What are some SnSs of tampenade?
- Compression of the heart due to fluid in the pericardium.
- • Chest tube with sudden stop in drainage
- • v BP
- • v Oxygen level
- • vHeart sounds
- • Cool periphery
What are some pulmonary complications to look for after heart Sx?
- • Atelectasis
- • Pumonary Edema
- • Pleural Effusions
- • Pneumothorax
What are some neurological issues to look for after heart Sx?
- • CVA (stroke), cerebral edema, neurological
What is something to look for in a child with tetralogy of fallot?
- • Hypercyanotic Spells (aka “TET spells” “blue spells”)
- Acute cyanosis and hyperpneic (rapid and/or deep breathing)
- Due to v pulmonary blood flow and increased R→L shunting
- Treatment: **knee-chest position, calm child, 100% O2,
What do you need to be concerned with in situations where blood shunts from rt-->lt?
- – Air from the venous side is allowed to flow into
- the arterial system and go directly to the brain,
- resulting in air embolism
- – Utilize extreme care, filters, pumps with
- sensors, etc.
What are you worried about in pts on Digoxin?
- • Monitor serum K+ (Potassium)
- – A fall in the serum K+ enhances the effects of Digoxin, increasing risk for Digoxin toxicity
- SnSs of Dig toxicity:
What is the most likely pathogen involved in aquired endocarditis?
- Streptococcus viridans
- Invades inner lining and valves.
SnSs of bacterial endocarditis?
- – Unexplained fever
- – Anorexia
- – Malaise
- – Weight loss
- – Splinter hemorrhages
- – Petechia
What is treatment and prevention of bact. endocard?
- • Treatment: Immediate use of high dose antibiotics, long-term (2-8 weeks)
- • Prevention: Prophylactic antibiotic administration before procedures that risk entry of organisms to child
What is Rheumatic Fever?
• Occurs after infection with Group A B-Hemolytic Strep
• Self limited, affecting the joints, skin, brain, serous surfaces and the heart
• Diagnosis based on JONES CRITERIA (a group of major and minor manifestations)
• S/S: carditis, polyarthritis, chorea, sub-Q nodules, arthralgia, fever
What is Kawasaki's Disease?
- Acute systemic vasculitis of unknown cause
- 80% of cases in children under 5 years of age
- 3 phases
- Cardiac involvement is most serious complication and risks include the potential for MI (due to inflammation)
- S/S: strawberry tongue, pink eyes (conjunctivitis but without discharge), trunk rash, dry/cracked lips, redness, swelling, flaking of palms and soles of feet
Treatment: Aspirin, IV Ig
Look up anaphylactic
and hypovolemic shock