flash cards

Test 12 Congestive Heart Failure

Question Answer
Congestive Heart Failure: the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.
Congestive Heart Failure: Classifications (two categories): Right-sided failure; Left-sided failure
Congestive Heart Failure: Right-sided failure where the ventricle is unable to pump blood effectively into the pulmonary artery.
Congestive Heart Failure: Left-sided failure where the left ventricle is unable to pump blood into the systemic circulation.
Congestive Heart Failure: It is clinical unusual to observe signs and symptoms that are indicative specifically of only right- or left- sided failure in children.
Congestive Heart Failure: Clinical Manifestations (three groups): Impaired Myocardial Function; Pulmonary Congesting; Systemic Venous Congestion
Congestive Heart Failure: Clinical Manifestations: Impaired Myocardial Function: Tachycardia. Sweating. Decreased urine output. Fatigue, weakness and restlessness. Anorexia. Decreased peripheral pulses. Decreased blood pressure. Gallop rhythm. Cardiomegaly.
Congestive Heart Failure: Clinical Manifestations: Pulmonary Congesting: Tachypnea. Dyspnea. Retractions in infants. Flaring nares. Exercise intolerance. Orthopnea.Cough, hoarseness. Cyanosis. Wheezing. Grunting.
Congestive Heart Failure: Clinical Manifestations: Systemic Venous Congestion: Weight gain. Hepatomegaly. Peripheral edema. Ascites. Neck vein distention.
Congestive Heart Failure: Diagnosis: 1. Diagnosis is based on symptoms.2. Chest x-ray shows cardiomegaly and increased pulmonary blood flow.3. EKG shows ventricular hypertrophy.
Congestive Heart Failure: Therapeutic Management: Goals: To improve cardiac function (increase contractility and decrease afterload).
Congestive Heart Failure: To improve cardiac function (increase contractility and decrease afterload): Administration of digitalis glycosides.
Congestive Heart Failure: Administration of digitalis glycosides. Digoxin is given orally or intravenously in divided doses over 24 hours to produce optimal effects.
Congestive Heart Failure: Administration of digitalis glycosides. Digoxin (Lanoxin): slow and strengthen the heartbeat.
Congestive Heart Failure: To improve cardiac function (increase contractility and decrease afterload): Angiotensin-Converting Enzyme (ACE) inhibitors are given.
Congestive Heart Failure: Angiotensin-Converting Enzyme (ACE) inhibitors are given. Captopril (Capoten): given three times a day.
Congestive Heart Failure: Angiotensin-Converting Enzyme (ACE) inhibitors are given. Enalapril (Vasotec): given two times a day.
Congestive Heart Failure: Therapeutic Management: Goals: Remove accumulated fluid and sodium (decrease preload):
Congestive Heart Failure: (b) Remove accumulated fluid and sodium (decrease preload): Diuretics; Fluid restrictions.
Congestive Heart Failure: Diuretics: furosemide (Lasix).chlorothiazide (Diuril). spironolactone (Aldactone).
Congestive Heart Failure: Therapeutic Management: Goals: Decrease cardiac demands:
Congestive Heart Failure: Decrease cardiac demands: Limit physical activity.Preserving body temperature.Treating infections.Reduce the effort of breathing.Prescribed medications to sedate an irritable child.
Congestive Heart Failure: Therapeutic Management: Goals: Improve tissue oxygenation and decrease oxygen consumption:
Congestive Heart Failure: Improve tissue oxygenation and decrease oxygen consumption: Use supplemental oxygen as ordered.
Congestive Heart Failure: Improve tissue oxygenation and decrease oxygen consumption: An oxyhood is preferred with young infants whereas a nasal cannula or face tent may be used with older infants and children.
Congestive Heart Failure: Improve tissue oxygenation and decrease oxygen consumption: Cool humidification is necessary to counteract the drying effects of the oxygen
Congestive Heart Failure: Nursing Considerations: Position the child for optimal ventilation.Administer oxygen by the most effective means.
Congestive Heart Failure: Nursing Considerations: IV access is established.Cardiac and respiratory function is monitored continuously via cardiac monitor and pulse oximeter.
Congestive Heart Failure: Nursing Diagnoses include: Decreased cardiac output related to structural defect, myocardial dysfunction.
Congestive Heart Failure: Nursing Diagnoses include: Ineffective breathing pattern related to pulmonary congestion.
Congestive Heart Failure: Nursing Diagnoses include: Fluid volume excess related to fluid accumulation/edema.
Congestive Heart Failure: Nursing Diagnoses include: Activity intolerance related to imbalance between oxygen supply and demand
Congestive Heart Failure: Nursing Diagnoses include: Risk for infection related to reduced body defenses, pulmonary congestion.
Congestive Heart Failure: Nursing Diagnoses include: Altered family processes related to a child with a life-threatening illness.
Congestive Heart Failure: Nursing Considerations: Assist in measures to improve cardiac function: Administer digoxin Count pulse (resting pulse if possible) for one full minute prior to administration.
Congestive Heart Failure: Nursing Considerations: Assist in measures to improve cardiac function: Administer digoxin If pulse rate is below 90-100 BPM the medication should be held and the physician notified.
Congestive Heart Failure: Nursing Considerations: Assist in measures to improve cardiac function: Administer digoxin In older children the pulse should be above 70 BPM.
Congestive Heart Failure: Nursing Considerations: Assist in measures to improve cardiac function: Administer digoxin: Observe for signs of toxicity: Nausea and vomiting.Anorexia.Sudden change in pulse.
Congestive Heart Failure: Nursing Considerations: Assist in measures to improve cardiac function: For children receiving ACE inhibitors monitor blood pressure before and after dose administration observing for hypotension and notify the provider if this occurs.
Congestive Heart Failure: Nursing Considerations: Decrease cardiac demands: Promote rest by organize care so that the infant is not unnecessarily disturbed
Congestive Heart Failure: Nursing Considerations: Decrease cardiac demands: Encourage parents to stay with child to providing the nurturing the infants and children need to sleep more soundly
Congestive Heart Failure: Nursing Considerations: Decrease cardiac demands: Feed the child when they are hungry instead of on a specific schedule. Feed in smaller quantities more frequently as indicated
Congestive Heart Failure: Nursing Considerations: Decrease cardiac demands: Closely monitor temperature promoting normothermia.
Congestive Heart Failure: Nursing Considerations: Reduce respiratory distress by positioning and administering oxygen as ordered.
Congestive Heart Failure: Nursing Considerations: Protect child from persons with respiratory infections and have a noninfectious roommate.
Congestive Heart Failure: Nursing Considerations: Maintain nutritional status: Feed small frequent meals.
Congestive Heart Failure: Nursing Considerations: Maintain nutritional status: Gavage feed meals as needed to ensure adequate calories in a child who is very stressed or fatigued, in respiratory distress or is tachypneic.
Congestive Heart Failure: Nursing Considerations: Maintain nutritional status: Use high calorie formula.
Congestive Heart Failure: Nursing Considerations: Assist in measures to promote fluid loss by: Giving diuretics as ordered.Maintaining strict I & O’s.Assess for dehydration.
Congestive Heart Failure: Nursing Considerations: Support child and family: Focus on reducing anxiety through anticipatory preparation, frequent communication with parent regarding the child’s progress and constant reassurance that everything possible is being done
Congestive Heart Failure: Nursing Considerations: Home care includes: Teaching the family about medications.
Congestive Heart Failure: Nursing Considerations: Home care includes: Teaching the family about the signs of worsening CHF that require medical attention Increased sweating.Decreased urine output.Poor feeding.
Decreased urine output can be a sign of what? Decreased cardiac output.

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