Quiz #3 Study Topics PDF

Quiz #3 Study Topics Cardiac Cyanotic VS Acyanotic Heart Lesions Acyanotic Heart Lesions (Increased Pulmonary Blood Flow) Left-to-right shunting (high → low pressure), ↑ pulmonary blood flow (right side), may develop CHF but NO cyanosis. Includes: ASD, VSD, PDA. CHF a common side effect (secondary...

Quiz #3 Study Topics Cardiac Cyanotic VS Acyanotic Heart Lesions Acyanotic Heart Lesions (Increased Pulmonary Blood Flow) Left-to-right shunting (high → low pressure), ↑ pulmonary blood flow (right side), may develop CHF but NO cyanosis. Includes: ASD, VSD, PDA. CHF a common side effect (secondary to) Acyanotic Heart Lesion Defect Description Symptoms Management Atrial Septal Abnormal opening between Often asymptomatic Observation (may close by age 2) Defect (ASD) the right and left atria Can lead to CHF if large/untreated Surgery if persistent & symptomatic Ventricular Septal Abnormal opening between Fatigue with feeding, failure to thrive Monitoring if small Defect (VSD) the right and left ventricles (FTT), tachycardia, tachypnea Surgery typically required for larger defects Patent Ductus Persistent connection between - Small PDA: asymptomatic Medications: Indomethacin ( (keeps the Arteriosus (PDA) the aorta and pulmonary - Large PDA: CHF, loud murmur, defect open long enough to get to surgery) or artery after birth desaturation, increased HR/RR IV Tylenol / Ibuprofen Surgery for persistent or large PDA Nursing Care for Acyanotic Lesions: - Preserve energy: High-protein, high-calorie diet; small, frequent feeds. - Fluid restrictions if in CHF. - Prevent URIs (upper respiratory infections) to reduce respiratory complications. - Monitor for CHF signs: Watch for changes in respiratory rate, fatigue, and feeding tolerance. - Strict I&O’s - Depending on the severity/extent and if diagnosis in utero, infants may stay in the hospital until healing/surgery Cyanotic Heart Lesions (Decreased Pulmonary Blood Flow) Right-to-left shunting, ↓ pulmonary flow, cyanosis due to deoxygenated blood entering systemic circulation. Includes: TOF (with Tet spells) and Tricuspid Atresia. Defect Description Symptoms Management Tetralogy of Consists of four defects: - Cyanosis - Knee-chest position for Tet spells Fallot (TOF) 1. Large VSD: equalizes pressure between R & L ventricles - Loud systolic murmur - Oxygen and morphine for severe 2. Pulmonary Stenosis: severity determines cyanosis - Tet spells (hypercyanotic spells 3. Right Ventricular Hypertrophy: from pulmonary episodes during activity - ex: - Surgical repair needed stenosis crying, feeding) 4. Overriding Aorta: opens to both ventricles Nursing Care for Cyanotic Lesions: - Manage Tet spells: Knee-chest “squat” position, oxygen, and morphine if severe. - Tet Spells - Spasm of RV cardiac muscle causes pulmonary flow, leading to R to L shunting and ↑ cyanosis - Hypercyanosis during activity (ex: crying, feeding) - Hyperpnea develops (deep rapid respirations) - Increased venous return of unoxygenated blood - Monitor HCT and platelet levels: Risk of polycythemia and stroke due to high RBC count. - Fluid management: To reduce stroke risk. - Prepare for surgical intervention if indicated. Congenital Heart Defect Coarctation of Aorta COA - Coarctation of the Aorta - Narrowing of the thoracic aorta - ↑ resistance results in LV hypertrophy - Severe coarctation in infants presents with CHF due to backup from L heart to lungs - BP/pulses of upper extremities > than lower extremities - think of a hose that is backed up, there will be more pressure above than below - Surgical excision of stenotic area and repair - Post-op: prevent ↑BP and bleeding at sutures Acquired Heart Defects Congestive Heart Failure - Assessment findings & Treatment CHF - Heart fails to circulate the blood effectively - Classic symptoms: - Vitals - ↑HR ; ↑RR - Weight Gain (d/t fluid retention) - Manifestation of CHF: - Poor weight gain, FTT - cardiomegaly/polycythemia - Poor perfusion - Hepatomegaly and splenomegaly - Squatting while at play - Clubbing - Treatment for CHF - Digoxin: a cardiac glycoside used to increase contractility, treat arrhythmias, control HR (decreases HR) - Effects:↑ contraction; ↓ heart rate; ↓ cardiac effort - Be careful – is it ordered as mg or as mcg! (*high alert med) - Dose depends on weight and age - Should only be given after 2 RN’s confirm dose - Risk for bradycardia: check apical pulse before giving (use child apical cut offs, e.g. 100/70/60) - - May give to child if HR ≥ 100 ; if HR is lower contact HCP - Monitor labs for K+ and dig level (refer to what your facilities guide) - too ↓ K+ and Dig may = arrhythmias and dig toxicity - narrow therapeutic range (check levels regularly) - Nausea, vomiting, bradycardia, arrhythmias, seeing halos ** signs of toxicity** - Treatment of overdose: Digibind, emesis induction, gastric lavage, administration of activated charcoal - Lasix (furosemide) - Watch K+ (may need to give potassium supplements) - Monitor I & O Rheumatic fever - Immune reaction to untreated GABHS (group A beta-hemolytic streptococci) pharyngitis **Prevention is key** - when you first see symptoms (fever and sore throat), get swabbed and treat strep early - Presents ~ 2-6 wks after pharyngitis (if untreated) - Classified by the Jones Criteria - Must have either: - 2 major OR 1 Major + 2 Minor with supporting evidence of recent GABHS infection (scarlet fever (can lead to RF) + throat culture, elevated antistreptolysin O (recent + strep inf) - Treatment and Nursing Care for RF - Bed rest to decrease workload of the heart especially during acute phase - Aspirin for arthritic pain (anti inflammatory) - usually can’t give Aspirin to children bc it can cause Reye’s syndrome, but this is an exception  - Steroids for severe, life-threatening carditis only - Prophylactic abx Benzathine benzylpenicillin (1.2 million units) essential part of treatment - IM q28 days for 5-10 years to reduce recurrence - Important to teach and encourage family the importance of compliance with medication adherence - Encourage/provide high calorie, high protein diet Kawasaki disease ( - pink eyes, strawberry tongue, peeling around the mouth) - Leading cause of AHD (Acquired Heart Disease) in U.S. - Highest prevalence in children of Asian descent - Toddlers - unknown cause - probably viral - Multisystem vasculitis of unknown etiology (possible immunological disease) - Possible cardiac complications - Pancarditis - Tachycardia; gallop rhythm ; CHF in 20% - May cause aneurysm of coronary arteries - Must exhibit 5/6 criteria, including fever: 1. Fever of at least 5 days PLUS 2. Non-purulent bilateral conjunctivitis 3. Altered oral mucosa (erythematous, cracked lips, "strawberry tongue", oropharyngeal reddening) 4. Polymorphous non-vesicular rash on trunk, palms, and soles, followed by desquamation (peeling skin -hands & feet) 5. Tense edema 6. Unilateral cervical lymphadenopathy - Labs Show - High WBC, high ESR (shows inflammation), high C-reactive protein - EKG - evidence of heart block - Echo - evidence of aneurysm Three Phases of Illness 1. Lasts 10-14 days → high fever, conjunctivitis, strawberry tongue, dry and cracked lips, erythematous rash - especially trunk, palms and soles 2. Lasts about 10 days → fever and rash begin to resolve, irritability, arthralgias and arthritis, but, most serious - Coronary artery aneurysms (May die from ruptured aneurysm) 3. Lasts until ESR returns to normal, develop grooves in fingernails Treatment Nursing Considerations - ​High dose IV immunoglobulin (IVIG) - Continuous monitoring of cardiac status (EKG - Initial high dose ASA tx (80-100 mg/kg/qd) daily/echocardiogram) - Reduces fever - I&O ; Daily weight - Decreased thrombosis risk - Assessment and prevention of dehydration - Low dose ASA for 6-8 weeks if aneurysms present - Skin and mouth care (special instance - can give child) - Comfort care - Warfarin for large aneurysms - Parental support as child may be extremely irritable and inconsolable Fluid and Electrolytes Dehydration S&S ; Highest priority assessment Key factors in Diagnosing Dehydration nSigns and Symptoms of Dehydration - Weight* - Fewer wet diapers than usual - Skin turgor/mucous membranes - No tears when crying; inside of mouth dry and sticky - I&O ; Vital signs - Lethargy ; Very poor skin turgor - Level of activity (sensorium) - ↑RR ; Abnormal skin color, temperature - Sunken fontanel, sunken eyes with dark circles Dehydration And Percentage of Weight Loss Mild → 3-5% weight loss infants Moderate → 6-9% infants Severe → > 10% in infants Slight thirst Capillary refill between 2 - 4 seconds Capillary refill > 4 seconds Capillary refill > 2 seconds Thirst and irritability ↑HR/orthostatic BP/ may progress to shock Behavior, mucous membranes, vital signs Slightly ↑HR/ BP slight orthostatic Extreme thirst / Oliguria normal Mucous membranes dry ; ↓ skin turgor Dry mucous membranes/ tented skin Normal to sunken anterior fontanel in infant Hyperpnea - Rapid and Deep Breathing No tears/ sunken eyeballs Sunken anterior fontanel Fluid volume DMV - Based on daily maintenance volumes (DMV) Daily Maintenance Fluid (DMF) Calculation Formula: 1. 100 ml/kg for the first 10 kg (0-10 kg) 2. 50 ml/kg for the next 10 kg (11-20 kg) 3. 20 ml/kg for any weight over 20 kg This formula breaks down the child’s weight into three sections and assigns a different fluid rate per kilogram in each section. Practice Question: A child weighs 25 kg. What is their daily maintenance fluid requirement? Weight Range Calculation Result First 10kg (0-10 kg) 10 kg × 100 ml = 1,000 ml 1,000 ml Next 10kg (11-20 kg) 10 kg × 50 ml = 500 ml 500 ml Remaining 5kg (>20 kg) 5 kg × 20 ml = 100 ml 100 ml Total Daily Maintenance 1,000 ml + 500 ml + 100 ml = 1,600 1,600 ml Hourly Rate (optional) 1,600 ml ÷ 24 hrs ≈ 67 ml/hr The child’s total daily maintenance fluid is 1,600 ml, or approximately 67 ml/hr. Care of a Child with Vomiting and Diarrhea Oral Rehydration Therapy - pedialyte? electrolyte drinks? - Indicated for the treatment of: Diarrhea ; Vomiting ; Dehydration of any degree Caring for a Child who is Vomiting - Observe and report vomiting - Assess for associated problems such as dehydration - Implement measures to reduce vomiting - Record accurate intake and output - Evaluate the effectiveness of therapy - Prevent aspiration*