Nursing Care Pre
The day of the procedure the nurse must complete these two assessments?
Health History and physical assessment.
During the physical assessment the nurse must obtain baseline vital signs and assess for any infections that could make them reschedule the procedure.
Bleeding, arrhythmia, hematoma, thrombus formation, and infections are considered?
Postprocedural complications
Why is cardiac catheterization done on pediatrics? (Name on)
cardiovascular disease causing cyanosis, severe heart failure, questionable anatomic or physiologic abnormalities, planned cardiac surgery, progressive monitoring related to pulmonary hypertension, periodic assessment after repair of cardiac defect, therapeutics interventions such as septostomy or balloon valvotomy
What is the most commonly used site of insertion for a cardiac catheterization?
Groin.
can also go through the neck or arm.
When administering the loading dose of digoxin the pediatric client should have what type of monitor on?
Heart monitor or EKG
Before administering digoxin what test should be done to confirm the need of digoxin?
ECG.
This confirms that the first-line defenses have failed.
During the assessments the nurse also assess for allergies. What allergy should the nurse ask about for the cardiac catheterization?
Iodine or shell fish.
Hypotension may signify what?
hemorrhage.
The nurse should instruct the parents to look for signs and symptoms of an infection. What are 4 signs and symptoms of a possible infection?
redness, irritation, swelling, drainage
The nurse needs to obtain the pulse rate before administering digoxin. How should the nurse obtain the pulse?
Apical pulse.
Listen for 1 full minute.
Pulse rate reference range is 60-100bpm.
The nurse should administer IV digoxin over how many minutes?
5 minutes
This electrolyte must be with in its normal range of 3-3.5 mEq/L (Adults 3.5-5mEq/L) for pediatrics?
Potassium
What two pulses should the nurse assess, document the quality of the pulses, and mark the location that the pulses were found in?
Dorsalis pedis and posterior tibial.
The reason for this is to make finding the pulses easier or determine if there is no pulse.
The nurse should assess what in both lower extremities and document the quality of them?
Pulses
3 days
As the nurse you need to be aware of common side effects. What medication can cause bradycardia, dizziness, nausea and vomiting, dyspnea, and hypoglycemia?
Propranolol.
Older children may experience abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrythmias can indicate what?
Digoxin toxicity.
In infants and small children the first sign of toxicity is cardiac arrythmias.
Approximately how long after the initial loading dose should the serum digoxin levels be drawn?
6-8 hours.
It takes about 4-6 hours either orally or IV for digoxin to be distributed completely.
The nurse can do this with younger children when doing the assessment?
Play therapy.
This is showing the kid the equipment and allowing them to use them or showing them on their toy.
The nurse needs to stress the importance of keeping their extremity straight that was used for the cardiac catheterization insertion site for how long?
4-8 hours.
Following the procedure the nurse should instruct the parents to check their child's temperature for 3 days. At what temperature should the parents report to their provider?
100.4 degrees F
This classification is contraindicated in clients who have heart block, uncompensated heart failure, cardiogenic shock, asthma, and pulmonary edema.
Beta Blocker..
propranolol, atenolol, sotalol are listed in the chart in the book on page 1470 (Ricci, S. S. et al. 2012).
When diluting 1mL of digoxin for IV push the nurse should dilute with 4mL of sterile water. What are the 2 types of sterile water that can be used to dilute the digoxin?
D5W and 0.9% NaCl
This procedure is used to treat atrial flutter, atrial fibrillation, and heart failure by administering digoxin intravenously?
Digitalization.
This treatment is used when all other treatments have failed.
The nurse will also need to confirm that the child not had what withing 4-6 hours before the procedure?
food and drinks
If bleeding were to occur after the procedure where should the nurse hold pressure at to help stop the bleeding?
1 inch above the insertion site.
This will create pressure over the vessel which will reduce the blood flow in the area.
During the post care teaching with the parents. The nurse should tell the parents avoid letting their child swim or take any baths for approximately 3 days. What should the nurse advise the parents to do for bathing?
Sponge bath or shower
For left-sided catheterization the catheter is passed through and artery into the aorta into the left-side of the heart. During a right-sided catheterization the catheter is passed through a large vein into the atrium. What vein is most commonly used to access the right atrium?
Femoral vein
How frequently should the client have their serum digoxin levels drawn?
weekly
Digoxin has a vagomimetic effects on what node in the heart?
The AV node.
Vagomimetic - resembling action caused by stimulation of the vagus nerve.
For school-age and older kids the nurse can offer a tour of what unit?
Cardiac catheterization laboratory.
The nurse can also talk to them about sounds and sighs they my experience during procedure.
Clear liquids
You as the nurse receives a phone call from a concerned parent about their child vomiting after taking their dose of digoxin. The parent is asking if they should give a second dose due to the child vomiting. What should the nurse tell the parent?
Do not give a second dose of digoxin even though they vomited.
This can increase the risk of digoxin toxicity and should wait till the next administration. Regardless of vomiting the child still may have some of the medication in their system.
Due to the exposure of radiation on growing organs and tissues, what are pediatric clients more at risk for from the radiation exposure during cardiac catheterization?
Cancer.
Due to the organs and tissues growing kids are more susceptible to cancer.
For maintenance dosing the client should receive how much of the initial loading dose?
1/4 of the loading dose given 2 times a day.
If the loading dose is 20mcg/kg the maintenance dose will be 5mcg/kg given every 12 hours.
This medication is part of the Digitalis drug class that has a therapeutic serum levels for pediatrics is 1-2.6 nmol/L?
Digoxin.
adverse reaction are arrythmias, bradycardia, anorexia, fatigue, and ECG changes.
IV administration: 10 years and older 8-12mcg/kg, 5-10yrs 15-30mcg/kg, 2-5yrs 25-35mcg/kg, 1-24months 30-50mcg/kg, full-term infant 20-30mcg/kg, pre-term infant 15-25mcg/kg.
Contraindicated in uncontrolled ventricular arrythmias, and heart block. use cautiously in hypokalemia, hypercalcemia, and hypothyroidism.
These meds can cause the risk of toxicity spironolactone, verapamil, and loop diuretics. Bradycardia may occur if concurrent use of beta blockers and diltiazem.
Decrease in severity of heart failure and increase cardiac output.