Peds hour 10
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Questions and Answers

What is the recommended management for polycythemia in children with congenital heart defects?

  • Use anticoagulants to thin the blood
  • Increase hydration and monitor blood viscosity (correct)
  • Initiate chemotherapy immediately
  • Implement a low-oxygen environment

Which of the following cardiac monitoring techniques is most beneficial for assessing patients with congenital heart defects?

  • EKG for electrical activity
  • Chest X-ray for size assessment
  • MRI for anatomical visualization
  • Echocardiogram for blood flow dynamics (correct)

What nursing intervention is crucial for a child recovering from congenital heart defect surgery?

  • Encouraging full activity immediately post-op
  • Monitoring for signs of infection at the surgical site (correct)
  • Performing chest physiotherapy daily
  • Prohibiting all fluid intake until discharge

Which cardiovascular diagnostic test is used to visualize the structure of the heart and blood flows in cases of congenital heart defects?

<p>Transesophageal echocardiography (A)</p> Signup and view all the answers

What is a common post-operative care concern for patients after repair of a congenital heart defect?

<p>Managing pain for comfort (B)</p> Signup and view all the answers

In cases of transposition of the great arteries, which condition may patients need to be monitored for during surgical post-operative care?

<p>Hypoxemia and tissue perfusion (D)</p> Signup and view all the answers

What is the purpose of administering aspirin after a surgical closure of an atrial septal defect?

<p>To assist in the healing of the septal wall (D)</p> Signup and view all the answers

Which condition typically requires immediate surgical intervention in children with congenital heart defects?

<p>Coarctation of the aorta (B)</p> Signup and view all the answers

What is the primary purpose of keeping the ductus arteriosus open in newborns immediately after birth?

<p>To ensure adequate systemic circulation (C)</p> Signup and view all the answers

Which symptom would most likely indicate decreased blood flow in the lower extremities due to aortic narrowing?

<p>Cool skin on the legs (C)</p> Signup and view all the answers

What is a common non-surgical treatment used to close a patent ductus arteriosus (PDA)?

<p>Transcatheter closure device (D)</p> Signup and view all the answers

Which of the following is a key nursing intervention for managing a patient with cyanotic spells from Tetralogy of Fallot?

<p>Placing the patient in a knee-chest position (B)</p> Signup and view all the answers

Which cardiovascular diagnostic test is not typically utilized for assessing conditions like a patent ductus arteriosus?

<p>Electrocardiogram (ECG) (A)</p> Signup and view all the answers

What critical monitoring should occur post-operatively after surgical correction of significant congenital heart defects?

<p>Frequent blood pressure checks and fluid balance assessments (A)</p> Signup and view all the answers

What is a potential sign of poor cardiac output in a newborn with a congenital heart defect?

<p>Persistent tachycardia (A)</p> Signup and view all the answers

In managing polycythemia in infants, which approach is commonly used?

<p>Hydration with electrolyte solutions (A)</p> Signup and view all the answers

Which of the following signs indicate hypoxemia in patients with cardiovascular issues?

<p>Cyanosis (B)</p> Signup and view all the answers

What is a critical nursing intervention for managing a child with tachypnea?

<p>Set the head of the bed at a 30-degree angle (C)</p> Signup and view all the answers

Which factor is essential to monitor when administering digoxin to an infant?

<p>Heart rate before administration (D)</p> Signup and view all the answers

What is the primary purpose of conducting a chest X-ray in cardiovascular assessments?

<p>To assess for possible cardiac abnormalities (A)</p> Signup and view all the answers

What medication is commonly used to relieve fluid overload in patients with heart failure?

<p>Lasix (D)</p> Signup and view all the answers

Which of the following could be a consequence of poor post-operative care following cardiac catheterization?

<p>Risk of thrombosis (B)</p> Signup and view all the answers

In managing polycythemia, which condition should healthcare providers monitor for its effects on the patient?

<p>Increased red blood cells (D)</p> Signup and view all the answers

What is a common sign of systemic vascular congestion in a child?

<p>Ascites (D)</p> Signup and view all the answers

What is a common symptom indicating impaired myocardial function in children with CHF?

<p>Pale and cool extremities (B)</p> Signup and view all the answers

Which nursing intervention is most important when caring for a child experiencing tachypnea?

<p>Monitoring oxygen saturation levels (A)</p> Signup and view all the answers

What should parents be warned about following cardiac catheterization in children?

<p>Potential risks of thrombosis or embolism formation (C)</p> Signup and view all the answers

Which symptom might suggest systemic vascular congestion in a pediatric patient?

<p>Peripheral edema (D)</p> Signup and view all the answers

Which congenital heart defect results in increased blood flow to the lungs?

<p>Atrial Septal Defect (ASD) (C)</p> Signup and view all the answers

What is an appropriate nursing measure to promote rest in a child with heart failure?

<p>Cluster care with feedings to minimize fatigue (C)</p> Signup and view all the answers

What is a common symptom associated with Cyanotic congenital heart defects?

<p>Cyanosis (B)</p> Signup and view all the answers

What is the typical time frame for the closure of the fetal ductus arteriosus in full-term newborns?

<p>72 hours (A), Up to 3 weeks (D)</p> Signup and view all the answers

When administering digoxin, which vital sign requires careful monitoring?

<p>Heart rate (D)</p> Signup and view all the answers

Which symptom is indicative of aortic narrowing in the lower extremities?

<p>Weak pulses (D)</p> Signup and view all the answers

Which of the following findings may indicate hypoxemia in a child?

<p>Clubbing of fingers (C)</p> Signup and view all the answers

Which surgical procedure is typically performed to close an atrial septal defect?

<p>Patch graft closure (A)</p> Signup and view all the answers

What is a key symptom of pulmonary congestion in pediatric patients with CHF?

<p>Stridor or grunting (D)</p> Signup and view all the answers

What is a potential treatment for preventing the closure of the ductus arteriosus immediately after birth?

<p>Prostaglandin administration (B)</p> Signup and view all the answers

What condition can lead to spontaneous closure in children before the age of three?

<p>Ventricular Septal Defect (VSD) (C)</p> Signup and view all the answers

What is a primary factor influencing whether or not surgery is needed for a septal defect?

<p>Size of the defect (D)</p> Signup and view all the answers

What procedure is utilized for non-surgical closure of a patent ductus arteriosus?

<p>Fluoroscopy-guided catheterization (C)</p> Signup and view all the answers

Which congenital heart defect commonly presents with deoxygenated blood circulating through the body?

<p>Hypoplastic Left Heart Syndrome (A)</p> Signup and view all the answers

Which of the following is a classic symptom of Tetralogy of Fallot?

<p>Cyanosis (C)</p> Signup and view all the answers

What are common observed signs in infants experiencing TET spells?

<p>Hypercyanotic episodes and systolic murmur (D)</p> Signup and view all the answers

What type of blood flow is characteristic of a left-to-right shunt?

<p>Increased blood flow to the lungs (C)</p> Signup and view all the answers

What is one of the results of an obstructed flow from the ventricles due to aortic narrowing?

<p>Nose bleeds and headaches (D)</p> Signup and view all the answers

Which method is commonly used to repair an atrial septal defect in children?

<p>Transcatheter closure (C)</p> Signup and view all the answers

Which treatment option is utilized if non-surgical efforts to close a PDA fail?

<p>Open heart surgery (D)</p> Signup and view all the answers

What is the typical age group most affected by widespread inflammation of small and medium-sized blood vessels?

<p>Children under 5 years old (D)</p> Signup and view all the answers

Which symptom is commonly associated with the acute phase of Kawasaki disease?

<p>Erythema of palms and soles (A)</p> Signup and view all the answers

What is the primary diagnostic method for confirming Kawasaki disease?

<p>Diagnosis based on symptoms (C)</p> Signup and view all the answers

Which treatment is often administered for Kawasaki disease if strep throat is ruled out?

<p>IVIG (intravenous immunoglobulin) (A)</p> Signup and view all the answers

What type of lab results might indicate a risk for coronary artery aneurysms during Kawasaki disease's subacute phase?

<p>Baseline EKG changes (B)</p> Signup and view all the answers

What is a significant nursing consideration for a child in post-operative care following heart surgery?

<p>Frequent checks on pressure dressings (A)</p> Signup and view all the answers

During which phase of Kawasaki disease do symptoms resolve but lab work remains abnormal?

<p>Convalescent phase (C)</p> Signup and view all the answers

In terms of surgical care, what is a vital aspect to manage in pediatric patients post-operative?

<p>Ensuring multiple IV lines are in place (B)</p> Signup and view all the answers

Flashcards

Congenital Heart Defect

A heart condition present at birth, can occur alone or with a syndrome like Down Syndrome.

Blood Flow Classification

Congenital heart defects are often classified based on the direction of blood flow (left to right or right to left shunt) instead of the patient's symptoms.

Atrial Septal Defect (ASD)

An opening in the wall between the atria, often a left-to-right shunt, increasing blood flow to the lungs.

Ventricular Septal Defect (VSD)

A hole in the wall between the ventricles that causes a left-to-right shunt, increasing blood flow to the lungs.

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Patent Ductus Arteriosus (PDA)

An abnormal connection between the aorta and the pulmonary artery that causes a left-to-right shunt and increased blood flow to the lungs.

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Cyanotic Heart Defect

These defects cause less blood to reach the lungs, often leading to bluish skin discoloration (cyanosis).

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Atrial Septal Defect Repair

Some ASDs may close spontaneously, but often require surgery or device closure, depending on the defect's size.

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Ventricular Septal Defect Repair

VSDs can sometimes close spontaneously, but surgical intervention is often needed if not, depending on defect size, and it might require a patch.

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What is a sign of impaired myocardial function?

Tachycardia, diaphoresis, decreased urinary output, fatigue, pale and cool extremities, weak peripheral pulses, and failure to thrive.

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What are some signs of pulmonary congestion?

Tachypnea, dyspnea, retractions, nasal flaring, excessive intolerance, stridor, grunting, and recurrent respiratory infections.

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What are some signs of systemic vascular congestion?

Peripheral edema, ascites, and neck vein distention.

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What are some signs of hypoxemia?

Cyanosis, clubbing, polycythemia, TET spells, and CHF.

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What is a nursing intervention for CHF?

Provide rest, HOB elevated 30 degrees or a hip nap angle, cluster care with feedings to allow good rest periods.

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What is another nursing intervention for CHF?

Administer sedation, oxygen as needed, and monitor oxygen saturation.

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What are some nursing interventions for CHF?

Administer digoxin (monitor for appropriate dosage and holding times), lasix (monitor for appropriate dosage and weight), and a low sodium formula diet.

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How to manage asepsis, hydration, hydration, and loose diapers in a child with CHF?

Use asepsis to prevent infection, monitor hydration to avoid fluid overload or deficit, and manage loose diapers to prevent abdominal breathing.

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PDA Treatment

Treatment can include catheterization with a device to close the connection or surgery to clip the connection.

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Coarctation of the Aorta

Narrowing of the aorta beyond the aortic arch, obstructing blood flow to the lower body.

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Coarctation of the Aorta Symptoms

High blood pressure in the upper body and low blood pressure in the lower body, weak pulses, and cool legs, among other symptoms.

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Tetralogy of Fallot (TOF)

A group of four heart defects: pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy.

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TOF Signs/Symptoms

Cyanosis (bluish skin), a systolic murmur, and episodes of bluish skin episodes (cyanotic spells) that can happen with crying or feeding.

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TOF Treatment

Treatment options include placing the infant in a knee-chest position and providing supplemental oxygen.

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Arterial Switch Operation

Surgical procedure to switch the positions of the major arteries (aorta and pulmonary artery) around the heart.

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Cardiac Defect Classification

Congenital heart defects are classified based on blood flow direction (left-to-right or right-to-left shunt) rather than the patient's symptoms.

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Left-to-Right Shunt

Blood flows from the left side of the heart to the right side, increasing blood flow to the lungs.

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Right-to-Left Shunt

Blood flows from the right side of the heart to the left side, decreasing blood flow to the lungs.

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PDA Closure Methods

PDA can be closed using a catheter inserted through a blood vessel, where a device is placed to block the opening. Alternatively, surgery can be done to clip the ductus.

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Coarctation Symptoms

Symptoms include high blood pressure in the upper body, low blood pressure in the lower extremities, weak pulses, and cool legs.

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TOF Signs and Symptoms

Signs include cyanosis (bluish skin), a systolic murmur, and episodes of bluish skin episodes (cyanotic spells) that can occur during crying or feeding.

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TOF Treatment - Knee-Chest Position

A knee-chest position, where the knees are bent and the chest is on the bed, helps improve blood flow to the lungs in a baby with TOF by improving the functioning of the heart.

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TOF Treatment - Supplemental Oxygen

Supplemental oxygen is given to increase oxygen levels in the blood, helping babies with TOF breathe better.

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Kawasaki Disease

A condition causing inflammation of small and medium blood vessels, especially coronary arteries, leading to potential aneurysm formation. It's most common in children under 5 years old.

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Kawasaki Disease Cause

The cause of Kawasaki disease is unknown, but it often appears in late winter or early spring. It's not contagious.

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Kawasaki Disease Symptoms

Symptoms mimic strep throat (sore throat, fever) but a strep test is negative. Other signs include red palms and soles, a 'strawberry tongue,' and cracked lips.

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Kawasaki Disease Diagnosis

Diagnosis is based on observing symptoms. There's no specific test for Kawasaki.

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Acute Kawasaki Disease

The first stage of Kawasaki, characterized by a sudden high fever that doesn't respond to fever-reducing medications, irritability, and swelling and redness of palms and soles.

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Subacute Kawasaki Disease

The second stage, following the fever, until all symptoms disappear. This is when coronary artery aneurysms are most likely to occur.

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Kawasaki Disease Treatment

Treatment involves intravenous immunoglobulin (IVIG) and aspirin therapy. Sometimes, antibiotics are used depending on the patient's situation.

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Convalescent Kawasaki Disease

The final stage, where symptoms are gone, but lab tests haven't returned to normal. This phase requires continued monitoring.

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CHF Assessments: Impaired Myocardial Function

Signs of impaired heart function include increased heart rate (tachycardia), excessive sweating (diaphoresis), decreased urine output, fatigue, pale and cool extremities, weak peripheral pulses, and failure to thrive.

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CHF Assessments: Pulmonary Congestion

Signs of fluid buildup in the lungs include rapid breathing (tachypnea), shortness of breath (dyspnea), retractions, nasal flaring, difficulty feeding, noisy breathing (stridor or grunting), and frequent respiratory infections.

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CHF Assessments: Systemic Vascular Congestion

Signs of fluid buildup in the body include swelling in the extremities (peripheral edema), fluid accumulation in the abdomen (ascites), and bulging neck veins (neck vein distention).

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Hypoxemia Signs

Signs that the body isn't getting enough oxygen include bluish skin discoloration (cyanosis), clubbing of the fingers and toes, increased red blood cells (polycythemia), episodes of cyanosis and breathing difficulties (TET spells), and heart failure (CHF).

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Nursing Interventions: Rest

Ensure the child receives adequate rest by keeping the head of the bed elevated at 30 degrees or using a hip nap angle, clustering care with feedings to allow for rest periods, and feeding only when alert and sucking.

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Nursing Interventions: Sedation & Oxygen

Administer sedation (morphine) to decrease respiratory rate if tachypneic, provide oxygen as needed, and closely monitor oxygen saturation levels.

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Nursing Interventions: Medication

Administer digoxin (monitor for appropriate dosage and holding times), lasix (monitor for appropriate dosage and weight), and a low sodium formula diet.

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Nursing Interventions: Asepsis, Hydration, and Diapering

Maintain strict asepsis to prevent infection, carefully monitor hydration to avoid fluid overload or deficit, and manage loose diapers to prevent abdominal breathing.

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Study Notes

Congenital Heart Disease (CHD)

  • Over 35 defects affecting the population
  • Can occur alone or with other syndromes (e.g., Down syndrome)
  • Classified based on blood flow, not symptoms

Normal Heart Function

  • Deoxygenated blood returns to the heart's right atrium.
  • Blood is pumped through the tricuspid valve into the right ventricle.
  • Blood travels through the pulmonary artery to the lungs.
  • Blood is oxygenated and returns to the heart via pulmonary veins.
  • Oxygenated blood flows through the bicuspid valve into the left ventricle.
  • Blood is pumped out of the heart through the aorta to the body.

Common Pediatric Heart Anomalies

  • Atrial septal defect (ASD)
  • Atrioventricular canal defect
  • Coarctation of the aorta (COA)
  • Ebstein anomaly
  • Hypoplastic left heart syndrome (HLHS)
  • Patent ductus arteriosus (PDA)
  • Pulmonary atresia
  • Pulmonary valve stenosis
  • Tetralogy of Fallot
  • Total anomalous pulmonary venous return (TAPVR)
  • Transposition of the great arteries (TGA)
  • Tricuspid atresia
  • Truncus arteriosus
  • Ventricular septal defect (VSD)

Classification of Defects

Acyanotic Defects

  • Left-to-right shunt
  • Increased blood flow to the lungs
  • ASD, VSD, PDA

Cyanotic Defects

  • Right-to-left shunt
  • Decreased blood flow to the lungs
  • Transportation of great arteries/vessels
  • Tetralogy of Fallot

Atrial Septal Defect (ASD)

  • Opening between the atria (failure of foramen ovale to close at birth)
  • Often closes spontaneously before 5-6 years of age
  • Repair depends on the size of the opening

Ventricular Septal Defect (VSD)

  • Opening between the ventricles
  • Often seen with other congenital heart defects
  • 30-50% close spontaneously by 3 years of age
  • 3-4 years old, patch graft or open-heart surgery
  • Potential need for ongoing heart surgery

Patent Ductus Arteriosus (PDA)

  • Opening between the pulmonary artery and the aorta (normal in utero)
  • Failure of the fetal ductus arteriosus to close
  • Common in premature infants
  • Usually closes within 72 hours or up to 2-3 weeks of life
  • Full-term newborns may need intervention to close the PDA
  • "Machine-hum" murmur, bounding pulses, wide pulse pressure

Coarctation of the Aorta (COA)

  • Narrowing of the aorta beyond the aortic arch
  • Obstructed flow from the ventricles
  • Symptoms:
    • Increased blood pressure and blood flow in upper extremities
    • Nosebleeds, headaches, bounding carotids
    • Decreased blood pressure and blood flow in lower extremities
    • Weak pulses, weak muscle tone

Tetralogy of Fallot

  • Four defects:
    • Ventricular septal defect (VSD)
  • Other defects (not specifically listed but implied from previous information in the notes)

Pulmonic Stenosis

  • Narrowing of the pulmonary valve
  • Symptoms:
    • Cyanosis
    • Systolic murmur
    • Tet spells/blue spells/hyper-cyanotic spells

Kawasaki Disease

  • Mimics strep throat (strep test is negative)
  • Inflammation of the small and medium-sized blood vessels, especially coronary arteries
  • 80% of children are 5 years old or younger
  • Cause is unknown
  • Seen late winter-early spring
  • Not communicable

Acute, Subacute, and Convalescent Phases of Kawasaki Disease

  • Acute phase: Sudden onset of fever that's not responsive to antipyretics, irritability, edema, erythema of palms and soles
  • Subacute phase: Begins with fever resolution, high risk of coronary artery aneurysms, continuous baseline ECG and ECHO monitoring.
  • Convalescent phase: Symptoms resolve, but lab work may not return to baseline yet.

Treatment for Kawasaki Disease

  • Culture is negative for strep.
  • Health teaching and monitoring for unresolved strep.
  • If strep negative, but Kawasaki disease is present - treatment with IVIG and aspirin.
  • Consider antibiotics if strep is present.

ASA Therapy

  • Might receive antibiotics (ABX) depending on the clinical situation.

Impaired Myocardial Function (CHF Assessments)

  • Tachycardia
  • Diaphoresis
  • Decreased urine output
  • Fatigue
  • Pale and cool extremities
  • Weak peripheral pulses
  • FTT/anorexia

Pulmonary Congestion (CHF Assessments)

  • Tachypnea
  • Dyspnea
  • Retractions and nasal flaring
  • Excessive intolerance
  • Stridor or grunting
  • Recurrent respiratory infections

Systemic Vascular Congestion (CHF Assessments)

  • Peripheral edema
  • Ascites
  • Neck vein distention

Signs and Symptoms of Hypoxemia

  • Cyanosis
  • Clubbing
  • Polycythemia
  • TET spells
  • CHF

Nursing Interventions

  • HOB 30 degrees or nap position
  • Cluster care with feedings
  • Feed only when awake (alert)
  • IV feed when needed
  • Morphine to decrease respiratory rate (if tachypneic)
  • Oxygen administration (PRN)
  • Digoxin use - need to be aware of dosages and holding conditions.
  • Monitor oxygen saturation

Diagnostic Tests

  • Chest X-ray
  • Echocardiogram

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