Rx For Success
This medication keeps the ductus arteriosus open in patients with ductal dependent heart disease
What are Prostaglandins?
These common newborn medications are recommended to be given to every baby, including cardiac patients, within the 1st hour of life.
What are erythromycin and vitamin K (eyes and thighs)?
This blueish skin tint is an assessment finding that can indicate poor perfusion and low oxygen levels.
What is cyanosis?
Many cardiac patients don’t tolerate feeds well due to their abnormal blood flow. That is why many of these patients on prostaglandins are started low and slow on ________ feeds through an NG or OG tube.
What is continuous?
This is a physiologic state characterized by inadequate oxygen delivery to body tissues.
What is shock?
This class of medications helps increase cardiac output by improving cardiac contractility and increasing heart rate
What are inotropes?
If ordered, four-extremity blood pressures should be obtained at admission and, at minimum, every _____ hours.
What is 12?
You are monitoring pre- and postductal oxygen saturations. Your new resident asks what extremity the preductal O2 sat is measured on. You tell them preductal O2 sats should be measured on the _______.
What is the right hand?
Many cardiac patients need respiratory support, but not extra oxygen. This is the lowest percent of oxygen we can give (i.e., “room air”).
What is 21%?
To compensate in a shock state, your body will shunt blood away from “less vital” organs. When blood is shunted away from the kidneys, we see it as this assessment finding.
What is low urine output?
Your patient has DiGeorge syndrome, and is hypotensive. You anticipate needing to give them ________, which will improve their electrolyte levels and support their cardiac output at the same time!
What is calcium (gluconate)?
This monitoring system measures the relative oxygenation of regional tissues, usually the brain and the flank (kidneys).
What are NIRS?
Your new resident orders an ABG for your cardiac patient. As a knowledgeable nurse, you know to ask the resident to order a _________ level too, which is an early indication of poor oxygen delivery to tissues.
What is lactate?
When cardiac patients go into shock, blood shunts away from their gut in order to preserve blood flow to vital organs. If your cardiac patient is experiencing this, they may exhibit ______ ______.
What is feeding intolerance (or poor feeding)?
You suspect your cardiac patient is entering a shock state. They are tachycardic with poor feeding, but still have a normal blood pressure. Because you caught it early, your patient is in __________ shock.
What is compensated?
Your patient is receiving prostaglandins, when the IV pump suddenly starts beeping off “occluded”. You trace your line, find the problem, and fix it, ensuring that the infusion isn't stopped. Thank goodness you set the IV pump pressure limit to ____mmHg, per policy!
What is 150 mmHg?
Far from doing double the work, these respiratory-related vital sign measurements are important to initiate for patients who have a ductal-dependent defect
What are pre- and postductal oxygen saturations?
An increase in this vital sign is often an early sign of respiratory compromise in cardiac newborns.
What is respiratory rate?
Your cardiac patient is on high flow nasal cannula and is not doing well. They are having worsening tachypnea and work of breathing. Their lactate on their ABG is rising. You anticipate needing to ________ your patient, so they can receive positive pressure ventilation.
What is intubate?
You start your shift by obtaining vital signs on your “mixed satter” cardiac patient. The VS are:
Which two vital signs warrant follow-up and escalation to your first call provider?
What are O2 sat and RR?
Your patient is more tachypneic, with new coarse breath sounds. You and your resident are concerned about worsening pulmonary edema. You anticipate giving a medication from this class, which will help the patient pee out extra fluid.
What are diuretics?
A new cardiac baby is admitted to the NICU, with a suspected ductal-dependent cardiac defect. The baby is doing well, has been hooked up to monitoring, and has a PIV. Your provider has put in the following orders:
- Obtain 12-lead EKG
- Initiate prostaglandin infusion
- Initiate maintenance fluids (D10)
- Begin NIRS monitoring on head and flank
This is the next priority intervention based on this order set.
What is initiate prostaglandin infusion?
Many cardiac patients are considered “mixed satters”, meaning they have a lower oxygen saturation goal due to mixing oxygenated and deoxygenated blood. In general, patients like this should have an oxygen saturation goal of _____ to ______%.
What is 75-85%?
Your cardiac patient is on 2L 21% nasal cannula. At your next assessment, your patient is more tachypneic with new moderate subcostal retractions. Your resident says we need to escalate respiratory support. You anticipate putting them on ____ _____ _____ _____, which can give them more support.
What is high flow nasal cannula?
You get a notice that your patient’s ABG + lactate results are in the computer. Their (abbreviated) results are:
Which result best indicates poor tissue perfusion and a potential shock state?
What is lactate?