Pediatric Congestive Heart failure
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| What is Congestive Heart failure ? | d/o of circulation in which cardiac output is inadequate to support the body's circulatory and metabolic needs.
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| what is the most common cause of CHF in infants ? | Blood volume overload.
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| What are sx of CHF in infants | The infant tires easily especially during feeding.
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| What are manifestations of CHF | weight loss, lack of growth, sweating, irritability, frequent infections.
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| what are clinical manifestations of CHF in older children | exercise intolerance, dyspnea, abdominal pain or distention, and peripheral edema.
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| As CHF progresses, what sx are manifested | tachypnea, tachycardia, pallor, cyanosis, nasal flaring, grunting, retractions, cough, crackles, FVO, periorbital and facial edema, hepatomegaly (FVE) JVD in older children.
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| __________ is enlargement of the heart by hypertrophy of its walls, occurs as the heart attempts to maintain CO. | Cardiomegaly
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| If CHF is not tx, cardiogenic shock may occur; what are the sx of CS | cyanosis, weak pulses, cool extremities, hypotension, heart murmur
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| what are dx test for CHF | based on clincal manifestations like tachycardia, resp distress and crackles. Chest radiograph, echocardiography, electrocardiogram
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| What are the goals of clinical therapy for CHF | make the heart work more efficiently and to remove excess fluid.
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| What kind of diuretics cause K+ loss? | Furosemide and chlorothiazide (K+ supps may be ordered)
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| What kind of diuretic does not cause K+ loss? | spironolactone.
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| what kind of medications are used to lessen the heart's workload and help it to work more efficiently ? | Inotropic medicine (improve velocity of contractility) and ACE inhibitors (reduce afterload)
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| What kind of drug is most commonly used to improve the heart's contractility and increase heart output? | Digoxin (NOT DIGITOXIN)
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| What is the surgical tx of choice for a congenital heart defect ? | correctional surgery or interventional cardiac catheterization
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| what kind of children might benefit from a heart transplant ? | end stage cardiomyopathy or complex congenital heart defects like hypoplastic left heart syndrome.
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| what is other types of supportive medical therapy for CHF? | airway management, ventilatory support, rest and fluid, diet, oxygen, Most children improve rapidly after meds are adminstered.
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| as diagnosis of CHF depends primarily on ________ nursing observations are important. | physical sx
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| What med increases myocardial contractility by improving systemic circulation? | Digoxin
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| What diuretic promotes rapid diuresis | furosemide
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| what kind of diuretic is used for maintenance, decreases absorption of NA, water, K+, Cl, and HCO3 in renal tubules ? | thiazides
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| this med promotes vascular relaxation and reduced peripheral vascular resistance. | ACE inhibitor
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| Beta blocker that increases contractility | Propanolol
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| Medication that improves left ventricular function, promotes vasodilation of systemic circulation for chronic heart failure and dilated cardiomyopathy | carvedilol
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| what is the physiologic assessment in a child with CHF | vitals, behavior, cardiac , resp, fluid status, detailed hx of onset of sx, (CHF develops slowly over time)
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| testing of developmental skills should be done with the __________ test. | Denver II
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| What is the primary nursing dx for CHF | decreased cardiac output r/t cardiac anomaly.
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| What should you do before giving the digitalizing dose of digoxin ? | get baseline vitals, quality of pulses, clinical sx, and ECG, serum electrolytes, hepatic and renal fx, hydration and hypovolemia.
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| what should you do before giving any dose of digoxin? | take apical pulse for 1 minute.
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| Before giving a dose of digoxin, you take the apical pulse and find that pulse is less than 60-100bpm or below 60 in teens, what should you do? | Hold the medication
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| Changes in heart rhythm and quality are noted before giving digoxin, what should you do ? | hold the medication and call a physician for advice.
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| Children with CHF usually recieve ________ and _______. | digoxin and furosemide
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| Signs of digoxin toxicity are ___________ . | Early sign is arrhythmias.
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| Serum digoxin levels are taken ______ hours after dose. | 6-8
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| What is the therapeutic serum level of digoxin? | 0.8-2ng/ml
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| what level of serum digoxin is considered toxic in children ? | 2ng/ml and higher.
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| Serum digoxin levels should be closely monitored when child is also taking what? | antibiotic therapy because altered intestinal flora might precipitate digoxin toxicity.
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| What are nsg interventions r/t monitoring fluid status | I and O, wieighing infant diapers, 1g=1ml of urine, assess edema, and circulation, daily weights,
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| What should you do if child has abdominal ascites ? | measure abdomen every day.
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| What should you do to prevent skin breakdown when edema is present ? | turn the child freq. and provide skin care.
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| What position promotes the maximum level of oxygenation in a child ? | semi-fowlers or 45degree angle
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| What is the importance of monitoring side effects of digoxin and K levels ? | prevent injury
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| child should recieve ____________ to prevent overexertion of the heart . | rest periods each hour
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| What is a sign of increased respiratory effort ? | diaphoresis.
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| an infant should be held at what position during feeding ? | at a 45 degree angle
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| How should a child with CHF be fed throughout the day ? | small frequent meals with rest periods in between
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| What should be expected if child is not gaining weight ? | NG feedings supplemental
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| feeding should last no longer than ________ | 20-30 minutes.
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| children should engage in what kind of activity? | quiet activites like watching tv or playing board games, no aggresive or horseplay kind of stuff.
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| what kind of exercises should children do to promote large muscle development without over exerting themselves ? | sitting, standing, walking for short periods with adequate rest afterwards.
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| Breast feeding should be encouraged because ______________ | breast milk reduces infections because of antibodies and it is naturally low in NA.
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| What are the manifestations of a deteriorating cardiac status while feeding ? | decreased intake, vomiting, sleeing through feedings, increased perspiration.
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| The most important thing to teach when sending a child home to the parents is to teach _______ and ______. | administration of medications and signs of worsening condition.
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| What are the sx that CHF is worsening ? | feeding difficulty, irritability, lethargy, breathing difficulty, puffiness around eyes or extremities.
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| An ______ in pulse rate can signal CHF and a ________ can indicate digoxin toxicity. | increase, decrease
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| do not give any herbals with digoxin because it may cause ___________. | toxicity
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| Digoxin should be administered at ________ each day and consistent in ___________ meals . | same time, before or after
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