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210 Ch. 25 Ped

Cardio dysfx

CHF is? heart failing to meet needs of body. s/s: tachy, fatigue, weakness, restlessness, pale, cool extremities, decr bp/urinary outputq
s/s pulmonary congestion assoc with CHF tachy, dyspnea, resp distress, excercise intolerance(not infants), cyanosis....back up from L side, pul htn
s/s systemic venous congestion assoc with CHF peripheral edema, wt gain, ascites, hepatomegaly, neck vein disention..back up from R side, syst venous htn
two causes for CHF 1.overcirculation failure: blood mixes inside heart 2. pump failure: heart muscle becomes damaged, not contract
how is heart failure id by parents in infants? inf: poor feeding, breathing prob, poor growth, feel bounding pulse
Mgmt for CHF? meds? mgmt: remove fluid/Na, decr cardiac demands, improve tissue O2, decr O2 consumption med: Lanoxin(dig)..lowers HR, makes pump harder, check HR for 1m, hold <90 for infant, 70 in child, not receive more than 1ml dose, if >4ml, check math
s/s dig toxicity N/V, anorexia, brady, dysrhythmias
ACE inhibitors vasodilate so decr pul/sys resistance, decr bp, reduce afterload, "prils", take bp b4/after
diruetics Lasix, maybe fluid/Na restrict in diet, but most kids need to drink more water
Decr cardiac demands how? limit physical activity, keep warm, treat inf, elevate head, smaller more freq meals, sedate, stop crying,
maintain nutritional needs for CHF greater caloric needs, gavage feedings, promote fluid loss, measure I/O
Hypoxemia less than normal O2 sat 80-85%, cyanotic, can cause polycythemia and cause body to build more blood cause decr O2, so viscous blood, anemia, eisenmenger complex
s/s hypoxemia polycythemia, clubbing, squatting with TET, hypercyanotic spells tx: morphine to decr O2 demand nsg: watch for fever/inf(endocarditis), prevent dehydration(worsen polycythemia)
Prepare family/child for surgery post op: VS, hypothermic, suction, chest tube drainage(>3ml for more than 3h or >5ml for 1h call dr renal failure if <1ml/kg/hr w/ elevated BUN/creatinine
Infectious/inflammatory cardiac disorders Endocarditis: inf valves/endocardium cause:strep/staph/fungal inf prophylaxis: 1h b4 procedure tx: antbx, amphtericin B
Rheumatic Fever inflammatory disease after Group A B hemolytic strep, affects joints,skin,brain carditis: in mitral vavle arthritis, rash, subq nodules, aschoff bodies
St. Vitus Dance 5th manifestation symptom of RF, chorea: sudden aimless mvmts of extremities, involuntary, facial grimaces
Prevent RHD, rheumatic heart disease treat strep with penicillin, sulfa, erythromycin
Two types of heart transplants orthotopic, heterotopic(piggyback)....rejection is issue
sytemic hypertension primary: no known cause secondary: id cause tx: treat cause
Kawasaki Disease fever 105 for 5 days, rash in groin area, painful joints, red eyes, strawberry tongue, puffy hands/feet with peeling tx: IVIG, aspirin
types of shock: anaphylaxis septic(systemic inflammatory response syndrome) toxic shock anaphylaxis: allergen sensitivity s/s: resp prob, uticaria(hives), LOC Toxic: fever,chills, rash, desquamation on hands/feet tx: antbx, take tampon out in 4-6h
septic shock s/s vasodilation from fever so feel warm
Created by: palmerag