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what is the HR of a child with heart failure?
hyoptentension represents decompensated shock
what does a pt with an impaired myocardial function?
brady or tachy?
skin sweating or dry?
urine output increase or decrease?
- low urine output
what does a pt look like with pulmonary congestion r/t heart failure?
- retraction, trouble breathing
what can the CXR tell you?
what is the Holter Monitor used for?
24 hr EKG. diary kept to associate arrythmias with activities.
what is an echocardiogram? what can this test tell you?
sound waves to crate a picture of the heart. tell you what that heart structures look like, size of the chambers, valve fx, blood flow direction, size of the defects.
pt is due for a cardiac catheterization, but has a severe diaper rash. what will you do with this pt?
do not proceed. femoral access is not possible d/t infection.
pt is due for a cardiac catheterization. child just tells you that he's allergic to shrimp. are you concerned? will this affect the surgery?
yes. may have an adverse reaction to the dye.
you are taking care of a post-op pt from a cardiac catherterization. to prevent bleeding from the affected extremity, you have to keep it in a ______ position for 4-8hrs.
why do we encourage the post-op cardiac cath pt to drink lots and void?
excrete the dye.
what angle do you keep the baby in the car seat to decrease workload on the heart? baby has a heart problem...
try to feed your baby every _ hours. the infant should be rested, which occurs right after awakening.
allow the baby to rest between feedings. the whole meal should take around __ mins to complete.
What is digoxin used for?
increased STR of heart contractions
what is an important nursing consideration when giving digoxin?
check pulse. if infant is less than 90, don't give. children? less than 70.
what does digoxin toxicity looks like?
what is Captopril or Enalapril used for?
what is lasix used for? is it potassium wasting or conserving?
diuretic. wasting. watch out for hypokalemia
When to TET spells usually happen?
In the AM, usually preceding feeding, crying, feeding, or BM.
What are two major consequences for congestive heart failure?
chronic hypoxemia and polycythemia.
what are some early signs of heart failure with a baby?
resting tachy. also failure to thrive because it isn't eating all that much.
heart failure > tired when eating > doesn't want to eat > failure to thrive.
_____ occurs rapidly with cyanotic heart disease.
with a baby with heart failure, one of the nursing care is increase tissue oxygenation. how are you going to do that?
cool, humidified O2, suction prn, check O2 sats 2-4hrs.
A toddler has been started on digoxin for cardiac failure. If
the child develops digoxin toxicity, the first sign the nurse would
note would be:
A. Lowered blood pressure
C. Nausea and vomiting
C. Nausea and vomiting
it does not cause the rest.
(this multiple choice question has been scrambled)
How do you administer Digoxin PO?
syringe in mouth, side and back. give water after.
What if an infant has an order for 2ml of Digoxin?
infants rarely get over 1ml. question.
Why are K+ levels important to a pt taking Digoxin?
hypokalemia can worsen Dig toxicity. They are at higher risks bc a heart failure pt are most likely on a diuretic, which causes hypokalemia.
Lasix, what is it?
diuretic to prevent vol. overload. decrease pulmonary and venous congestion.
What is the correlation with Spironalactone and K+?
withhold the order for K+. Spiro is a K+ sparring diuretic.
What do drugs like Catopril and Enalapril do? What's an important nursing consideration for these drugs?
ACE inhibitors. reduce afterload by vasodilation. Monitor BP before and after.
what is rheumatic fever? what med is given to treat it?
you get it after untreated URI from GABHS. tx it with PCN.
You have a pt that you are referencing to the Jone's criteria to see if they have rheumatic fever. they have endocarditis. what is that?
fibrin-like plaque on the valve surfaces. leads to mitral and aortic valve dmg.
rheumatic fever major criteria: migratory polyarthritis. What is that?
a migrating inflammation of joints.
Rheumatic fever major criteria: syndenham chorea (aka St. Vitus' dance). what is that?
kinda like parkinsons. aimless movements, facial grimacing.
What are the major manifestations for RF?
- erythema marginatum
- subcutaneous nodules
RF major criteria: erythema marginatum. what is it?
red skin lesions starting on trunk and spreading peripherally.
RF major criteria: carditis. what is that?
inflammation of endocardium, myo and peri cardium. valves. usually diagnosed by hearing a murmur.
what are minor criteria for RF?
- hx of RF
- arthralgias (joint pain) w/o arthritis
- elevated ASO titers
- 1st degree AV block
what is the tx plan for RF?
- pcn (penV) or erythromycin (EryPed). used to erradicate strep infection.
- assess for allergic rxn.
- educate to completely finish meds.
- promote rest and rehydration.
- prophylaxis may be min of 5yrs or up until 18yo.
- follow up every 5 years.
your pt has chorea d/t RF. what nursing considerations are you supposed to be aware of concerning safety?
they have uncontrollable movements. twitching. all that. sleep on a mattress on the floor and assist when going up and down stairs.
Kawasaki disease has 3 phases. Acute, subacute, convalescent. Describe them.
Acute: fever, swollen hands/feet, enlarged nodes. conjunctivis. changes in mucous membranes. fever does not respond to antibx.
Subacute: lasts during 3rd-4th week. fever disappears, most sx resolve. desquamation, arrythmias, HF, coronary aneurisms.
Convalescent: final stage beings when most sx have gone.
What is the criteria for diagnosis?
- bilateral conjunctivitis
- intense oral erythema
- induration of hands and feet
- rash on trunk
- cervical lymphadenopathy (enlarged nodes on neck)
what is the tx for kawasaki disease?
- high dose of aspirin.
describe what you would see in ASA toxicity?
- undue drowsiness