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Cardiac Output
- CO=HR X SV
- the volume of blood ejected by the heart in 1 min
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Stroke Volume
- Preload, afterload, and contractility
- amount of blood ejected by the heart in any one contraction
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Preload
Volume of blood returning to the heart or circulating blood volume
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Afterload
resistance against which the ventricles must push to pump blood out
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contractility
efficiency of the myocardial fiber shortening or the ability to pump
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Chest X-ray
- heart size and configuration
- pulmonary blood flow
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Preop for cardiac cath
- teach child about procedure
- -what they will feel, hear, and see
- -videos, picture books, tour of cath lab
- may need to withhold morn meds
- NPO
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Cardiac Cath complications
Pulses distal to site may be weaker for the first couple of hours but will gradually increase in strength and then be equal and symmetric
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If a postop cardiac cath pt has a soaked bandage, what do you do?
direct continuous pressure 1 inch above the site
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What is CHF most likely related to?
Most commonly related to defects (VSD is the mosti common)
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Why would you see CHF in kids?
- related to defects
- increased risk with maternal chronic illness like diabetes, poorly controlled phenylketonuria, alcohol consumption, exposure to environmental toxins or infections
- highly related to trisomy 21,13,18
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What is the normal heart rate for a newborn?
- Awake- 100-180
- Sleep- 80-160
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What is the normal HR for 1 wk- 3 month?
- 100-220- awake
- 80-200- sleep
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What is the normal HR for 2 month - 2yr?
- 80-150 awake
- 70-120 asleep
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What is the normal HR for 2yr-10yr?
- Awake- 70-110
- Asleep- 60-90
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What is the normal HR for 10 yr- adult?
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What are examples of ACE inhibitors?
Catopril, enalapril, lisonopril
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What is the apical pulse that you would withhold dig?
- Infants and young children >90-110
- Older children > 70
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Dig Toxicity
- bradycardia, nausea, freq vominting
- visual and neuro disturbances
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What parents need to know about administering dig:
- regular intervals
- administer to the side back of the mouth
- do not mix with food or fluid
- if child has teeth- rinse with water or brush teeth
- if dose is missed or vomited do not repeat dose
- if more than 2 doses are missed call HCP
- keep in safe place- pref locked cabinet
- if OD suspected call nearest poison control
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Nutrition for child with CHF
- Increased calories
- feed immediately after awakening
- ensure good rest before feeding
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What should you monitor with an infant with CHF?
Weight- same scale same time of day
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How would you decrease risk of CVA in a child in a hypoxic state?
Give fluids
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What position should you put a child in during a hypercyanotic spell?
Knee to chest- reduces the venous return from th elegs and increases systemic vascular resistance wich diverts more blood into pulm artery
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What can a left to right shunt lead to?
increased pressure to the pulmonary artery which leads to pulm edeam which leads to CHF
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VSD and ASD are categorized as:
increased pulmonary blood flow
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PDA- Patent Ductus Arteriosus is surgically closed to prevent what?
increased pulm blood flow--> CHF
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Increased Pulmonary Blood Flow
- ASD
- VSD
- PDA
- Atrioventricular canal
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Decreased pulmonary blood flow
- tetralogy of fallot
- tricuspid atresia
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Mixed blood flow
- transposition of great arteries
- total anomalous pulmonary venous return
- truncus arteriosus
- hypoplastic left heart syndrome
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obstruction of blood flow from ventricles
- coartation of aorta
- aortic stenosis
- pulmonic stenosis
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Tetralogy of fallot
- ventricular septal defect
- pulmonic stenosis
- overriding aorta
- right ventricular hypertrophy
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A mother of a child with congenital heart disease is worried about letting him play with other kids?
- most do not need to restrict activity
- treat child normally and allow self limited activity
- decide which sports need to be restricted with cardiologist
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Prepping kid for heart surgery
- Educate on procedure and what to expect before after and during
- reduce anxiery, improve pt cooperation
- ICU tour may be wanted- avoid frightening sights
- review importance of deep breathing, ambulation, drinking and eating after surgery
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What do you do if a kid has a fever after surgery?
Notify HCP
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Suctioning with a child after heart surgery
provide oxygen before and after
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What is a worrisome amount of chest drainage?
- more than 3ml/kg/hr
- 5-10ml in any 1 hr
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If a child with VSD is not feeling well and has been having fevers, what should the nurse tell the parents
Tell them to bring them in
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Who is at a high risk for infective (bacterial) endocarditis?
- congenital anomalies, previous heart surgery, indwelling catheters
- artificial heart valves
- previous Dx of IE
- CHD
- cardiac transplant with cardiac valvulopathy
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What are the clinical manifestations of rheumatic fever?
- carditis
- polyarthritis
- chorea
- erythema maginatum
- subcutaneous nodules
- arthralgia, fever
- elevated ESR & C reactive
- positive strep test
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Why do you typically get rheumatic fever?
a previous infection of groub A beta hemolytic streptococci
- TX penicillin
- children who have had it are at risk to have again
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What is the therapeutic management of kawasaki's disease?
- Salicylates like aspirin to reduce inflammation and fever
- IVIG- early intervention to reducve fever and incidence of coronary artery abnmormalities
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How do you get an accurate measurement of BP to dx HTN?
- Sitting postition on at least 3 diff occasions
- make sure child is quiet and relaxed
- make sure cuff fits
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What is the HTN drug related to angiotensin II?
ACE inhibitors
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Cholestoral screening- when do you want to check
- Obesity
- Family Hx of elevated cholesterol or early heart disease
- cigarrete smoking
- diabetes type I or II
- hypertension
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What is the leading cause of death after cardiac transplant?
- Initially rejection
- long term CAD
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What are the discharge instructions for cardiac cath?
- Remove pressure dressing 1 day after cath
- cover site with a bandaid, change daily for 2 days
- keep site clean and dry
- avoid tub bath for 3 days
- older children may shower 1st day after
- observe for signs of redness, swelling, drainage, bleeding, fever
- monitor cardiac cath leg for coolness
- notify HCP if any are observed
- child should avoid strenuous activity for several days
- may attend school
- may resume reg diet without restrictions
- use acetaminophen or ibuprofen for pain
- keep follow up appts per practitioner instructions
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