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Patel CHF in peds

Pediatric Congestive Heart failure

What is Congestive Heart failure ? d/o of circulation in which cardiac output is inadequate to support the body's circulatory and metabolic needs.
what is the most common cause of CHF in infants ? Blood volume overload.
What are sx of CHF in infants The infant tires easily especially during feeding.
What are manifestations of CHF weight loss, lack of growth, sweating, irritability, frequent infections.
what are clinical manifestations of CHF in older children exercise intolerance, dyspnea, abdominal pain or distention, and peripheral edema.
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.
__________ is enlargement of the heart by hypertrophy of its walls, occurs as the heart attempts to maintain CO. Cardiomegaly
If CHF is not tx, cardiogenic shock may occur; what are the sx of CS cyanosis, weak pulses, cool extremities, hypotension, heart murmur
what are dx test for CHF based on clincal manifestations like tachycardia, resp distress and crackles. Chest radiograph, echocardiography, electrocardiogram
What are the goals of clinical therapy for CHF make the heart work more efficiently and to remove excess fluid.
What kind of diuretics cause K+ loss? Furosemide and chlorothiazide (K+ supps may be ordered)
What kind of diuretic does not cause K+ loss? spironolactone.
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)
What kind of drug is most commonly used to improve the heart's contractility and increase heart output? Digoxin (NOT DIGITOXIN)
What is the surgical tx of choice for a congenital heart defect ? correctional surgery or interventional cardiac catheterization
what kind of children might benefit from a heart transplant ? end stage cardiomyopathy or complex congenital heart defects like hypoplastic left heart syndrome.
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.
as diagnosis of CHF depends primarily on ________ nursing observations are important. physical sx
What med increases myocardial contractility by improving systemic circulation? Digoxin
What diuretic promotes rapid diuresis furosemide
what kind of diuretic is used for maintenance, decreases absorption of NA, water, K+, Cl, and HCO3 in renal tubules ? thiazides
this med promotes vascular relaxation and reduced peripheral vascular resistance. ACE inhibitor
Beta blocker that increases contractility Propanolol
Medication that improves left ventricular function, promotes vasodilation of systemic circulation for chronic heart failure and dilated cardiomyopathy carvedilol
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)
testing of developmental skills should be done with the __________ test. Denver II
What is the primary nursing dx for CHF decreased cardiac output r/t cardiac anomaly.
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.
what should you do before giving any dose of digoxin? take apical pulse for 1 minute.
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
Changes in heart rhythm and quality are noted before giving digoxin, what should you do ? hold the medication and call a physician for advice.
Children with CHF usually recieve ________ and _______. digoxin and furosemide
Signs of digoxin toxicity are ___________ . Early sign is arrhythmias.
Serum digoxin levels are taken ______ hours after dose. 6-8
What is the therapeutic serum level of digoxin? 0.8-2ng/ml
what level of serum digoxin is considered toxic in children ? 2ng/ml and higher.
Serum digoxin levels should be closely monitored when child is also taking what? antibiotic therapy because altered intestinal flora might precipitate digoxin toxicity.
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,
What should you do if child has abdominal ascites ? measure abdomen every day.
What should you do to prevent skin breakdown when edema is present ? turn the child freq. and provide skin care.
What position promotes the maximum level of oxygenation in a child ? semi-fowlers or 45degree angle
What is the importance of monitoring side effects of digoxin and K levels ? prevent injury
child should recieve ____________ to prevent overexertion of the heart . rest periods each hour
What is a sign of increased respiratory effort ? diaphoresis.
an infant should be held at what position during feeding ? at a 45 degree angle
How should a child with CHF be fed throughout the day ? small frequent meals with rest periods in between
What should be expected if child is not gaining weight ? NG feedings supplemental
feeding should last no longer than ________ 20-30 minutes.
children should engage in what kind of activity? quiet activites like watching tv or playing board games, no aggresive or horseplay kind of stuff.
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.
Breast feeding should be encouraged because ______________ breast milk reduces infections because of antibodies and it is naturally low in NA.
What are the manifestations of a deteriorating cardiac status while feeding ? decreased intake, vomiting, sleeing through feedings, increased perspiration.
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.
What are the sx that CHF is worsening ? feeding difficulty, irritability, lethargy, breathing difficulty, puffiness around eyes or extremities.
An ______ in pulse rate can signal CHF and a ________ can indicate digoxin toxicity. increase, decrease
do not give any herbals with digoxin because it may cause ___________. toxicity
Digoxin should be administered at ________ each day and consistent in ___________ meals . same time, before or after
Created by: puja