Nursing 3 Test 3/Perfusion
What are the causes of Hypovolemic Shock?
#1 - Blood Loss (hemorrhage) #2 - Dehydrated
What are the Nursing Interventions for children in HTN?
#1 - If primary, dietary & lifestyle changes Heart healthy, low sodium, low fat diet (dec lipid levels) Weight loss, inc exercise No smoking Reduce stress If lifestyle mod. is unsuccessful, then start with one medication Treat underlying cause *first if secondary HTN (Cong Heart Defect)
What are the Nursing Interventions for Hypovolemic Shock?
#1 Ensure patent airway, prepare to intubate ready at bedside IV acesss 2 sites - large bore 16,18-20, mult sites preferred, if can't get a vein go IO Administer Oxygen, often 100% by mask Elevate patients feet (blood flow back to heart-venous return), HOP flat or less then 30 degrees. Examine patient for overt bleeding, treat (Hold pressure) Continuous ECG monitering, pulse ox monitoring, Cent Venous Pressure monitering Administer meds as ordered (Dopamine & Epinephrine) IV fluid boluses (NS,LR) & possible blood transfusion DO NOT LEAVE THE PATIENT!!!! DO NOT DELEGATE THESE PTS TO ANYONE!!!! VITALS Q 15 MINS
What are the Pharmacological measures for Shock?
****Vasoconstrictors (Vasopressors) Renal perfusion dose is 10mcg/kg & under, and 11-20mcg/kg/hr is your pressor dose (trying to save the heart, can't worry about the kidneys right now) Dopamine and Norepinephrine increase cardiac output & MAP - vasoconstrictor-pulls fluid from periph to save heart lungs, and kidneys ****Inoptropic Agents: Dobutamine & Milrinone will stimulate Heart muscle cx and inc recoil. Might have both going ****Agents enhancing myocardial perfusion: Sodium Nitroprusside (Nipride). *These meds are saving the patients life
Respirations Assessment?
***Distress S&S: nasal flaring Grunting Stridor Deep sighing respirations Accessory muscle use Left chest prominence ******Activity: Tires easily **Squatting Rest frequently Quiet & Quiet play
What effects does aortic stenosis have on the heart?
**The inc resistance of ejection of blood (after load) results in ventric. hypertrophy; CO becomes fixed & can't meet body's demand with exertion
The nurse identifies s&s of internal hemorrhage in a post-op pt. What is included in the care of this pt in hypovolemic shock? SATA
*Elevate the feet with the head flat or elevated 30 degrees *Monitor vital signs Q 5 mins until they are stable *Provide Oxygen therapy *Ensure IV access *Notify the Rapid Response team
The nurse finds a pt on the bathroom floor. There is a large amount of blood on the floor & on the pt's hospital gown. Which actions does the nurse take? SATA
*Elevate the pt's legs *Establish large bore IV access *Look for the source of the bleeding *Ensure a patent airway
Pre op care for open heart procedures?
...
A pt comes to the ED dept with severe injury and significant blood loss. The nurse anticipates that resuscitation will begin with which fluid?
0.9 sodium chloride (NS)
A child who is 3 yrs old has a cardiac catherterization with access throughout the femoral vein. The child has returned to the nursing unit. While assuring the child that the procedure is over, the nurse should do which of the following? Prioritze the actions in order
1 - Inspect the dressing for bleeding 2 - Palpate pedal pulses 3 - Obtain HR 4 - Remind the child to remain flat in bed
The nurse is caring for an infant who is hospitalized prior to surgery for Tetralogy of Fallot. The infant has a cyanotic episode. The nurse should do the following in priority order
1 - Put in knee-chest position 2 - Hold in an upright position 3 - Calm and soothe the infant 4 - Aminister oxygen (frequently the first 3 provide appropriate relief)
The nurse is caring for a 1 yr old who has been diagnosed with CHF. Treatment began 3 days ago and has included digoxin and furosemide. The child no longer has retractions, lungs are clear and equally bilateral, and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has diuresed successfully and has good renal perfusion when the nurse notes the childs urine output is :
1cc/kg/hr
When does rheumatic fever occur?
2-6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract.
BP screenings to detect end-organ damage should be done routinely beginning at what age?
3 yrs old
Which of the following assessments indicate that the parents of a 7 yr old are following the prescribed treatment for congestive heart failure?
50th percentile height and weight for age (indicates good growth & dev and good nutrition and perfusion)
What is the normal MAP?
60-70mmHg (necessary to perfuse major organs.. Brain, Heart & Kidney)
A 1 yr old child is being prepared for a cardiac catheterization. Which of the following findings in the child might delay the procedure?
A diaper rash (risk for infection, bc they go through the groin)
What are the assessments of Tetralogy of Fallot?
A harsh systolic crescendo-decrescendo murmur is heard. Acute episodes of cyanosis & hypoxia occur when the infants oxygen requirements exceed the blood supply, such as during periods of crying, feeding, or defecating
The nurse is caring for a post-op pt who had major abdominal surgery. Which assessment finding is consistent with hypovolemic shock?
A rapid, weak & thready pulse
What are the assessments for pulmonary stenosis?
A systolic crescendo-decrescendo ejection murmur at the left upper sternal border (pulmonic area). Infants & children may be asymptomatic Newborns with severe narrowing are cyanotic. CHF may occur
What are the signs of truncus arteriosus?
A systolic murmur si present in the 3rd left intercostal space. CHF and variable cyanosis, poor growth, and activity intolerance. Surgical repair is performed in the first few months of life.
What is an atrial septal defect (ASD)?
ASD is an abnormal opening bt the atria that causes increased flow of oxygenated blood from the left side of the heart into the right. Right atrial & ventricular enlargement. Infant may be asymptomatic or may have decreased cardiac output.
What are the defects of Increased Pulmonary Blood Flow?
ASD- Atrial Septal Defect = hole in atrium septum VSD- Ventricular Septal Defect = hole in ventricles AVC- Atrioventricular Canal Defect = hole in middle of atria and ventricle PDA- Patent Ductus Arteriosus = failure of ductus arteriosus to close
What are the types of atrial septal defect?
ASD1 - (Ostium primum) ASD2 - (Ostium secundum)
What is VSD?
Abnormal opening in septum bt Right & Left vent Leads to overload with Right vent & atrial hypertrophy & CHF Left to right blood flow
Renin-angiotensin system (RAS)
Activated by reduced blood flow to the kidneys
Which of the following individuals is at greatest risk for systemic HTN?
African American child who is 14 yrs old and obese
Patient who had a ruptured aortic aneurysm Pt with ruptured spleen due to trauma Pt receiving heparin therapy Pt with dehydration Pt with Diabetes Pt who has upper GI bleeding, with a nasogastric tube Pt receiving excessive diuretic therapy
All are patients at risk for hypovolemic shock
The nurse is caring for an infant with congestive heart failure. The following are interventions to decrease cardiac demands on the infant. SATA
Allow the parents to hold and rock their child Make frequent position changes Feed the child when sucking the fists Change bed linens only when necessary Organize nursing activities
Which patient would require feeding by gavage (tube feeding)?
An infant with congestive heart failure
What is rheumatic fever?
An inflammatory autoimmune disease affecting the connective tissues of the heart, joints, subq tissues, and blood vessels of the CNS. Complications include, carditis, valve insufficiency, heart failure, and death. The mitral valve is most commonly affected.
Parents report that their 6 yr old has been seen by the school nurse for dizziness that occurred when standing in line for recess and homeroom since the start of the school term. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks the child if her chest ever hurts, she says yes. Based on this history the nurse suspects that she has:
Aortic Stenosis (exercise intolerance that is better at rest)
What is aortic stenosis?
Aortic stenosis is a narrowing or stricture of the aortic valve, causing resistance to blood flow from the left ventricle into the aorta resulting in decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion. Caused by a bicuspid valve or fusion of the cusps.
An infant with Congestive Heart Failure is receiving digoxin to enhance myocardial function. What should the nurse assess prior to administering the med?
Apical pulse
Pediatric Cardiac Assessment?
Apical pulse for 1 minute @ PMI 3-5th ICS @MCL, or palpated at brachial or carotid pulse BP cuff 2/3rds the upper arm Cap refill Periph pulses - quality & equality Heart for rate rhythm & murmurs BP is late sign of problem
A preschooler has just returned to his hospital room from the cardiac catheterization recovery room. He is vomiting and bleeding: anxious, pale, crying, and sitting in a puddle of blood and emesis. The nurse should first:
Apply direct continuous pressure 1 in above the percutaneous site
The nurse is caring for a child who has undergone cardiac catheterization. During the recovery phase, the nurse notices the dressing is saturated with bright red blood and a 6 inch circle of blood on the bed sheet. The nurses first action is to:
Apply direct pressure 1 inch above the puncture sight
The UAP reports repeatedly & unsuccessfully trying to take a patients BP w/ the electronic and manual device. the nurse notes that the pt's apical pulse is elevated & the pt is at risk for hypovolemic shock. The pt begins to deteriorate. What is the quickest way for the nurse to determine the systolic BP?
Apply the manual cuff and palpate for the systolic
What are the signs of right-sided heart failure?
Ascites Hepatospenomegaly JVD Oliguria (low urine output) Peripheral edema Weight gain
A pt is at risk for heart failure, but currently has no official medical dx. While assessing the pts lungs, the nurse hears fine profuse crackles. What does the nurse do next?
Ask the pt to cough and reauscultate the lungs
A pt in hypovolemic shock is receiving sodium nitroprusside (Nipride) (Nitropress) to enhance myocardial perfusion. What is an impt nursing implication for administering this drug?
Assess BP q 15mins bc systemic vasodilation can cause hypotension
What are the assessments of Shock?
Assess Vital Signs including BP for Map, PP, HR, RR. (GET BASELINE BP!!!!) Validate with manual readings. O2 with pulse ox Resp for rate ease & depth Urinary output. Measure at least Q hour Skin temp, color, moisture (first changes occur in oral mucous membrane Capillary Refill (slowed or absent) *must be 3 or less, 4 bad CNS: thirst, LOC changes, agitation, feeling of impending doom progresses to confusion, lethargy, stooper, coma Generalized muscle weakness, DTRs dec/absent
Assessment post op balloon valvuloplasty
Assess cath insertion site for bleeding Monitor heart sounds & rhythm, and CO Observe for any signs of embolism
What are the Nursing Interventions for adults in HTN?
Assess mod & non-mod risk factors Low Na & Low fat diet Dec lipid levels Weight loss Increase exercise Smoking Cessation Decrease stress Multi-Drug therapy
The nurse is performing the am shift assessment on several patients. the nurse is immediately concerned about decreased tissue perfusion if the capillary refill time was delayed for which patient?
Asthmatic
S&S of aortic regurg?
Asymptomatic for years Dyspnea Parox nocturnal dyspnea palpitations nocturnal angina diaphoresis
Which defects cause Increased Pulmonary Blood Flow?
Atrial Septal Defect Atrioventricular Septal Defect Patent Ductus Arteriosus Ventricular Septal Defect
What are the 4 disorders with Increased Pulmonary blood flow?
Atrial Septal Defect Ventricular Septal Defect Atrioventricular Septal Defect Patent Ductus Arteriosus
Babies with Down syndrome can have what defect?
Atrialventricular Canal Defect
What is the Atrioventricular Septal Defect?
Atrioventricular Septal Defect results from incomplete fusion of the endocardial cushions. The defect is the most common cardiac defect in Down Syndrome. A crescendo-decrescendo murmur occurs at upper left sternal border. The infant usually has mild to moderate CHF, with cyanosis with crying. Signs of decrease cardiac output may be present (see above)
The nurse is reviewing the lab results for a pt whose chief complaint is dypnea. Which diagnostic test best differentiates between heart failure and lung dysfunction?
B-type natriuretic peptide
Where is the ductus arteriosus located?
B/t the pulm artery and the aorta
Surgical tx for valvular disease?
Balloon valvuloplasty for stenosis / valve replacement
The nurse is caring for a 4 yr old female with a Glascow Coma scale of 3, HR of 88beats per minute and regular, RR of 22, BP of 78/52, and a blood sugar of 35. The nurse asks the caregiver about accidental ingestion of what drug?
Beta blocker (lower HR and BP indicates use of a beta blocker & beta blockers also can cause hypoglycemia)
Where is the Tricuspid valve?
Between Rt Atrium and Rt Vent
Where is the Pulmonic valve?
Between Rt Vent and the Pulmonary Artery
Where is the Mitral valve?
Between the Left Atrium and the Left Vent
Where is the Aortic valve?
Between the Left Vent and the Aorta
If patient is acyanotic?
Blood flows left to right
If patient is cyanotic?
Blood flows right to left
What is the assessment for coarctation of the aorta?
Blood pressure is higher in the upper extremities than the lower ones.; bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities. CHF in infants. HTN may cause headaches.
What is shunting?
Body pulls blood from non vital areas (periph) & sends it to Vital organs.. Brain heart & kidney.. through vasoconstriction
In dilated cardiomyopathy what are the dx tests?
CXR (heart will be bigger) Echocardiography (ultrasound that can measure) ABGs (for metabolism and oxygenation of your blood) LABS: H&H (bc of compen mech of polycythemia), CMP (elect = look at potassium & Kidneys) BNP = hormone we measure that is particular to the heart.. UA = are kidneys ok Right sided heart failure later in the disease; Afib (causes embolism, stroke)
An adolescent is admitted to the hospital with RF. Nursing assessment reveal that the client has a sore throat, painful swollen joints,and a rash on his trunks. He has random movements of his extremities. The temp is 99*F, RR are 25, apical HR is 150 and BP is 120/82. The nurse should first:
Call the HCP. (Increase HR is a sign of carditis)
What is the treatment for VSD?
Can close spontaneously Surgery usually in 1st yr of life Anitbiotic prophyl Reduce exposure to Resp infection Diuretics, Digoxin, and ACEInhib for CHF Tube feeding & nutritional supp PRN
What are the major jones criteria for rheumatic fever?
Carditis Arthralgia (joint pain) Chorea (jerky uncontrolled movements) Erythema marginatum (pink rings on the trunk and inner surfaces of the limbs that come and go) subcutaneous nodules
Some facts:
Characterisitc of rheumatic fever polyarthritis are tender painful joints in elbows knees ankles and wrists. Subcutaneous nodules are small contender swellings often over the joints.
The night shift nurse is listening to report and hears that a pt paroxysmal nocturnal dyspnea. What does the nurse plan to do next?
Check on the pt several hours after bedtime and assist the pt to sit up-right and dangle the feet when dyspnea occurs
A pt receives dopamine 20mcg/kg/min IV for the tx of shock. What does the nurse assess for while administering this drug?
Chest pain & HTN
The nurse is instructing the family and a child who has been diagnosed with RF. Which of the following is included in the teaching plan?
Child will need prophylactic antibiotic for invasive procedures.
After a cardiac surgery a child has chest tubes inserted that are attached to a water seal drainage system. The tubing to the water-seal drainage container becomes disconnected. The nurse should do which of the following first?
Clamp the tube near the chest. (to prevent a pneumothorax)
What is the intervention for VSD?
Closure during cardiac catheterization. Open repair may be done with cardiopulmonary bypass.
What congenital Heart defects use PGE1 to keep Ductus Arterisus patent?
Coarctation of the Aorta Pulmonic Stenosis Tet of fallout Tricuspid Atresia TOGA Hypoplastic left heart
The school nurse has been following a female who comes to the office frequently. She has come mainly for vague complaints of dizziness and headache. Today she is brought after fainting in the cafeteria following a nosebleed. Her BP is 122/85 and her radial pulses are bounding. Calling for the ambulance, the nurse suspects she has:
Coarctation of the Aorta (elevated BP & bounding pulses)
In which of the following congenital heart defects would the nurse need to take upper and lower extremity BP's?
Coarctation of the aorta
What fluid carries oxygen to peripheral tissues?
Colloid
What fluid is a substitute for blood?
Colloid
Assessment findings of a pt with trauma injuries reveals cool, pale skin; reported thirst, urine output 100ml/q 8 hours , BP 122/78; Pulse 102; RR 24 w/decreased breath sounds. This patient is at what phase of shock?
Compensatory / non-progressive
A child born with Down Syndrome should be evaluated for what associated cardiac manifestations?
Congenital heart defects
The nurse is caring for a 9 month old who was born with congenital heart defects. Assessment reveals a HR of 160, capillary refill of 4 seconds, bilateral crackles, and sweat on the scalp. These are signs of :
Congestive Heart Failure
What is the surgical management of total anomalous venous connection?
Corrective repair in early infancy. The pulmonary vein is anastomosed (cause to join or open into each other) to the left atrium, the ASD is closed, and the anomalouse pulmonary venous concoction is ligated (tie up or close off)
What are the signs of left-sided congestive heart failure?
Crackles Wheezes Coughs Dyspnea Grunting (infants) Head bobbing (infants) Nasal flaring Orthopnea Cyanosis spells Tachypnea THINK LEFT =LUNG
The nurse is caring for a child who is 2 yrs of age who has had surgery to repair a ventricular-septal defect (VSD). The nurse should report which of the following to the surgeon?
Crackles bilaterally in the lungs (sign of heart failure & requires medical intervention)
What is a fluid replacement used in shock pts?
Crystalloid
What is the presentation of tricuspid atresia?
Cyanosis, tachycardia and dyspena are seen in the newborn. Older children have chronic hypoxemia (causes respiratory distress and tissue hypoxia) & clubbing.
What is the presentation of Tetralogy of Fallot in infants?
Cyanotic at birth or may have mild cyanosis that worsens over the 1st yr of life as the pulmonic stenosis worsens.
A pt is showing early clinical manifestations of hypovolemic shock. The physician orders ABG. Which ABG values does the nurse expect to see in hypovolemic shock?
Decrease pH with decreased PaO2 and increased Paco2 (low oxygen, and increased carbon dioxide b/c of respirations...)
What are the signs of decreased cardiac output?
Decreased peripheral pulses Exercise intolerance Feeding difficulties Hypotension Irritability Restlessness Lethargy Oliguria Pale Cool extremities Tachycardia
Left sided heart failure (ventricular)
Decreased tissue perfusion from poor CO and pulmonary congestion from increased pressure in the pulmonary vessels
The patient has decreased oxygenation and impaired tissue perfusion. Which clinical manifestations are evidence of one of the non-progressive or compensatory stages of shock?
Decreased urine output Increased HR
Congenital heart defects are classified by which of the following? SATA
Defects with increased pulmonary blood flow Defects with decreased pulmonary blood flow Mixed defects Obstructive defects
What causes Mitral regurg?
Degeneration from aging, and infective endocarditis
What is the pre-op care for valve replacement?
Dental exam (infection) Stop taking anti-coags 72 hours b4 surgery
The nurse is assessing a pt with right-sided heart failure. Which assessment findings does the nurse expect to see in this pt? SATA
Dependent edema Polyuria at night (large production of urine) Hepatomegaly
A child who is 15 yrs old with systemic HTN is taking propranolol (Inderal) for systemic HTN. The nurse instructs the child and family to report which of the following to the HCP?
Depression
What is the management of the coarctaction of the aorta?
Dilation of the defect may be done by balloon angioplasty, but restenosis can occur. Resection of the coarcted portion with end to end anastomosis of the aorta or enlargement of the constricted section using a graft may be required. Cardiopulmonary bypass is not required.
What is the management of pulmonary stenosis?
Dilation of the narrowed valve by cardiac catheterization. Surgical management of infants is a transventricular valvotomy in children, a pulmonary valvotomy with cardiopulmonary bypass is performed
What is the management of aortic stenosis?
Dilation of the narrowed valve during cardiac catheterization. Surgical aortic valvotomy may be done; a valve replacement may be required at a second procedure.
The nurse is assessing a pt with left-sided heart failure. Which assessment findings does the nurse expect to see in this pt? SATA
Displacement of the apical impulse to the left S3 heart sound Paroxysmal nocturnal dyspnea Oliguria during the day (not enough urine) Wheezes or crackles
A premature infant has a PDA. What are the expected effects following administration of indomethacin (Indocin)?
Ductus arteriosus closes
The nurse administers prostaglandin E to an infant born with transposition of the great vessels. What is the expected effect of this drug?
Ductus arteriosus remains open, allowing blood to mix
S&S of aortic stenosis?
Dyspnea Angina syncope on exertion Rt heart failure late in disease
What are the clinical manifestations of Shock?
Early - Apprehensiveness, irritability, increase HR, Normal BP(poss slightly elevated DBP), Narrow PP, thirst, pallor,decreased urinary output, dec perfusion of extremities , O2 sats 90-95% NP Late - Confusion, somnelence, inc RR, mod metabolic acidosis, oliguria, poor cap refill, O2 sats 76-80% (Prog stage) Irreversible - Thready weak pulses, hypotension, periodic breathing/apnea, anuria, stupor/coma (any O2 sats less then 70%)
Which test is the best tool for diagnosing heart failure?
Echocardiography
When administering norepinephrine (Levophed), what does the nurse monitor for in the pt?
Extravasation
What is Patent Ductus Arteriosus, and what is the effect on the heart?
Failure of Ductus Arteriosus to close Blood shunts to the pulm artery, recirculated through lungs & returned to LA to LV (makes a big circle)
What is the Total anomalous pulmonary venous connection?
Failure of the pulmonary veins to join the left atrium. Mixed blood is returned to the right atrium and shunted from the right to left through an ASD. The right side of the heart hypertrophies, but the left side of the heart may remain small.
The most reliable indicator that causes the nurse to suspect shock in the pt is changes in the systolic BP
False: In 1st stages BP is normal or slightly elevated
When shock occurs, the body fails and death is the inevitable result
False; Shock progresses in a predictable & orderly fashion
Assessment for valvular disease?
Family Hx of heart & valve disorders RF Infective endocarditis Use of preventive antibiotics Hx of IV drug abuse Hx of recent strep fatigue, palpitations, angina & dyspnea Vitals, edema, peri pulse Listen to heart & lung sounds
The nurse is feeding an infant who has a congenital heart defect. Which of the following nursing measures will improve the caloric intake of this infant?
Feed the infant 20 cal/oz infant formula in amounts desired by the infant. (don't offer frequent feedings for ex: q 3hrs)
A nursing action that promotes ideal nutrition in an infant with congestive heart failure is?
Feeding formula that is supplemented with additional calories
A 2 month old is being treated with furosemide for Congestive heart failure. Which of the following plans would also be appropriate in helping to control the CHF?
Feeding in the semi-fowler position (with chf there is great difficulty with feeding)
What are the minor jones criteria for rheumatic fever?
Fever Arthralgia Elevated ESR or Positive C-Reactive Protein level Prolonged P-R interval on electrocardiogram 2 major or 1 major and 2 minor manifestations accompanied by evidence of a preceding strep infection (Pos throat culture and an elevated antistreptolysin O titer)
S&S of Infective endocarditis?
Fever on & off for weeks and a new murmur Chills, night sweats, malaise & arthralgia Chest pain & or heart fail Petechiae Hemologic impairment New or changed murmur Red, painless spots on hands & soles (Janeway) Red painful nodes on fingers & toes (Osler)
What is mitral regurgitation
Fibrotic & Calcific changes keep valve from closing completely during systole
B-type natriuretic peptide (BNP) is produced and released by the ventricles when the pt has ______ as a result of heart failure
Fluid overload
What serves as the septal opening bt the atria of the fetal heart?
Foramen Ovale
What are the holes that close when a fetus is born?
Foramen ovale Ductus Arteriosus Ductus Venosus
A pt is in hypovolemic shock rt hemorrhage from a large gunshot wound. Which order does the nurse question?
Give Furosemide (Lasix) 20mg slow IVP
Tx of Hypoplastic Left Heart?
Give PGE1 IV Surgical: Norwood Glenn @ 6months Fontan by 6 years Heart transplant
Tx of TOGA?
Give Prostaglandin E 1 IV Rashkind procedure: Atrial septostomy (this is a CC procedure) Surgical: Arterial switch or transplant
When auscultating a childs heart murmur with a stethoscope, the nurse identifies a murmur. The murmur is characterized by being soft, of medium intensity, heard immediately and without a thrill present. The nurse documents the grade of this murmur as:
Grade II/IV
Medications used in valve disease?
HF: Diuretics, Beta Blockers, Digoxin Regurgitant flow dec: Vasodilators Afib: diltiazem, amiodarone, warfarin & cardioversion
What 2 factors determine CO?
HR*SV=CO
What is the surgical treatment for Hypoplastic left heart syndrome?
Heart transplant in the newborn period may be needed. In the preoperative period, the newborn requires mechanical ventilation and a continuous infusion of prostaglandin E1 to maintain ductal patency and systemic blood flow. (Opens)
What are the risks of cardiac catheterization?
Hemorrhage from the entry site, clot formation, arterial obstruction distally, and transient dysrhythmias.
What are the interventions for digoxin therapy in children?
Hold digoxin if the apical pulse is less then 90-110 beats/min in infants and in young children. Less then 70 beats/min in older children. Infants rarely receive more then 1mL of digoxin in one dose. Monitor digoxin levels and for signs of toxicity, including anorexia, poor feeding, nausea, vomiting, bradycardia, and dysrhythmias. Normal Digoxin level is 0.5-2ng/mL. Administer ACE inhibitor, furosemide (Lasix). MOnitor potassium level (normal level is 3.5-5.1mEq/L) Limit fluids
The nurse is administering prescribed digoxin to an infant. Within 10 minutes the infant vomits. The nurse should :
Hold repeat dose: administer the next dose at the regular time (if more then two consecutive doses are missed (vomited) notify the HCP
A 2 month old with TOFallot is seen in your clinic for a check up. During the examination, the child develops severe respiratory distress and becomes cyanotic. The nurses first action should be to:
Hold the child in knee chest position to decrease venous blood return.
A hospitalized infant who is 2 months of age with tricuspid atresia has been receiving digoxin for 3 days. Prior to administering the drug, the nurse checks the infants apical HR. The HR is 88 beats per minute. After checking the medication record, the nurse should perform which of the following interventions?
Hold the drug and notify the HCP (Pulse is below 90-110 per minute)
What are the assessments for VSD?
Holosystolic murmur at lower left sternal border (tricuspid area). CHF
What is the assessment for the Pediatric History?
Hx: Poor feeding Poor weight gain Activity intolerance Fatigue or Sweating with activity Respiratory Infections Color changes Cyanosis Family Hx of Cardiac Defects
The nurse is caring for a preschool female diagnosed with Congestive heart failure. She is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room and her HR is 70 beats per minute. The nurse suspects what lab finding?
Hypokalemia (halos = dig toxicity... HR is slow = dig toxicity, and the lasix can cause a decrease in potassium, which can increase the risk for dig toxicity)
A child with CHD undergoes the Norwood procedure. This procedure is used to correct?
Hypoplastic Left Heart Syndrome
What type of shock is total body fluid decreased (in all fluid compartments?
Hypvolemic Shock
The nurse is interviewing a pt with a hx of High blood pressure and heart problems. which statement by the pt causes the nurse to suspect the pt may have heart failure?
I had to take off my wedding ring last week
Which statement by the mother of a male toddler with Rheumatic fever show she has good understanding of the care of her child?
I will give him the aspirin that is ordered for pain and inflammation
What statement by the mother of an infant boy with CHF who is being sent home on Digoxin indicates she understands proper care of her child?
I will give him the med at regular 12 hour intervals If he vomits, I will not give the make-up dose If I miss a dose, I will not give an extra dose, but keep him on his same schedule.
Which statement by the mother of an infant boy with Congestive Heart Failure who is being sent home on Digoxin indicates she needs further education on the care of her child?
I will mix the digoxin in some of his formula to make it taste better
The home health nurse is evaluating a pt being treated for heart failure. Which statement by the pt is the best indicator of hope and well-being as a desired physiological outcome?
I'm looking forward to dancing with my wife on our wedding anniversary
What is the tx of Anomalous Connection?
IF CHF treat Surgery depends on type & presence of obstruction
What is the tx of AVC defect?
If CHF, diuretics, Dig, & ACEI ^Nutrition Surgery to close defect and construct new valves
What are the post - procedure nursing interventions of cardiac catheterization?
If bleeding is present, apply continuous direct pressure at the cardiac catheter entry site. Immobilize the affected extremity in a flat position for 6-8 hours for an arterial entry site. Acetametaphen (Tylenol) or Ibuprofen (Motrin)
Which statement by the mother of a patient with Rheumatic fever (bacterial infection) shows she has and understanding of prevention in her other children?
If their culture is pos for Group A Strept, I will give them their antibiotic
What is HTN?
In adults is defined as a systolic pressure of 140mm Gg or higher. And diast pressure of 90 or higher. 140/90. In children HTN is defined as having a syst or diast BP that consistently falls >95th percentile for age & gender.
What are the causes of congestive heart failure in children?
In infants and children, inadequate cardiac output most commonly is caused by congenital heart defects
The nurse is teaching a mother of an infant with Tetralogy of Fallot. The nurse instructs the mother to place the infant in which of the following positions if the infant suddenly becomes cyanotic and dyspneic?
In knee-chest position
What is Tetralogy of Fallot?
Includes 4 defects; VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy. If pulmonary vascular resistance is higher then systemic resistance, the shunt is from left to right. If systemic resistance is lower then pulmonary resistance the shunt is right to left.
What is Truncus Arteriosus?
Incomplete division of the great common vessel that becomes the aorta & pulm artery. This one great vessel straddles a large VSD. **Mixing of unoxyg blood & oxyg blood = desat & hypoxemia
CO is the product of heart rate and stroke volume, and an increase in HR results in an immediate ________ in cardiac output
Increase
A pt is brought to the ED w/ a gunshot wound. The nurse closely monitors the pt for early signs of hypovolemic shock. What early signs does the nurse look for? SATA
Increase in HR Increase in RR
The nurse is evaluating the care & tx for a pt in shock. Which finding indicates that the pt is having an appropriate response to the tx?
Increased urinary output
Right sided heart failure (ventricular)
Increased volume & pressure develop and result in peripheral edema
What is the presentation of Tetralogy of Fallot in children?
Increasing cyanosis, squatting, clubbing, and poor growth.
The nurse is reviewing the lab results of a pt with a systemic infection. What is the significance of al left shift in the differential leukocyte count?
Indication that the infection is outpacing the white cell production
What is the management of patent ductus arterioles?
Indomethacin (Indocin), a prostaglandin inhibitor, may be administered to close the PDA in premature infants. The defect may be closed during cardiac catheterization, or the defect may be closed surgically
What are the signs of transposition of the great arteries?
Infants with minimal septal defects are severely cyanotic and depressed at birth. Infants with large septal defects or a PDA are less severely cyanotic, but have CHF. Cardiomegaly develops a few weeks after birth.
The following are examples of acquired heart disease. SATA
Infective endocarditis Rheumatic Fever Cardiomyopathy Kawasaki Disease
Causes of aortic regurg?
Infective endocarditis congential anomaly HTN & Marfan Synd
What is infective endocarditis?
Inflammation of & damage to cardiac valves & endocardium by a bacterial or fungal, or viral agent. Veg forms on valves. *Most commonly strep or staph.
What are the 4 stages of Hypovolemic Shock?
Initial Stage, Nonprogressive , Progressive, Refractory
Risk for infective endocarditis? *****
Invasive procedures - Dental Cardiovascular GI surgery Scopes IV drug use Cardiac defects Valve replacements
What are the rheumatic fever chorea?
Involuntary movements of the extremities and face, which affect speech.
Describe the "Refractory Stage"?
Irreversible = Your pt is dying. Severe tissue hypoxia, ischemia, necrosis, release myocardial depressant factor-pancreas, buildup toxic metabolites, MODS (Multi organ dysfunction syndrome) .. Death
The student nurse is assessing a pts mental status bc of the pts risk for decreased tissue perfusion. The supervising nurse intervenes when the student nurse asks the patient which question?
Is your name Mr. John Smith?
A child with a history of cardiac surgery requires an annual electrocardiogram. What can the electrocardiogram detect? SATA
Ischemia Injury Dysrhythmias Conduction Delay
An infant has been diagnosed with an Atrial Septal Defect or an Atrialventricular Canal (AVC) defect. The flow of blood throughout the heart with this type of defect is:
It is usually Left to right, but the answer is "Either direction"
What are the nursing actions for hyper cyanotic spells in an infant?
Knee chest position 100% oxygen Morphine IV fluids
The nurse is teamed with an LPN in caring for a group of cardiac patients on a pediatric unit. Which action by the LPN indicates that the nurse should intervene immediately?
LPN assists child to the bathroom 2hrs after a cardiac catheterization (strict bed rest for 3 hrs with head only slightly elevated after this procedure)
An 18 month old with a myelomeningocele is going to undergo a cardiac catheterization. The mother expresses concern about the use of dye in the procedure. The child does not have any allergies listed on the medical record. In addition to the concern for an iodine allergy, what other allergy should the nurse bring to the attention of the catheterization staff?
Latex (children with spina bifida often have a allergy to latex= the balloon is made of latex)
A 5 month old has been diagnosed with ASD. The flow of blood through the heart with this type of defect is:
Left to right
A 3 month old has been diagnosed with Ventricular Septal Defect (VSD). The flow of blood through the heart with this type of defect is?
Left to right (pressures in the left side are greater)
Where is the Ductus Venous located?
Left umbilical vein & inferior vena cava
Most heart failure begins with failure of the ___ and progresses to failure of both ventricles
Left ventricle
Describe the "Progressive Stage"
Life threatening ... MAP greater then 20 mm Hg from baseline, anoxia of NV organs, hypoxia of vital organs, overall metabolism; anaerobic (moderate acidosis, mod inc K+, TISSUE ischemia)
The mother of a toddler reports that the babys father has just had a MI. Bc of this information, the nurse recommends the child have a:
Lipid profile
What are the assessments for rheumatic fever?
Low grade fever Elevated antistreptolysin O titer Elevated ESR Aschoff bodies (nodules found in rheumatic fever patients hearts, brains, blood vessels and serous surfaces)
Describe the "Nonprogressive Stage"?
MAP 10-15mm Hg from baseline, mod vasoconstriction with inc HR, dec PP(narrowing), chemical compensation (renin, aldosterone, ADH), Inc vasoconstriction, dec Urinary output, thirsty, anaerobic metabolism NV organs (mild acidosis, mild inc K+)
Describe the "Initial Stage"?
MAP 5-10mm Hg from baseline, mild vasoconstriction with inc HR, inc RR and inc DBP(comp. mech)
What are the assessments of PDA?
Machinery-like murmur. An infant may be asymptomatic or have signs of CHF. Widened pulse pressure.
What is the pre-procedure nursing interventions for cardiac catheterization?
Measure height & weight to determine correct catheter size. Ask about allergy to iodine (shrimp). Check dorsal is pedis and posterior tibial pulses. Measure baseline oxygen saturation.
A pt who was admitted for newly dx heart failure is now being discharged. The nurse instructs the pt and family on how to manage heart failure at home. What 5 major self management categories should the nurse include?
Meds Activity weight Diet Symptoms
List one teaching component for ea of the self-management categories you identified in the previous question
Meds; take as prescribed; keep rx filled; know purpose & sd effect for ea; Activity: Stay active but avoid over-exertion; know your limits; make it a goal to converse while exercising Weight: weigh daily at the same time & use same scale & amount of clothing; monitor for fluid retention Diet: Limit daily sodium to 2-3g; Limit daily fluid intake to 2L S&S: notify HCP immediately of any new or worsening of symptoms
What are the assessments for aortic stensosis?
Mid systolic ejection murmur is heard over the aortic area right second intercostal space). Infants with severe defects have decreased cardiac output. Children have exercise intolerance, chest pain, and dizziness.
What are the signs of hypoplastic left heart syndrome?
Mild cyanosis and signs of CHF occur until the ductus arteriosus closes; then progressive deterioration, cyanosis, decreased cardiac output, and cardiovascular collapse occur. Death occurs in the first few months of life.
A pt with heart failure has inadequate tissue perfusion. Which nursing interventions are included in the plan of care for this pt? SATA
Monitor RR, rythum and quality q 1-4 hours Auscultate breath sounds Q 4-8 hours Provide supplemental oxygen to maintain O2 sat at 90% or greater assist the pt in performing coughing and deep breathing exercises Q 2 hours
What are the interventions for congestive heart failure?
Monitor strict I&O. Monitor daily weight to assess for fluid retention ; a weight gain of 1lb in 1 day is caused by the accumulation of fluid. Position in semi-fowler. Cool humidified oxygen, digoxin (Lanoxin)
What is an early sign of left ventricular failure that a pt is most likely to report?
Nocturnal coughing
What is coarctation of the aorta?
Obstructive disease;narrowing or constriction of the aorta near the insertion of the ductus arteriosus.
A patient with cardiac tamponade will have what type of shock?
Obstructive shock
A pt with hypovolemia is restless & anxious. The skin is cool and pale. Pulse is thready at 135beats/min; BP is 92/50; RR are 32/min. What actions does the nurse take? SATA
Obtain a stat order for a Normal Saline IV bolus Administer supplemental o2 Notify the Rapid Response team
What is ASD1 (Atrial septal defect 1) Ostium primum?
Opening is at the lower end of the septum
What is ASD2? Ostium secundum?
Opening is near the center (middle) of the septum
Indomethacin may be given to close what congenital heart defect in newborns?
PDA
While assessing a newborn with respiratory distress, the nurse auscultates a machine like murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCo2, and decreased Poz. The nurse suspects that the newborn has?
PDA (machine like murmur is the giveaway)
What is Patent Ductus Arteriosus?
PDA is failure of the fetal ductus arterioles (artery connecting the aorta and the pulmonary artery) to close within the first weeks of life.
which IV therapy results in the greatest increase in oxygen-carrying capacity for a pt with hypovolemic shock?
Packed red blood cells
What is the post-op care for valve replacement?
Pain control Incision care Prevent oxygen problems Assess for hemorrhage Assess for S&S of heart failure & CO Cluster nursing activities
Which change in the skin is an early indication of hypovolemic shock?
Pallor or cyanosis in the mucous membrane
Assessment for Congenital Heart Defects?
Patent Airway Assess need for suction O2 sat S&S of distress: grunting, nasal flaring Auscultate lungs for wet breath sounds OXYGENATION IS PRIORTITY!!!!!!!!!!!
What are the interventions for rheumatic fever?
Penicillin Aspirin Seizure precautions (if chorea) Anibiotic prophylaxis for dental work is not recommended
Ejection fraction
Percentage of blood ejected from the heart during systole
A pt at risk for shock has had some small & subtle changes in behavior w/in the past hour. How does the nurse evaluate the pts mental status throughout the night?
Periodically attempt to awaken the patient and document how easily he or she is aroused
While looking through the chart of an infant with congenital heart defects of decreased pulmonary blood flow, the nurse would expect what laboratory finding?
Polycythemia
Hypoxic spells in the infant with congenital heart defects can cause which of the following? SATA
Polycythemia Blood clots CVA (cardiovascular accident) Developmental delays Brain damage
What two physiological changes occur as a result of hypoxemia in congestive heart failure?
Polycythemia and clubbing
What factors effect SV?
Preload, Afterload & contractility
When are most cases diagnosed in heart defects?
Prenatally by US screening @ 16-20 weeks
What is the pre op care for open heart procedures?
Prepare child & family Inform parents of the procedure, equipment child will have after surgery, and type of unit child will be on (PACU, PICU, CCU) Introduce them to the environment and the equipment before surgery
The nurse is reviewing diagnostic test results for a pt who is hypertensive. Which lab result is an early warning sign of decreased heart compliance, and prompts the nurse to immediately notify the HCP?
Presence of microalbuminuria
What is the prevention & treatment of Infective Endocarditis?
Prevention: Oral hygiene Antibacterial prophylaxis w/ amox or clindamycin Treatment: IV antibiotics 4-8 weeks Surgically remove vegetations or remove & replace valves
A post-op hospitalized pt has a decrease in MAP of greater then 20 mm Hg from baseline value; elevated, thready pulse; decreased blood pressure; shallow RR of 26/min; pale skin; moderate acidosis; and moderate hyperkalemia. This pt is in what phase of shock?
Progressive
For the child with hypoplastic left heart syndrome, what drug would be given to allow the PDA to remain open until surgery?
Prostaglandin E
Which med should the nurse give to a patient who is diagnosed with transposition of the great vessels?
Prostaglandin E
What is the Non-surgical management of transposition of the great arteries?
Prostaglandin E1 increases blood mixing. Balloon atrial septostomy by cardiac catheterization may be performed to increase mixing. SURGICAL MANAGEMNET = Arterial switch
What is the tx of PDA? Pharm tx?
Prostaglandin inhibitor (Indomethicin) to close PDA
Valve replacement Types of valves and Types of surgery?
Prosthetic: (aortic must be prosthetic) Biologic: Xenograft = cow/pig Autograft = human Open heart surgery
Expectation if surface area of aortic valve is less then 1cm?
Pt is going to surgery!!! Urgent!
Based on the etiology and the main cause of heart failure, which pt has the greatest need for health promotion measures to prevent heart failure?
Pt with HTN
Which pt is most likely to show elevated hemoglobin & hematocrit during shock?
Pt with severe vomiting and large watery diarrhea stools
What is Total Anomalous Pulm Venous Connection?
Pulm veins fail to connect with LA; instead Pulm veins connect to RA. Mixed blood in RA is shunted to LA thru an ASD
A newborn is diagnosed with a cardiac heart defect. The test results reveal that the lumen of the duct bt the aorta and the pulmonary artery remains open. This is known as?
Pulmonary Ductus Arteriosus
What is the management of Atrioventricular Septal Defect?
Pulmonary artery banding for infants with severe symptoms (palliative) or complete repair via cardiopulmonary bypass.
What is pulmonary stenosis?
Pulmonary stenosis is narrowing of the entrance to the pulmonary artery, causing right ventricular hypertrophy, and decreased pulmonary blood flow; the right ventricle may be hypoplastic (underdeveloped). Pulmonary atresia is the extreme form of pulmonary stenosis with total fusion of the commissures (where two things are joined) and no blood flow to the lungs.
A young trauma pt is at risk for hypovolemic shock r/t occult hemorrhage. What baseline indicator allows the nurse to recognize the early signs of shock?
Pulse rate
A 10 yr old has undergone a cardiac catheterization. At the end of the procedure, the nurse should first assess:
Pulses
A young woman comes to the emergency department ED with lightheadedness and "a feeling of impending doom". Pulse is 110; res.'s 30; BP 140/90; Which factors does the nurse ask about which could contribute to shock?
Recent accident or trauma Prolonged diarrhea or vomiting Possibility of pregnancy Use of over the counter meds
What are Oslers nodes?
Red painful nodes on the pads of fingers & toes associate with Infective endocarditis
What are Janeway lesions?
Red painless skin spots on the palms & soles associated with infective endocarditis
A pt has a localized infection. What assessment findings are considered evidence of a beneficial inflammatory response?
Redness & edema that appear but subside in several days
Aspirin has been ordered for the child with RF in order to:
Reduce joint inflammation
Which hormones are released in response to decreased MAP?
Renin Antidiuretic Hormone (ADH) Epinephrine Aldosterone
The nursing student takes the morning BP of a post-op patient and the reading is 90/50. What does the student nurse do next? SATA
Report the reading to the primary nurse as a possible sign of hypovolemia Assess the pt for subjective feelings of dizziness or SOB Check the pts chart for trends of normal vital sign readings Notify the instructor to verify the significance of the finding
The nurse is caring for an older adult pt at risk for shock. What is an early sign of shock in this pt?
Restlessness
The nurse is caring for an 8 yr old girl whose parents indicate she has developed spastic movements of her extremities and trunk, facial grimace, and speech disturbances. They state it seems worse when she is anxious and does not occur when she is sleeping. The nurse questions the parents about what recent illness?
Rheumatic Fever
A 10 yr old child is recovering from a severe sore throat. The caregiver now states that the child complains of chest pain. The nurse observes that the child has swollen joints, nodules on the fingers, and a rash on the chest. The likely cause of this syndrome is?
Rheumatic fever
What are the signs of hypokalemia?
Serum potassium level less then 3.5mEq/L causes muscle weakness and cramping, confusion, irritability, restlessness and inverted T waves or prominent U waves. Potassium supplements
Heart transplant may be indicated for a child with which of the following symptoms?
Severe heart failure & hypoplastic left heart syndrome
Which patients are at risk for shock r/t fluid shifts?
Severely malnourished patients Patient with paralytic ileus Pt with kidney disease Pt with large wounds
The school aged female whom you are caring has been diagnosed with valvular disease following RF. During patient teaching, you discuss the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery and childbirth. The parents indicate that they understand when they say:
She will need to take antibiotics for the rest of her life
Which statements about shock are true?
Shock is a whole body response to body tissues not receiving enough oxygen Shock is widespread abnormal cellular metabolism Shock may occur in older adults in response to urinary tract infections
What are the signs of total anomalous pulmonary venous connection?
Signs of CHF. Cyanosis worsens with pulmonary vein hypertrophy
Which interventions are effective for a pt with a potential for pulmonary edema caused by heart failure?
Sodium & fluid restriction Administration of loop diuretics Position in semi-fowlers to high-fowlers position
The nurse is performing a psychosocial assessment on a pt who is at risk for shock. Which statement made by the pt is of greatest concern to the nurse?
Something feels wrong, but I'm not sure what is causing me to feel this way
What is the treatment of ASD?
Spontaneous closure can occur in first year Surgical repair in 2-5 yrs, endocarditis prophyl 6months post surgery Diuretic & Digoxin if CHF Antidysrhytmics if needed Left to right blood flow
During play, a toddler with a history of Tetralogy of Fallot might assume which of the following positions?
Squatting
What are the Nursing Interventions for Congenital Heart Defects?
Suction prn Semi or High Fowlers Ambu bag at bedside ^ Nutritional intake = small frequent meals (cut hole in nipple so baby doesn't have to suck hard to get food) Assist family w/coping Educate family
The nurse is caring for a toddler who has been hospitalized for two days with vomiting due to gastroenteritis. During morning assessment, she is sleeping and difficult to wake up. Assessment reveals vital signs of a regular HR of 220 bpm, RR of 30 a minute, BP of 84/52 and a capillary refill of 3 seconds. Which dysrhythmia does the nurse suspect in this child?
Supraventricular tachycardia
What is the most common dysrhythmia in pediatrics?
Supraventricular tachycardia
Tx of PDA procedures & surgeries?
Surgical ligation & cardiac cath: Placement of obstructive device
What is the treatment of Tetralogy of Fallot?
Surgical management is a palliative shunt, which increases pulmonary blood flow and increases oxygen saturation in the infants (who cannot undergo primary repair). The shunt provides blood flow to the pulmonary arteries from the left or right subclavian artery. Complete repair is done in the first year of life.
What are the assessments of congestive heart failure?
Tachycardia (especially during rest & slight exertion), tachypnea, diaphoresis, fatigue & irritability, sudden weight gain, respiratory distress
A pt is at risk for hypovolemia secondary to large amounts of watery diarrhea and vomiting. The pt reports feeling a little thirsty and slightly lightheaded. What does the nurse do next?
Take the BP & Pulse & compare it to the pt's baseline
A pts blateral radial pulses are occasionally weak and irregular. Which assessment technique does the nurse use first to investigate this finding?
Take the apical pulse for 1 minute, noting any irregularity in heart rythum
A pt with blunt trauma to the abdomen has been NPO for several hours in preparation for a procedure and now reports subjective thirst. What is the nurses priority action?
Take the pts vital signs and compare to baseline
The nursing student is as asssiting in the care of an pt with advanced right sided heart failure. In addition to bringing a stethoscope, what additional piece of equipment does the student bring in order to assess this pt?
Tape measure
Patient teaching for valve replacement?
Teach pt s&s of heart failure If prosthetic, lifelong use of anti-coags Medications: Pain meds, diuretics, Beta Blockers, Calcium channel blockers, Vasodilaters, prophylactic antibiotics Plan activities and ^Rest
The 6 month old who has a "tet spell" could have the congenital heart defect of decreased pulmonary blood flow called
Tetralogy of Fallot
What is the management of ASD?
The defect may be closed by catheterization. Open repair with cardiopulmonary bypass may be performed before school age
The nurse is examining a 5 yr old boy who has diarrhea and fever. The caregiver states that the boy is normally active and healthy. On examination the nurse hears a murmur at the left sternal border. The caregiver asks why the pediatrician has never said anything about it. The nurse explains:
The fever increased the intensity of the murmur
Which statements about the systemic effects of shock is correct?
The kidneys can tolerate hypoxia and anoxia up to 1 hour w/o permanent damage
What is transposition of the great vessels?
The pulmonary artery leaves the left ventricle, and the aorta exits from the right ventricle.
The nurse is assessing an infant with congenital heart disease. To assess this infant for cyanosis, the nurse should assess the?
Tongue and buccal membrane
What is Hypovolemic Shock?
Too little circulating blood volume causes a decrease in a mean arterial pressure (MAP) = inadequate total body oxygenation (Dehydration, Hemorrhage)
What are 3 factors that influence MAP?
Total blood volume CO size of vascular bed
What are the Mixed Defects?
Transposition of the Great Vessels Total Anomalous Pulm Venous Conn Truncus Arteriosus Hypoplastic Left Heart Synd
What is the Tx of Truncus Arteriosus?
Treat CHF & Polycythemia Surgery: close vdd & attach aorta to LV & graft pulm artery to RV Endocarditis prophylax
What is tricuspid atresia?
Tricuspid atresia is complete failure of the tricuspid valve to develop. There is no communication from the R atrium to the R ventricle. Blood flows through an ASD or a patent foramen ovale to the left side of the heart and through a VSD to the R ventricle and out to the lungs. Complete mixing of unoxygenated and oxygenated blood = cyanosis, tachycardia and dyspnea.
Dehydration as a result of decreased fluid intake or increased fluid loss can cause hypovolemic shock.
True
Examples of external causes of hypovolemic shock are trauma, wounds, and surgery
True
Oxygen administration is appropriate therapy for any type of shock
True
Regardless of the cause the pathophysiologic cellular response is the same for all types of shock
True
What is truncus arteriosus?
Truncus arteriosus is failure of septation of the trunk into the pulmonary artery and the aorta, resulting in a single vessel that overrides both ventricles. Blood from both ventricles mixes in a common great artery, causing hypoxemia.
What is Hypoplastic Left Heart?
Underdeveloped left side of the heart resulting in hypo plastic LV & aortic atresia. Blood from LA flows thru foramen ovale to RA, to RV, & out pulm artery - PDA supplies systemic circulation
What is hypoplastic left heart syndrome?
Underdevelopment of the left side of the heart, resulting in a hypoplastic left ventricle and aortic atresia
The parent of an infant newly diagnosed with TOF is asking the nurse which defects are involved. SATA
VSD Right ventricular hypertrophy Pulmonary Stenosis Overriding aorta
What is ventricular Septal Defect?
VSD is an abnormal opening between the right and left ventricles. Many VSDs close spontaneously during the first year of life if small or moderate defects
What is mitral stenosis?
Valve thickens from fibrosis, calcifications, rheum carditis=can come from strep, leaflets fuse and bc stiff, chordea tendinae contract & shorten
Post-op open heart surgery care?
Vital Signs BP ECG CR Arterial / Venous Pressures Maintenance of respiratory Maintain fluid & elect's & AB *****Provide Pain Relief***** Increase nutritional intake Prevent infection Prevent & Assess for hemorrhage Provide emotional support for family
A pt is admitted for heart failure and has edema, NVD, and ascites. What is the most reliable way to monitor fluid gain or loss in the pt?
Weigh the pt daily at the same time with the same scale
The nurse is taking a history on a pt recently dx with heart failure. Then pt admits to "sometimes having trouble catching my breath", but is unable to provide more specific details. What question does the nurse ask to gather more data ab the pts symptoms?
What was your most strenuous activity in the past week?
The nurse is caring for a 3 month old patient with VSD. The physicians have decided not to repair it surgically. Then parents express concern that this is not best for their child, and ask why their daughter will not have an operation. The nurses best response to the parent is:
Your daughter's defect is small and will likely close on it's own by the time she is 2 yrs old.
S&S associated with Increased Pulm blood flow defects?
^BP Murmor Poor feeding & FTT Tachypnea Fatigue & DOE Resp failure w/ CHF Upper Resp Infect
What is stroke volume?
amnt of blood ejected by the left ventricle during each cx
What is CO?
amnt of blood pumped from the left ventricle ea minute
What is aortic stenosis?
aortic orifice narrows & restricts LV outflow during systole
What is aortic regurg?
aortic valve leaflets do not close properly during diastole & the annulus may be dilated, loose or deformed
What are the effects on aortic regurg on the heart?
back flow of blood from aorta back into LV during diastole, LV dilates & eventually hypertrophies
Where is the foramen ovale located?
between right atrium and left atrium.
What are the effects on Mitral stenosis on the heart?
blocks blood flow from LA to LV, LA pressure Increases, LA dilates, Pulmonary artery pressure Increases, RV hypertrophy=pulmonary congestion Right heart failure Decreased CO
What is the effect of mitral regurg on the heart?
blood back flows into L atrium, LA & LV hypertrophy from Increased volume
What is the effect on the heart with mitral valve prolapse?
can progress to mitral valve regurg
The nurse is caring for a patient with Hypovolemic shock. Which indicators of shock does the nurse monitor for?
decreasing urine output Increasing HR
As the ejection fraction decreases tissue perfusion ____ and blood accumulates in the ____ vessels
diminishes pulmonary
Cardiac Defect shunt:
goes from ^pressure to dec pressure to maintain survival
What is atrialventricular canal defect?
incomplete fusion of endocardial cushions, a low ASD & a high VSD result in a central hole Most common is L - R shunting of blood
The initial compensatory mechanism of the heart that maintains CO is increased ________
sympathetic stimulation
What is transposition of the Great Vessels?
the pulm artery leaves the LV & the aorta leaves from the RV with no comm. bt the systemic & pulmonary circulation. BLUE BABY! PT IS GETTING NO O2 BLOOD
What is mitral valve prolapse?
valvular leaflets enlarge & prolapse into LA during systole
