Week 10 Pedi: VOPP CV Dysfunction

fetal circulation

umbilican vein, vena cava, ductus venosus, RA, RV, pul trunk, lungs, LA, LV, aorta, ililacs, umbilical artery, placenta to pick up o2/drop off co2

3 main circulatory changes at birth

First breath → inc O₂, dec pulmonary resistance → inc lung blood flow → inc LA pressure closes foramen ovale

inc O₂ and dec prostaglandin constrict ductus arteriosus

Cord clamping → inc systemic resistance; umbilical flow stops → ductus venosus closes

PDA

PDA

allows mixing between pul art and aorta because it is a passageway between the two

PFO

hole between two atriums allowing mixing of blood between them

an arrythmia is an

iregular rhythm

cardiomegaly is

enlarged heart

chorea is

involventary, abrupt, irrregular movements

lymphadenopathy

swollen lymph nodes

polycyhtemia

increased RBC which means increased H/H

Vaculitis

inflammation of blood vessles

digoxin MOA

enhance myocardial fx

digoxin indication

heart failure, tachycardia

digoxin major se

bradycarida

digoxin nursing assessments/monitoring

AP x1 min before and assess for toxicity

ACE inhibitors (Captopril) MOA

decrease afterlaod

ACE inhibitors (Captopril) indication

HF, HTN

ACE inhibitors (Captopril) major SE

hyperkalemia (if also on spironolactone/supplements)

ACE inhibitors (Captopril) monitoring

hypotension, hyperkalemia

Aspirin MOA

low dose to prevent platelet aggregation and subsequent shunt narrowing

Aspirin indication

pre-op shunt procedure x severeal months

Aspirin major se

ototoxicity

Inodmethacin MOA

prostaglandin inhibitor

Inodmethacin indication

closure of PDA in premature infants/some newborns

indomethacin major s/e

renal toxicity, GI bleeding, bleeding

furosemide (loop) MOA

decrease accumulated fluid

furosemide (loop) indication

heart failure

furosemide (loop) major se

hypokalemia (can reult in dig toxicity)

n/v/d

ototoxicity

postural hypotension

furosemide (loop) monitoring

output

s/s dehdhydration

encourage K+ foods

s/s dig toxicity

Spironolactone (K+ sparing) MOA

decrease accumulated fluid

Spironolactone (K+ sparing) indication

HF

Spironolactone (K+ sparing) major s/e

hyperkalemia

skin rash

drowsiness, ataxia

Spironolactone (K+ sparing) nursing care/monitoring

no K+ supplements

Prostaglandin E MOA

increase pulmonary blood flow

Prostaglandin E indication

defects where PDA needs to be kept open (temporarily)

Prostaglandin E majoe s/e

profound smooth muscle relaxatio SO… triggers side effects apnea, hypotension, flushing

Prostaglandin E monitoring

cont CP monitoring, breahing

IVIG MOA

prevents body from attacking itself to decrease iflammation

IVIG indication

antibody deficiencies

IVIG s/e

fluishing, fever, chills

rash

nausea

muscles aches

severe→ aspectic meningitis

digoxin theraputic level

0.8-2.0

What heart rates do you hold digoxin

<60 adult, <90 infant

digoxin pre/administration

before adminisrating, assess apical HR for full 1 min (rate, quality, rhythm)

take orally 1 hour before or 2 hours after a meal

if a dose of digoxin is missed and it has been over four hours since dose was due, what should you do as the nurse?

wait to give until next dose is due

what should the nurse do if the patient missed two doses of digoxin in a row (i.e. ordered Q12h, missed 2 in 24h)?

call provider

What should the nurse do if they just gave a patient digoxin and the patient vomited

hold until next dose

what electrolyte can cause digoxin toxicity

hypokalemia

what are s/s of digoxin toxicity

bradycardia, n/v/d, lethargy

where does the heart lie in a child until age 7

horizontally, apex higher

as the heart/lungs grow, where do they go?

downwarn displacement

which part of the heart dominates during the first several weeks of life

right ventricle

what are pediatric circulatory variations

mumurs can be ok

higher baseline HR

low CO

assessment of a general appearance in pediatrics

color

skin perfusion

LOC

breahting

position of comfort

hypotension is a ___ indicator of cardiac decompensation

LATE

AR and RR increase with

stress/anxiety

what should the nurs ebe concerned for if the pt AR and RR are normal but the pt looks bad

concerned for ominus cardiac decomp, assess further

in neonates (up to 28 days old), hypotension is a systolic BP of

<60

in infants (1 to 12 mos old), hypotension is a systolic BP of

<70

in children (1 to 10 YO), hypotension is a systolic BP of

<70 + (age in years x 2)

pt is 7 yo. what is their sysoltic that classifies as hypotension

7×2=14

70 mmgh+ 14= 84 bpm

in children >10 yo, hypotension is a systolic BP of

<90

ascultate how?

clockwise

where is S1 best heard

at the apex of the heart.

where is S2 best heard

base of heart

apical impulse is where in children <7 yo

left MCL 4th ICS

apical impulse is where in children >7 yo

left MCL 5th ICS

pediatric history of cardiac dysfunction s/s reported

poor feeding

tachypnea/tachycardia

FTT, poor weight gain

activity intolerance

developmental delays

prenatal history of cardiac dysfunction

rubella

alcoholism

DM

lupuis

adv maternal age

tetragenous drug→ dilantin

cardiac dysfunction is seen w (history)

fam hx of cardiac disease

Downs/T21

with persistent increased in HR, CO will

dec

thrills feel like

cat purring

Heaves feel like

abnormally large beating of the heart

bradycardia is seen with what dysfunctions

hypoxemia, hypoventilation, hypothermia

what is normal sinus arrythmia?

increased HR w inhale, dec w exhale

ex- HR steady while holding breath

nursing care pre cardiac cath

NPO

preop teaching

sedation

nursing care post cardiac cath

feel pulses distal to site (expect to be decreased) + mark w marker

cardiac/pulse ox monitoring

assess color/temp pf limb

VS Q150 HR, rhythm, BP

I+O, give pt fluids to prevent coagulation

keep arm striaght for 4-8 hrs

assess temp Q1 day, if >- 100.5 call provider

avoid baths and acitivty

what should you do if pt bleeds from cardiac cath sirte

place pressure 1 in above site

what to teach fam post cardiac cath

how to assess color/temp/pulses

what to do in hemorrage

pain mngt= iburpofen/acetaminopehn

3 lead placement

RA= right clavical MCL

LA= lef clavical MCL

LL (left limb)= lower abdomen

do we need an order for a CP monitor?

NO, can be nursing judgement

arryhtmias in children types

brady, tachy, omit

digoxin HR guidlines to hold in infants/young children (<5 yo)

<90 bpm

digoxin HR guidlines to hold in older children

<70 bpm

digoxin HR guidlines to hold in older adolescents/adults

<60

if a pt is decompensating and we cannot feel pulses, how to we take their BP?

by palpitation, place cuff on pt to above baseline let air out and feel for pulse, # occurs= systolic