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Cardiac Dysfunction
Peds Exam 2
| Term | Definition |
|---|---|
| beta blockers | Example: carvedilol (Coreg) Decreased HR and BP, vasodilation Side effects: dizziness, headache, and hypotension |
| ACE inhibitors | Examples: captopril (Capoten), enalapril (Vasotec), and lisinopril) Decreased pulmonary and systemic vascular resistance, decreased BP, and a reduction in afterload Side effects: hypotension, cough, and renal dysfunction |
| Furosemide (Lasix) | Drug of choice in severe HF Causes excretion of chloride and potassium (hypokalemia may precipitate digitalis toxicity) Begin to record output as soon as drug is given Observe for dehydration |
| side effects of Furosemide (Lasix) | nausea and vomiting, diarrhea, ototoxicity, hypokalemia, dermatitis, postural hypotension |
| teaching for Furosemide (Lasix) | Encourage consumption of foods high in potassium and/or give potassium supplements Monitor chloride and acid-base balance with long-term therapy Observe for signs of digoxin toxicity |
| Spironolactone (Aldactone) | Weak diuretic Has potassium-sparing effect; frequently used with thiazides, furosemide Poorly absorbed from GI tract Takes several days to achieve maximum actions Do NOT administer potassium supplements |
| side effects of Spironolactone (Aldactone) | skin rash, drowsiness, ataxia, hyperkalemia |
| Digoxin (Lanoxin) | Oral inotropic agent Generally given in the ICU setting During initiation, the child is monitored by means of an ECG to observe for the desired effects and detect side effects, especially dysrhythmias |
| Digoxin teaching | Narrow therapeutic window so watch for toxicity Nausea and vomiting (refusing to eat, crying/fussing) Rapid onset Check HR prior to administration |
| Atrial Septal Defect | abnormal opening between atria that allows blood from higher-pressure left atrium to flow into lower-pressure right atrium Causes increased flow of oxygenated blood into right side of heart Characteristic murmur |
| ventricular septal defect | abnormal opening between ventricles Blood volume into lung increases, which increases risk of lung disease May be incredibly small May also have absence of septum completely “Common Ventricle” |
| ventricular septal fix options | Palliative Approach: medications, oxygen, comfort care, postponing repair OR fix defect as soon as possible Complete Repair: sutures used for small defects Large defects use surgical patch closure |
| patent ductus arteriosus | failure of fetal ductus arteriosus to close within first few weeks of life Allows blood flow from higher-pressure aorta to lower-pressure artery and causes left-to-right shunt Amount of shunting determines clinical signs machine like murmur |
| Tetralogy of Fallot | combination of four heart defects Ventricular Septal Defect Pulmonic Stenosis: narrowing at entrance to pulmonary artery Overriding Aorta: displacement of aorta above both ventricles Right Ventricular Hypertrophy: thickening of right ventricle |
| signs of Tetraology of Fallot | Characteristic murmur “Tet Spells” - acute episodes of cyanosis and hypoxia Blue lips, fingertips, and toes When upset, may turn completely blue |
| nursing care for Tetraology of Fallot | performing basic needs all at once and at a schedule to avoid irritation and crying Exertion will cause heart to work really hard and cause spells and manifestations |
| Coarctation of Aorta | narrowing of aorta High blood pressure and bounding pulses in upper extremities Low blood pressure and temperature in lower extremities |
| Transportation of Great Arteries or Vessels | pulmonary artery exits left ventricle and aorta exits right ventricle, with no communication between systemic and pulmonary circulations No normal sinus rhythm present Arterial switch operation common to reestablish normal circulation |
| congestive heart failure | inability of heart to pump adequate amount of blood to system circulation at normal filling pressures |
| signs and symptoms of CHF | Impaired myocardial function Pulmonary congestion Systemic venous congestion Pediatric patients with heart failure may require lengthy hospitalizations until symptoms improve |
| nutrition for infant/child with congenital heart defect | Metabolic rate is greater because of poor cardiac function and increased heart and respiratory rates, therefore their caloric needs are greater than those of the average infant |
| tips for nutrition for feeding an infant with a congenital heart defect | Infant should be well rested before feeding and fed soon after awakening so as not to expend energy on crying A 3-hour feeding schedule works well for many infants A feeding goal of 150 mL/kg/day and at least 120 kcal/kg/day |
| care for child after cardiac catheterization | Patients are placed on a cardiac monitor and a pulse oximeter for the first few hours of recovery Usual diet can be resumed as soon as tolerated, beginning with sips of clear liquids and advancing as the condition allows Acetaminophen for pain |
| nursing responsibility after cardiac catheterization | PULSES: especially below the catheterization site, for equality and symmetry TEMPERATURE AND COLOR OF AFFECTED EXTREMITY: coolness or blanching may indicate arterial obstruction |
| vital signs and blood pressure after cardiac catheterization | VS: taken as frequently as every 15 minutes, with special emphasis on heart rate, which is counted for 1 full minute for evidence of dysrhythmias or bradycardia BP: especially for hypotension, which may indicate hemorrhage |
| Dressing and fluid after cardiac catheterization | for evidence of bleeding or hematoma formation in the femoral or antecubital area both IV and oral, to ensure adequate hydration (blood loss in the catheterization laboratory, the child’s NPO status) |
| how to help the child and family cope with congenital heart disease | supports parents, supplying information as needed, reduce anxiety through anticipatory preparation |
| other ways to help the family and child cope | diagram and pictures can be helpful, help/teach the family how to administer medications at home, and signs of worsening HF, exercise, good nutrition, immunizations, prepare child for invasive procedures |
Created by:
ellabrewer3
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