What class of medication is Digoxin? What class of medication is Digoxin? How does Digoxin improve cardiac function?

What cardiac condition is Digoxin used to treat?

A Cardiac Glycoside A Cardiac Glycoside It improves contractility of the heart Heart failure An initial dose is given to achieve a therapeutic range, typically over a 24 hour period. From there, a smaller dose is given to maintain a therapeutic range

What does it mean when someone prescribes a digatilizing dose of Digoxin?

A child's Digoxin dose should be withheld if their heart rate is less than 70 beats per minute ________. An infant's Digoxin dose should be withheld if their heart rate is less than ________. 90-100 beats per minute

The apical heart rate must be What should be done prior to given a child or infant a dose of Digoxin? taken one hour prior to the scheduled dose. Always double check the calculation with another RN prior to dosing, remember that Digoxin is administered in mcg, not mg. Dosage must not be rounded! NEVER double the dose. Notify the HCP and dose at the next regularly scheduled time. Renal failure, oral antibiotics, and hypokalemia. Bradycardia, anorexia, nausea, vomiting. If old enough, the child may report the characteristic vision changes. Hold the dose, prepare to give Digibind if ordered. 0.8-2 ng/mL The fetal heart is the first functioning organ and develops during the 3rd-8th weeks of gestation, starting at about 21 days.

What are some important nursing actions when calculating a dose of Digoxin for an infant or child?

A dose of Digoxin for an infant has been missed. Should you double the next dose or just dose the child at the next scheduled time? What factors can increase the risk of digoxin toxicity? (3) What are signs and symptoms of Digoxin toxicity in the pediatric population? What should be done if a child is exhibiting signs and symptoms of Digoxin toxicity? What is the therapeutic range for Digoxin in the pediatric population? The fetal heart is the first functioning organ and develops during the _______ weeks of gestation, starting at about _____ days.

Describe in general terms, the order of major structure development during fetal development of the heart...

First tubular structures are developed that turn into the four chambers. Next the pulmonary artery develops, then the aorta. The foramen ovale is located in the right atrium and serves as a blood bypass for the lungs. A fetus's blood is already oxygenated by the mom. It is a connection between the pulmonary artery and the aorta and serves as a bypass for blood around the lungs. The foremen ovale allows more than half the blood entering the right atrium to cross immediately into the left atrium, bypassing pulmonary circulation.

Where is the foramen ovale located and what is its function?

Where is the ductus arteriosus and what is its function?

The foremen ovale allows more than half the blood entering the ________to cross immediately into the _________, bypassing pulmonary circulation.

The __________ is located between the aorta and the pulmonary artery and connects the pulmonary artery to the aorta, allowing a bypass of the pulmonary circuit. It protects the lungs from circulatory overload The ductus arteriosus by shunting blood (right to left) into the descending aorta. A small portion of blood flows through the pulmonary circuit for the purpose of providing oxygen and nutrients and for removal of waste products. With the baby's first breath, air pushes into the lungs, triggering an increase in pulmonary blood flow and pulmonary venous return to the left side of the heart. Pressures in the left atrium become higher than in the right atrium. Systemic vascular resistance increases and blood return to the heart via the inferior vena cava decreases. This causes an increase in pulmonary blood flow and left atrium pressure which closes the foramen ovale.

Describe the events that trigger the closure of the foramen ovale.

In order for the foramen ovale to close, pulmonary blood flow and pulmonary Left venous return increases in the ________ side of the heart. In order for the foramen ovale to close, Pressures in the left atrium become higher than in the right pressures in the _____ atrium become atrium higher than in the ______ atrium. In order for the foramen ovale to close, Systemic vascular resistance increases and blood return to the systemic vascular resistance ______ heart via the inferior vena cava decreases. and blood return to the heart via the

inferior vena cava ______. This causes an increase in pulmonary blood flow and left atrium pressure The ductus arteriosus becomes functionally closed within a few hours of birth, with _______ being the most important factor in its closure. The first few minutes of life, the babys heart rate is ______ bpm. It then begins to decrease to an average of _______ bpm. Which side of the infant heart has the highest pressures, right or left? Pulmonary artery pressures in the infant should be the same as the pressure in the __________. What prenatal/maternal health history factors would be significant for the development of fetal cardiac problems? (4) What are common findings in infants with cardiac problems? (4) What is the normal heart rate for a toddler/preschooler? What is the normal heart rate for a school aged child? What is the normal heart rate for an adolescent? Oxygenation-Aeration of the lungs at birth from the first breath, causes a decrease in pulmonary vascular resistance and allows pulmonary blood flow to increase and for oxygen exchange to occur in the lungs The first few minutes of life, the babys heart rate is 120-180 bpm. It then begins to decrease to an average of 120-130 bpm. Left Right ventricle Alcohol use, use of teratogenic drugs (like Dilantin), infections during pregnancy (like Rubella), and the presence of certain medical conditions (like Lupus/DM) Fatigue, tachypnea, sweating when feeding, and poor weight gain. 80-105 beats per minute 70-80 beats per minute 60-68 bpm

Digoxin should be given at regular 12 hours, i.e. 8:00 AM & 8:00 PM intervals, usually every _______ hours. Digoxin should be given at least _______ hour before eating or _______ hours after 1 hour before or two hours after

T/F If a child vomits after being given Digoxin, they should not be given True another dose. Edema of __________ is characteristic of right ventricular heart failure in the lower extremities older children. When measuring a child's blood pressure, you note that the blood pressure in the right side of the arm is Coarctation of the aorta. It is also possible to have a BP higher in the upper extremities than the lower extremities

significantly higher than the left arm. You know this is a common finding with what heart condition? What is the normal urine output expected for a child? _______ output is a good indicator of cardiac output. 1 ml/kg/hour until they weight 30 kg (66 lbs.), then it should be 30 ml/hr (the adult rate) Urine output Tachypnea, crackles (from fluid build-up related to congestive heart failure), wheezing, grunting, history of frequent respiratory infections.

What assessment findings might you find in the respiratory system that would indicate a cardiac problem?

What assessment findings in the integumentary system Edema, cyanosis, clubbing might be observed in a child with cardiac problems? Prominence of the precordial chest wall is often seen in Cardiomegaly infants and children with __________. A femoral pulse that is weak or absent in comparison to the brachial pulse is associated with what cardiac Coarctation of the aorta condition? A bounding pulse is characteristic of what two heart conditions in infants or children? A narrow or thready pulse may occur in children with ________ or _________. When palpating a child's abdomen you note hepatomegaly. You know this can be a sign of what cardiac problem? What heart sound is always associated with cardiac abnormalities? What information can be gleaned from radiological studies (X-ray) related to the heart? Patent ductus arteriosus or aortic regurgitation Heart failure or severe aortic stenosis Right-sided heart failure S4 Heart shape, size, position, configuration and blood flow pattern

What nursing intervention is important when preparing Make sure a gonadal shield is in place to a child for an X-ray? preserve potential fertility What information can be gleaned from electrocardiography (ECG) regarding the heart? Electrical function, rate, rhythm. It can detect underlying dysrhythmias/conduction disturbances, hypertrophy of the ventricles, and if using a 12-lead, how the heart is lying in the chest wall.

This diagnostic study can provide information regarding electrical function, rate, rhythm. It can detect underlying dysrhythmias/conduction disturbances, Electrocardiography (ECG) hypertrophy of the ventricles, and if using a 12-lead, how the heart is lying in the chest wall.

For a child who has continuous monitoring via ECG, what intervention can you perform to prevent skin breakdown? What are the nursing implications for a child undergoing an ECG? What are some important teaching points for a child wearing a Halter moniter? If a child is ________, an ECG won't be accurate

Rotate the lead patches every 24-48 hours Distract the child long enough to get a snapshot of heart function, instruct them not to pull on the leads Don't get it wet, don't take it off, if an electrode pops off, put it back on. Crying

Structural problems related to the size/shape of the heart, structural abnormalities, (especially What can be ascertained using a 2-D Echocardiogram? valvular diseases), blood flow & velocity (and turbulence) False, A tranthoracic echocardiogram is a nonT/F A tranthoracic echocardiogram is an invasive invasive diagnostic tool used to assess cardiac diagnostic tool used to assess cardiac structures, detect structures, detect valvular disease, and measure valvular disease, and measure blood velocity. blood velocity. It is very similar to an ultrasound What is a complication related to getting an accurate Echocardiogram for a child? They have to lay still during the test.

A baby has been sedated in order to get an Echo. What Versed. The baby needs to be monitored every medication was most likely used and what are the 15 minutes from the administration of the drug nursing implications of this? and for at least 1-2 hours post-procedure. It is a transducer inserted into the mouth to the esophagus. It What is a transesophageal transmits ultrasound waves through less tissue to achieve high echocardiogram (TEE) and when quality images of the heart. Can be used for same purposes of regular would it be used? echo. It would be used when there is too much interference during a standard echo from fat, bone or other tissues A pediatric patient is scheduled to have TEE. What are the nursing The patient should be NPO 4-6 hours prior. Babies can be given implications related to this glucose water up until 1-2 hours before. Need to get informed procedure that should be consent considered in advance? Why is Versed used for a TEE? The patient needs to be able to swallow during the procedure, requiring conscious sedation

During a TEE, viscous lidocaine is given before the probe is inserted and then Hurricane spray Absence of a gag reflex is sprayed into the back of the throat. What is the best indication that the throat is numb? T/F A bite block is used during a False. A bite block is inserted to protect the probe from being bitten

TEE in case a seizure occurs to prevent damage to the patient's tongue. What are some nursing implication during and after a TEE? What is a cardiac catheterization used to assess? VItals need to be monitored frequently, the patient is NPO until the gag reflex returns, and they need to be monitored for aspiration and respiratory depression. It is used to visualize coronary perfusion (but usually not a problem in babies), measure different pressures in the different chambers, visualize blood flow (using IV contrast).

What diagnostic test is used to visualize coronary perfusion, measure different pressures in the Cardiac catheterization different chambers of the heart, and visualize blood flow (using IV contrast). A child is having a cardiac catheterization to visualize the left side of the heart. You know that the catheter will need to be inserted into a/an ________.

Artery, usually the femoral

A child is having a cardiac catheterization to visualize the right side of the heart. You know Vein, the right side of the heart is venous that the catheter will need to be inserted into a/an ________. Get informed consent, assess for allergies to the dye (shellfish/iodine, measure pulses distal to the insertion site, and mark them with a marker so they can be easily relocated. Educate them on what to expect Need to assess BUN/creatinine in advance to ensure kidney function is good. Want to look for s/s of infections prior to the procedure. Must be NPO about 8 hours, but again, babies/infants can have sugar water up to 1-2 hours prior. Morning meds may be held, anything that will thin their blood will definitely be held (like aspirin).

What are pre-procedural activities for a cardiac catheterization?

Prior to a cardiac catheterization, allergies to ________ must be Shellfish (iodine is used) assessed. Prior to a cardiac catheterization, the presence of ___________ is Diaper rash. an absolute contraindication for the procedure. T/F A patient who has an allergy False, medications are given in advance to prevent a reaction from to shellfish will be unable to have occurring. a cardiac catheterization due to

the use of dye during the procedure. T/F A patient who has poor kidney function will be unable to False, medication is given in advance to prevent injury to the have a cardiac catheterization due kidneys to the use of dye during the procedure. T/F Prior to a cardiac catheterization, distal pulses should be assessed and the area True marked with a marker so they can be easily found again postprocedure. After a cardiac catheterization, vital signs and pulses will be assessed every ________. 15 minutes

It is important to assess the extremities distal to the insertion Pulses, capillary refill, warmth, color, and sensation. site of a cardiac catheter. What specifically is assessed? What is a patient likely to feel A warm, flushed feeling or they may feel like the peed on the table. when the dye is injected during a Warm them of this possibility prior to the procedure. cardiac catheterization? After a cardiac catheterization, what is it important to monitor the patient for in order to recognize potential complications? Hypotension, bleeding from the insertion site, loss of circulation to the extremities, dysrhythmias, development of a hematoma, nausea or vomiting

Why is nausea and vomiting a concern after a Vomiting can trigger bleeding from the insertion site, cardiac catheterization? very problematic if it was arterial You are assessing a patient after a cardiac catheterization. You note that the patient is Apply pressure for 5 minutes BELOW the insertion site bleeding from the venous insertion site. What should you do? You are assessing a patient after a cardiac catheterization. You note that the patient is Apply pressure for 15 minutes ABOVE the insertion bleeding from the arterial insertion site. What site. should you do? What is it important to educate the patient about with respect to what to expect post cardiac catheterization? A patient is being discharged home after a They will be on bedrest and will be expected to drink lots of fluids to assist in eliminating the dye from their body Keep the insertion site covered with a band-aid for

cardiac catheterization. What are important education points to cover before they leave? What procedures can be performed during a cardiac catheterization? (6) Captopril (Capoten, Enalapril (Vasotec) and Lisinopril (Prinivil)are all examples of what class of drug? How do drugs like Captopril (Capoten, Enalapril (Vasotec) and Lisinopril (Prinivil)work to treat cardiac problems?

several days, no baths for 3-4 days, report signs of infection, if bleeding begins, call EMS and hold pressure at the site, can return to school but avoid strenuous activity, take Tylenol or Ibuprofen for pain Balloon Septostomy Balloon Valvuloplasty Coil Occlusion Device Closure Stent Placement Radiofrequency Ablation (RFA) ACE-I inhibitors They block the production of angiotensin II which reduces afterload (stroke volume resistance) and decreases workload. They increase excretion of sodium and water by acting on the kidneys.

What heart conditions are drugs like Captopril (Capoten, Enalapril (Vasotec) and Lisinopril Heart failure and hypertension (Prinivil)usually used to treat? What are the nursing implications related to medications like Captopril (Capoten, Enalapril (Vasotec) and Lisinopril (Prinivil)? Angioedema is characterized by swelling of the tongue and pharynx and is a very serious complication associated with what medications? Furosemide (Lasix),Chlorothiazide (Diuril),and Spirononlactone (Aldactone)are all what class of medications used to treat cardiac problems? What are the major nursing implications related to drugs like Furosemide(Lasix),and Chlorothiazide (Diuril)? Monitor for hypotension. A dry, hacking cough is a common side effect. Potassium levels, BUN and creatinine must be monitored closely. Angioedema is a serious complication characterized by swelling of the tongue and pharynx. Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Prinivil)

Diuretics Must not initiate if the patient isn't on a potassium supplement, monitor potassium closely, can cause hypotension. Monitor I&O, lung sounds, assess for edema. Patient should be encouraged to eat potassium rich foods.

Which of the following, Furosemide(Lasix),Chlorothiazide (Diuril),and Spirononlactone (Aldactone) is a Spirononlactone (Aldactone) potassium sparing diuretic and therefore doesn't require potassium supplementation? What cardiac conditions are Furosemide(Lasix),Chlorothiazide (Diuril),and Spirononlactone (Aldactone)typically used to treat? Heart failure and HTN

What class of medication are Carvedilol (Coreg)and Propanolol (Inderal)? How do medications like Carvedilol (Coreg)and Propanolol (Inderal)treat cardiac conditions? What are the nursing implications related to medications like Carvedilol (Coreg)and Propanolol (Inderal)?

Beta Blockers They decrease HR, BP, which decreases cardiac output & workload. Known for causing bradycardia, so check their radial pulse and hold if their HR is too low. Watch for hypotension, dizziness and fainting. Close monitoring is especially required if the child has asthma.

What type of medications are typically withheld for several days prior to a cardiac Any anticoagulants (like aspirin) catheterization to prevent the development of problems? ________ after a cardiac catheterization may indicate hemorrhage due to perforation of the Hypotension heart muscle or bleeding from the insertion site. You are assessing a child's distal extremities post cardiac catheterization and note blanching and pallor. You suspect, based on the assessment the child has ________. What position is a child placed in post cardiac catheterization?

An obstruction in bloodflow They are placed in a position that makes it possible to keep the extremity with the insertion site straight for at least 4-8 hours to promote healing.

_________ is defined as a structural abnormality from embryonic development of a normal structure, essentially something formed incorrectly or a failure Congenital heart defect (CHD) of a structure to progress beyond an early stage of embryonic development (foramen doesnt close, septum doesnt divide, etc.). The most common type of congenital heart defect is ________. Ventricular septal defect

About 1/4th of children with a congenital heart defect Trisomy 21 (Downs) or trisomy 13 also have another recognized anomaly like... What is the cause of congenital heart defects? May be related to genetic or environmental factors, however the majority are of unknown etiology May be related to genetic or environmental factors, however the majority are of unknown etiology

What is the cause of congenital heart defects?

In normal blood flow of the heart, blood flows from an area of ______pressure to an area of ______ pressure. So, normally the pressure on the ____side of the heart is lower than the ______ side, the resistance to pulmonary circulation is ______ than the resistance to systemic circulation. What are the two methods of categorization of congenital heart defects?

Blood flows from an area of high pressure to an area of low pressure and takes the path of least resistance Normally the pressure on the right side of the heart is lower than the left side, the resistance to pulmonary circulation is less than the resistance to systemic circulation Acyanotic vs. Cyanotic, or blood flow patterns/hemodynamics (more accurate but less used) More blood flow is going to the lungs from abnormal connections between two sides of heart-either in the septum or the great vessels (pulmonary artery/aorta like ductus arteriosus), or an obstruction is redirecting blood flow. Blood flows from left to right, increasing blood volume on the right side of the heart. To the lungs, hence the lack of cyanosis. Decreased systemic blood flow, increased pulmonary blood flow Atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular canal (AV Canal), patent ductus arteriosus (PDA), Coarctation of the aorta, aortic stenosis (AS), and pulmonary stenosis (PS).

What is the underlying pathology in acyanotic congenital heart defects? In acyanotic congenital heart defects, blood flow in the heart is from ______ to ________, which increases blood volume on the _______ side of the heart. In acyanotic congenital heart conditions, where is the increased blood flow ultimately going? In acyanotic congenital heart conditions, there is ________ systemic blood flow and ________ pulmonary blood flow. (Increased or decreased)

What are the acyanotic congenital heart defects?

Cyanotic congenital heart defects are characterized by blood flow from the ______ side of the heart to the Right side to the left side _______ side of the heart. In a heart condition caused by stenosis, the In a heart condition caused by stenosis, the pressure in pressure in the area distal to the obstruction is the area distal to the obstruction is ______, and the low, and the pressure before the obstruction is pressure before the obstruction is _______. high. What type of acyanotic heart condition is coarctation of the aorta, an abnormal connection in the heart or one of obstructed blood flow? Obstructed blood flow A structural defect leads to obstruction of the pulmonary blood flow. This increases pressure on the right side of heart, causing blood to flow right to left and pushes desaturated/deoxygenated blood out to the systemic circulation.

What is the underlying pathology of cyanotic congenital heart defects?

In a cyanotic heart defect, a structural defect leads to obstruction of the pulmonary blood flow. This _____ pressure on the right side of heart, causing blood to flow ______ to _______.

Increases pressure on the right side of heart, causing blood to flow right to left

xamples of cyanotic congenital heart defects include:

Tetrology of Fallot (TOF), Transposition of the Great Vessels or Arteries (TGA, Truncus Arteriosus and Hypoplastic Left Heart Atrial Septal Defect (ASD), acyanotic True Surgical patches, ASD closure devices, occluders

Which heart defect? Increased pulmonary blood flow, Abnormal opening between atria, Blood flow left to right, May lead to HF. T/F It is possible for an atrial septal defect to be asymptomatic. How is an ASD treated?

Which congenital heart defect? Increased pulmonary blood flow Abnormal opening between the ventricles Blood flow left to right Ventricular Septal Defect (VSD), Increased Peripheral Vascular Resistance and workload of right acyanotic heart Heart failure f. Treatment: pulmonary banding, surgical repair, can close spontaneously How is a VSD typically treated? With ASD and VSD, most likely a ________ will be auscultated when listening to the cardiac sounds. A Pulmonary artery band, patch, trial device closure A murmur Bacterial endocarditis, requiring prophylaxis prior to any procedure where an injury allows pathogens to enter the bloodstream (like dental work)

What infection are patients with VSD at increased risk for?

Which congenital heart defect? Increased pulmonary blood flow, left side has to work harder as well as the right. More resistance in the Patent Ductus Arteriosus (PDA), pulmonary arteries. Higher rate in preterm infants, Failure of ductus acyanotic arteriosis to close, Blood shunts from aorta (high) to pulmonary aorta (low), May lead to HF What are the signs and symptoms of patent ductus arteriosus? Murmur, widened pulse pressure, bounding pulses, may develop signs of congestive heart failure Indocin is used to keep the ductus arteriosus open, surgical ligation, coils or occluders are used to repair it.

How is patent ductus arteriosus treated?

What congenital heart defects require prophylaxis prior to any VSD, PDA, AS medical or dental treatment that may introduce blood into the blood

stream and cause a bacterial endocarditis infection? What congenital heart defect? Obstruction to blood flow, Narrowing near ductus arteriosis, in the aorta, Increased pressure proximal to defect, decreased pressure after defect, Disparity in pulses in arms Coarctation of the aorta, acyanotic and legs (increased blood flow to arms and head and decreased blood flow to the legs) BP will be high, May have epistaxis (nosebleeds from high pressure in their heads) How is coarctation of the aorta treated? Grafts, patches, PTA. High risk for restenosis

What congenital heart defect? Obstruction to blood flow Narrowing at aorta Increased resistance to ejection of blood from ventricles, Aortic stenosis (acyanotic) eventually to HF What are the signs and symptoms of aortic stenosis? Decreased pulses, hypotension, tachycardia, poor feeding, exercise intolerance, chest pain, dizziness Valve repair/ replacement, Norwood (severe), usually angioplasty (PTA) Crying causes pressure changes in the heart, resulting in a pulmonary artery spasm, decreasing blood flow to the lungs temporarily.

How is an aortic stenosis treated?

A child with an atrioventricular canal defect turns mildly cyanotic when they cry. The mom asks why this happens. You explain...

What congenital heart defect? Obstruction to blood flow, Narrowing at pulmonary artery, Increased workload right heart may lead to HF, Pulmonary Stenosis (acyanotic) If severe, increased pressure may reopen foramen ovale and lead to right to left shift, therefore can become cyanotic . With ________, the child may have mild CHF, cyanosis, a murmur, Pulmonary stenosis or cardiomegaly. VSD-ventricular septal defect, Pulmonic stenosis, Overriding aorta-a shift to midline and Right ventricular hypertrophy-increases right side pressure Tetrology of Fallot Tetrology of Fallot. A spasm of the pulmonary artery results in shunting of right ventricle blood into aorta. Occurs when crying, straining, feeding. It is a significant right-to-left shift(deoxygenated blood is going out into systemic circulation). It is a life threatening hypercyanotic spell

What are the four characteristic defects associated with Tetrology of Fallot? What congenital heart defect is associated with a boot shaped heart on an X-ray?

What happens in the heart during a Tet spell, and what condition is it associated with?

What are the treatments for a child who is having a Tet spell? How is tetrology of fallot treated?

Knee to chest position & medications (Inderal, oxygen, morphine)relieves spasm & improves blood flow Shunt (BT, used temporarily until big enough for complete repair

During a Tet spell, a spasm of the _____ results in shunting of _____ ventricle blood into _______. Occurs Pulmonary artery, results in right ventricle when crying, straining, feeding. It is a significant right-toblood shunting into the aorta left shift(deoxygenated blood is going out into systemic circulation). Which congenital heart defect? Mixed blood flow, Incompatible with life unless PDA or septal defect, if present, try to keep the defect open as long as possible to buy time to fix the problem, PA leaves the left ventricle, Transposition of the Great Arteries (TGA) Ao leaves the right ventricleno communication between pulmonary and systemic circulation. Oxygenated and deoxygenated blood always remains oxygenated and deoxygenated. The child will be on prostins (PGE1) to keep the foramen ovale open until surgery, How is Transposition of the Great Arteries (TGA) treated? septosomy until surgery,once biggersurgical switch What congenital heart defect? Aorta and pulmonary are fused together and are one giant artery What are the common signs and symptoms related to truncus arteriosus? How is a truncus arteriosus treated? Truncus arteriosus CHF, cyanosis, failure to thrive, activity intolerance, murmur Resection and patching

What congenital heart defect? Atrial and ventricular septal defects Left to right shunt Occurs in many children with AV Canal Downs Syndrome Poor valve formation What congenital heart defect? Valves between the right atrium and right ventricle fail to develop. No opening to allow blood to flow from the pulmonary artery to the lungs Cyanotic condition Tricuspid atresia

What congenital heart defect? The pulmonary veins don't connect to the left atrium, they connect to the right atrium, Total Anomalous Pulmonary Venous typically via the superior vena cava. More common in Connection (TAPVR) boys. Cyanotic condition. What is the treatment for Total Anomalous Pulmonary Venous Connection (TAPVR)? Prostins to keep FO open and anastamosis PV to LA

What congenital heart defect? The child wont survive the Hypoplastic Left Heart Syndrome (HLHS) problem. Usually live about 6 weeks. Can go on transplant list or get surgery. Triad of surgeries. Only 25% chance of

surviving each surgery. Left ventricle and aorta are very small. What symptoms are typically exhibited by infants with congenital heart defects? Cyanosis (generalized), Cyanosis (with exertion), Fatigue, Dyspnea, FTT, Frequent respiratory infections, Feeding difficulties, Excessive sweating, Syncopal attacks

Impaired growth, Frail body, Fatigue, What symptoms are exhibited by children with congenital Dyspnea, Orthopnea, clubbing of the fingers heart defects? and toes, Headache, Squatting to relieve dyspnea, Epistaxis What are the benefits to providing preoperative education Helps reduce anxiety, builds trust and to a child about to undergo a cardiac procedure? improve cooperation Children who undergo cardiac procedures often have a chest tube inserted to manage drainage. What amount of drainage is a cause for concern and warrants a call to the physician? _________ is a condition that results from defects causing left to right shunting (too much flow that the right side is not used to handling). Drainage of > 3ml/kg/hr for 3 consecutive hours warrants contacting MD- may indicate hemorrhage

Heart failure

___________ results from defects that cause decreased pulmonary blood flow (not enough O2 Hypoxemia being oxygenated). Flu-like, weight loss, cough, joint pain, fever, malaise, Splinter hemorrhages, new or changed heart murmur, Janeways lesions on palms and solesred spots, painless, Oslers nodes in pads of finger, toes painful, pea sized, red or purple.Petechiae in conjunctiva, mucous membranes

What are the signs and symptoms of bacterial endocarditis?

_________ is characterized by vegetation on the walls of the heart comprised of fibrin, organisms Bacterial endocarditis. and platelets that can embolize to circulation and damage heart valves. What conditions create an increased risk of getting bacterial endocarditis? What is the best way to prevent bacterial endocarditis in a child with a preexisting heart condition? Heart defects (VSD, PDA, TOF), heart surgury, Prosthetic valves, CM, valve disease Antibiotic prophylaxis in those at high risk w/ invasive procedures, prophylatic antibiotic counseling and early s/s recognition- this is key to preventing long term problems

Where does peripheral edema typically begin to First in the face, then the presacral region, and then develop in infants? the extremities. What respiratory condition may be a sign of congenital heart disease? Frequent bouts of pneumonia can be a significant sign of pediatric heart disease

Diaphoresis is a sign often reported by parents of early heart failure infants who are experiencing ___________ . Why does clubbing not typically appear in children until they are at least a year old? A child has undergone a Blalock-Taussig shunt to connect the subclavian artery to the pulmonary artery in order to treat tetrology of fallot. What are some nursing measures for the post-operative period? ________ is a congenital heart defect where the valves between the right atrium and right ventricle fail to develop. The child must experience chronic hypoxia in order for clubbing to develop and it is a process which takes time. Don't take BP measurements or perform venipuncture in the affected arm. Pulses may not be palpable in that arm. Monitor for ventricular arrythmias.

Tricuspid atresia

To treat ______, a temporary Blalock shunt or pulmonary artery banding is done to help the Tricuspid atresia (the ultimate goal is to get blood child until they are 3-6 months old. At that point, flow via the pulmonary artery to the lungs) the SVC is detached from the heart and reconnected to the pulmonary artery. In children with congenital defects resulting in increased pulmonary blood flow, _______ is not a recommended intervention because it is a Oxygen potent vasodilator and can start a cascade which results pulmonary hypertension. Signs and symptoms of what cardiac defect? Fixed split S2, systolic ejection murmur (best heard in the pulmonic valve area), right ventricular heave, shortness of breath, fatigue, poor growth. What condition is Eisenmenger syndrome (cyanosis and pulmonary hypertension) associated with?

Atrial Septal Defect

Ventricular Septal Defect (VSD)

What cardiac condition occurs 30 times more in children born in high altitudes than those born at Patent Ductus Arteriosus (PDA) sea level? What complications can develop in children with Stroke, aortic rupture, or aortic aneurysm coarctation of the aorta? Signs and symptoms of what cardiac condition? Epistaxis, headaches, leg pain with activity, Coarctation of the aorta bounding pulses, widened pulses, notching of the ribs, murmur. Which heart defect doesn't result in abnormal growth of the child? Pulmonary Stenosis

Significant cyanosis without a murmur in an infant is highly indicative of what congenital heart defect? ________ is a rare congenital heart defect in which the pulmonary veins don't connect normally to the left atrium, instead they connect to the right atrium, usually via the SVC. What is the most common cause of acquired heart defects? How long should a child with acute rheumatic fever be on bed rest? What is the biggest concern with Kawasaki's disease?

Transposition of the Great Arteries (aorta connected to the right ventricle, pulmonary artery connected to the left) Total Anomalous Pulmonary Venous Connection (TAPVC)

Kawasaki's Disease Until the fever is resolved, beyond that, they can begin to resume moderate activity As the symptoms start to resolve in the subacute phase, the coronary vessels change and become more prone to aneurysms. This increases the risk for MIs throughout life and requires regular EKGs to monitor.

Tachypnea is a sign of congestive heart failure. The left Which side of the heart is failing? Decreased urine output is a sign of which side of the heart failing? Periorbital edema is a sign that which side of the heart is failing? Left Right

Feeding times should be limited to a duration of ______ for infants with a cardiac disorder to 30 minutes allow enough time to eat, but also prevent exhaustion. For a child with heart failure, what activities Crying, too high/low body temperature, long feeding should be limited or avoided due to their effect periods, exposure to cold of increasing O2 consumption? (4) What are physiological changes related to hypoxemia? Why can hypoxemia increase the risk of strokes? How is bacterial endocarditis diagnosed? How is Kawasaki's Disease diagnosed? How is acute rheumatic fever diagnosed? Polycythemia, clubbing, cyanosis, poor feeding, fatigue, poor weight gain, tachypnea, dyspnea, possible neurological problems. Polycythemia develops, increasing blood viscosity and resulting in poor perfusion and increased stroke risk ECG changes (prolonged P-R interval), elevated ESR rate, elevated C-Reactive Protein, blood cultures, echocardiogram There is no diagnostic test, it is dx by the cluster of symptoms Use of the Jones criteria, essentially: is carditis present? Is arthritis present? Is chorea present?Is erythema marginatum present? Are there subQ nodes?

Fever? Elevated sed rate? Elevated C-reactive protein?