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47 Cards in this Set
- Front
- Back
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Prior Knowledge |
Cardiac Health history cardiac/ peripheral vascular assessment cardiac interventions cardiac test
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Changes - Adult normal |
first breath..lungs inflate - decreases pulmonary vascular resistance..increases blood flow to lungs changing pressure in pulmonary artery..DA closes change in pressure in La... FO closes cord clamping.. lack of blood flow.. DV closes |
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Changes? Adult normal |
first breath.. lungs inflate - decreases pulmonary vascular resistance... increases blood flow to lungs changing pressure in pulmonary artery.. da closes change in pressure in LA .... Fo closes cord clamping..lack of blood flow...dv closes |
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#1 ! - Improve cardiac fnx |
digoxin (digitalous glycosides) calculated in mcgs for infants po/iv |
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digoxin nursing management |
Admin/calculate doses monitor for s/s toxicity teaching- draw up doses, provide MAR, s/s toxicity Apical pulse, limits vary with age infants - 90-100 .. 70 in children |
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Dig toxicity |
N/v anorexia bradycardia dysrhythemias |
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Number 2! - Remove accumulated fluid and sodium |
diuretics Lasix- furosemide hydrochlorothiazide - diuril
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Nursing management - diuretics |
I/o dehydration s/e K* |
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Potassium chloride- micro- K, K-Dur Electrolyte |
correct K deficit prevent hypokalemia dosage: meq/kg. day/ bid-qid individualized based on serum potassium levels |
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Potassium chloride |
more or less can be life threatending warning- watch with : renal failure, hydration imbalances, acide-base imbalances, cellular damage (burns, accidents, surgery), diabetes watch k levels with digitalis, diuretics, iv fluids increase k = increase irritatbility, diareah, ecg changes decrease k = weakness, decrease reflexes, dsyrthymias, ecg changes 3.50 5.0 meq/l! |
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# 3! -Decrease cardiac demands |
limit physical activity- cluster care smaller more frequent feedings minimize stress/sedation maintain body temp treat infections/ assess for s/s infection change position |
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#4!- improve tissue oxygenation |
o2 therapy nc o2 hood vapotherm ventilators |
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Nursing management: Tissue o2 |
careful assessment count RR for one minute HOB up monitor o2 sat assess for s/s infection antibiotics as per orders |
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# 5! - nutrition |
greater metabolic rate well rested q3 hours/over half hour possibly ng feedings additives - increase slowly |
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Relieving hypercynatic spells |
use calm, comforting approach place infant or child in knee to chest position provide supplemental o2 admin morphine sulfate 0.1mg/kg iv, im or subq supply iv fluids admin propranol - 0.1 mg/kg iv |
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#7!- child and family support |
anticipatory prep commnuication be calm and attentive reassurance education |
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prepare for invasive procedures
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expected outcomes reduce anxiety improve cooperation enhance recovery develop trust |
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prepare IP contd... |
teaching - including post op instructions tours written info picture books hospital noises equipment familiar objects |
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post op complications |
chf decreased cardiac output atelectasis pulmonary edema seizures cva infections anemia |
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post op nursing care |
observe vitals maintain resp status pain relief measures monitor fluids rest/activity regimen |
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post op - pain relief measures |
median sternotomy thoracotomy PCA NSAIDS paralyzing agents |
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discharge intructions |
meds activity diet/nutrition wound care bacterial endocarditis prophylaxis med alert bracelet follow up appts s/s to report review of dx and procedure support groups return to school vna? |
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nursing diagnoses |
decrease cardiac output re: structural defects ineffective breathing pattern re: pulmonary congestion fluid volume excess re edema activity intolerance re imbalance between o2 supply and demand |
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nursing diagnosis |
risk for infection re: reduced body defenses altered family processes re: child with life threatening illness deficient knowledge re: anxiety and unfamiliarity with the disease process |
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Disorders with decreased pulmonary blood flow |
Tetralogy of Fallot Tricuspid atresia |
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Disorders with increased pulmonary blood flow |
PDA Asd Vsd |
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Obstructive disorders |
Cortication of the aorta Aortic stenosis Pulmonary stenosis |
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Obstructive disorders |
Cortication of the aorta Aortic stenosis Pulmonary stenosis |
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Kawasaki Disease or mucocutaneous lymph node syndrome |
causes systemic vasculitis most children who contract illness are younger then 5 and 80 % are younger then 2 |
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The biggest concern with KD is not recognizing symptoms and promptly iniating treatment. -child can develop coronary artery abnormalities and expierence MI -without diagnosis child with kd is at risk for ischemic heart disease and sudden death in young adulthood |
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KD |
coronary damage and giant aneurysms can develop in treated patients |
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S/S |
ocular signs - bulbar conjuctivae oral signs- strawberry tongue, redness within the mouth or the pharynx, red or cracked lips. skin signs- morbillin (measles-like) maculopapular (red patches and bumps), erythematous (red skin), skin peeling may occur in the convalescent stage of the illness |
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clinical presentation |
fever of atleast 5 days duration with atleast 4 major clinical manifestations - cervical lymphadenopathy, nonpurulent conjunctivitis, oral mucosal variations, swelling and edema of the extremieties, and a hetergenous rash. |
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labs |
cbc with differential and platelets reveals leukocytosis - greater then 15,000/mm, especially in the initial phase anemia can develop with a prolonged inflammatory duration. elevated acute phase reactants like ESR and C-reactive protein are common in the presentation then usually return to normal 6-8 weeks. |
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KD treatment |
reduction of inflammation in the myocardial tissue and coronary arteries is goal includes- high dose salicylate and iv ig therapies |
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salicylate therapy |
need to be monitored for reye's syndrome, gi bleeding, abdominal pain, ototxicity, and tinnitus. meases and varicella immunizations should be deferred for 11 months after a child receives ivig |
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atrial septal defect ASD |
blood shunted from left to right atrium to right ventricle increases blood to lungs causes congestion in pulmonary artery which causes CHF may close on its own edema, rales, fatigue |
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ventricle septal defect VSD |
defect in lower chambers. o2 rich blood pumped left to right shunt blood which causes congestion=CHF poor eating, ftt, tachypnea, tires easily, pht, endocarditis, arrhythmias. may close on own - watchful waiting surgery put a DALCRON patch. pulmary artery banding should help infant grow so vsd can be reapired. HARSH MURMUR - LEFT STERNAL BORDER edema - pedal and eyes |
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patent ductus arteriosus PDA |
aorta and pulmonary artery remain open left to right shunt, increases pulmonary blood flow to lungs. MACHINE LIKE MURMUR!!! poor feeding, tachypnea, edema-eyes, pedal, endocarditis, *common preterm - inability to remain oxygenated or keep pda closed meds- indomethicin=npo. diverts o2 to close - watch urinary output. med 3x- may need surgery to close = ligate at bedside |
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pulmonic stenosis |
obstructive blood flow from right ventricle to pulmonary arteries. may occur as a muscular obstruction below pulm valve, an obstruction at the valve, or narrowing of pulm artery above the valve. right ventricle works harder = hypertrophy of right vent and decrease pulm blood flow. H/F, arrhythmias treatment- balloon angioplasty to pen right vent to pulm artery |
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aortic stenosis |
obstruction of blood flow between the left vent and the aorta. left vent must work harder to pump blood to aorta. causes by a muscle obstruction below the aortic valce, obstruction of the valve, or narrowing just above the valve. h,f, PULMONARY EDEMA, arrhythmias, endocarditis, left ventricile hypertrophy. treatment- replace valve, balloon angioplasty to allow blood into aorta. treatme |
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coartication of aorta |
OBSTRUCTIVE narrowing of aorta. increase b/p, aortic anyreusm, androcarditis, cva, CHF dizzy, faint, nose bleed. treatment- before age of 10, remove section sew back together. balloon angioplasty plus stent to keep open. MONITOR B/P IN ALL EXTREMS. LOWER IN LOWER EXTEM |
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tetralogy of fallot |
1. vsd- left to right shunting 2. pulmonic stenosis- blood can't get to lungs 3. overriding aorta- opens to both vents = mixed blood into aorta 4. ventricular hypertrophy- thick muscle. right vent becomes hypertrophied. s/s - cyantic spells, poor eating, late=clubbing. TET SPELLS- rapid decrease of 02 in blood SQUAT POSITION - knee to chest. -calm comfort approach, provide o2, morphine, iv fluids, meds- induril. DECREASES PULMONARY BLOOD FLOW. may cause polycethemia!!
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KAWASAKI DISEASE |
inflammation of vascular system mi or sudden death strawberry tongue, peeling of hands feet, fever, blood clot provide antibodies
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salicylates |
give with meals gi upset anticuag and anti pyretic therapy lab values - platelets risk for bleeding may cause - reye syndrome, tinnitus. |
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polycethemia |
increase rbc, causes clotting, heart works harder. |
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cardiac cath |
pre cath- vitals, platletes, hemo, allergies, INFOMED CONSENT. contrast material has diuretic effect cardiac cath- treatment or diagnosis look at dressing for frank red blood - pressure 1 inch above artery in bleeding. keep legs straight no strenuous activity, no baths, watch for fever, skin color changes, motrin for pain. |
