NR 328 Exam 2 Study Guide
I I I I I
Fluid I& IElectrolytes IChapter I29:
• Signs Iand Isymptoms Iof Ifluid Ioverload I Ipg. I1056 pg. I949 I& I956-957
Generalized Iedema, Ipulmonary Iedema I(moist Irales I& Icrackles), IHepatomegaly, Islow Ibounding Ipulse, Iweight
Igain, Ilethargy, Ielevated Ivenous Ipressure, Iseizures, Icoma. ILab Ifindings: IDecreased Iserum Ielectrolytes, Ilow Iurine
Ispecific Igravity, Idecreased Ihematocrit, Ivariable Iurine Ivolume.
• Signs Iand Isymptoms Iof Ifluid Ideficit pg. I1056 pg. I949 I& I951-955
Top I3: I#1 IPoor Iskin Iturgor I#2 Iabnormal Irespirations= ITachypnea I#3 IProlonged Icapillary Irefill I>2 Isecs
ITachycardia, Idry Iskin I& Imucous Imembranes, Isunken Ieyes I& Ifontanels, Iirritability, Ilethargy, Ithirst, Iweight Iloss,
Idiminished Iurine Ioutput, Iand Ialtered Ilevel Iof Iconsciousness, Idisorientation. ILab Ifindings: IHigh Iurine Ispecific
Igravity, Iincreased Ihematocrit, Iincreased IBUN, Iincreased Iserum Iosmolality
• Hypo Iand Ihyperkalemia I& IFoods Ithat Icontain Ipotassium Pg. I1359 pg. I1271
➢ Hypokalemia:
o < I3.5 ImEq/L
o Abnormal IEKG; Inotched Ior Iflattened IT Iwaves, Idecreased IST Isegment, Ipremature
Iventricular Icontractions
o I Muscle Iweakness, Icramping, Istiffness, Iparalysis, Ihyporeflexia, Ihypotension, Icardiac Iarrhythmias,
gallop Irhythm, Itachycardia Ior Ibradycardia, Iileus, Iapathy, Idrowsiness, Iirritability, Ifatigue
➢ Hyperkalemia:
o > I5.5 ImEq/L
o Variable Iurine Ivolume
o Flat IP Iwave Ion IECG, Ipeaked IT Iwaves, Iwidened IQRS Icomplex, Iincreased IPR Iinterval
o I Muscle Iweakness, Iflaccid Iparalysis, Itwitching, Ihyperreflexia, Ibradycardia, Iventricular Ifibrillation
Iand Icardiac Iarrest, Ioliguria, Iapnea—respiratory Iarrest
➢ Foods Ithat Icontain Ipotassium: IFoods Iwith Ithick Iskin: IOranges, Ibanana, Inuts, Isquash, Icarrots, Ibroccoli,
kale, Itomatoes, Ibeans, Iavocado, Ifish, Imushrooms
• Signs Iand Isymptoms Iof Ihypo I& Ihypernatremia pg. I1056 Ipg. I949-950
➢ Hyponatremia I(less Ithan I135 ImEq): Ianorexia, Inausea, Ivomiting, Iweakness, Ilethargy, Iconfusion,
Imuscle Icramps, Itwitching, I& Iseizures.
➢ Hypernatremia I(more Ithan I145 ImEq): IThirst, Ihyperpyrexia I(Extremely Ihigh Ifever), Isticky Imucous
membranes, Idry Imouth, Ioliguria I(diminished Iurine Ioutput) Ihallucinations, Ilethargy, Iirritability, I&
Iseizures.
• Types Iof Idehydration: IIsotonic, Ihypotonic, Ihypertonic I(see IEcollege:DocSharing: IPowerpoints: IGI
Idysfunction)
➢ Babies= IECF I> IICF I(75% Iwater) Ileads Ito Imore Irapid Iloss
➢ Isotonic IDehydration: IThis Iis Ithe Iprimary Iform Iof Idehydration Ioccurring Iin Ichildren I(Na Iremains
Inormal Isince IH2O Iloss Iand Ielectrolyte Iloss Iare Iequal. ILeads Ito Ishock) IH2O Iloss I= Ielectrolyte Iloss I
Ihypovolemic Ishock. IThe Imajor Iloss Iis Ifrom Ithe IECF. ISymptoms Iare Irelated Ito Ihypovolemic Ishock
➢ Hypotonic IDehydration: I Dehydration Ioccurs Iwhen Ithe Ielectrolyte Ideficit Iexceeds Ithe Iwater Ideficit.
Water Imoves Ifrom IECF Ito IICF Iwhich Ifurther Iincreases Ithe IECF Ivolume Iloss Iand Ileads Ito Ishock. I(Na
Ilevel Iusually Iless Ithan I130 ImEq/L) IElectrolyte Iloss I>H2O Iloss I Ishock I& Iseizures I(low Isodium)
, ➢ Hypertonic IDehydration: IDehydration Iresults Ifrom Iwater Iloss Iin Iexcess Iof Ielectrolyte Iloss Iand Iis
Iusually Icaused Iby Ia Iproportionately Ilarger Iloss Iof Iwater Ior Ia Ilarger Iintake Iof Ielectrolytes. IThis Itype Iof
Idehydration Iis Ithe Imost Idangerous Iand Irequires Imuch Imore Ispecific Ifluid Iof Itherapy. I(Na Ilevel Iusually
Igreater Ithan I150 ImEq/L ICauses Ilethargy, Iseizures, Ihyperirritability Ito Istimuli Ilosing Ifluid Ifrom Ithe IICF)
IH20 Iloss I> Ielectrolyte Iloss I Ineuro.
• Nursing Icare Iof Idehydration: Ioral I& Iintravenous Irehydration, I reintroduction Iof Iregular Idiet
The Imajor Igoals Iin Ithe Imanagement Iof Iacute Idehydration Iinclude I1) Iassessment Iof Ifluid Iand Ielectrolyte
Iimbalance, I2) Irehydration I3) Imaintenance Ifluid Itherapy, Iand I4) Ireintroduction Iof Ian Iadequate Idiet. ITreat Iinfants
Iand Ichildren Iwith Iacute Idiarrhea Iand Idehydration Ifirst Iwith Ioral Irehydration Itherapy I(ORT). IORT Iis Ione Iof Ithe
Imajor Iworldwide Ihealth Icare Iadvances. IIt Iis Imore Ieffective, Isafer, Iless Ipainful, Iand Iless Icostly Ithan IIV
Irehydration. IOral Irehydration Isolutions I(ORSs) Ienhance Iand Ipromote Ithe Ireabsorption Iof Isodium Iand Iwater.
These Isolutions Igreatly Ireduce Ivomiting, Ivolume Iloss Ifrom Idiarrhea, Iand Ithe Iduration Iof Ithe Iillness.IRehydration
Iwith Ioral Isolutions Ican Ibe Iused Iover I4-6hours Iof Imild Ito Imoderate Idehydration.
IV Irehydration I(Normal Isaline I20ml/kg; Ilactated Iringers I20ml/kg I Iinfuse Iover I20minutes. IYou Ineed Ia Idoctor’s
Iorder Ito Ido Ia Ibolus) Iif Isevere Iand Iunable Ito Itake Iby Imouth I(PO). IReintroduction Iof Iregular Idiet Iafter
Irehydration.
• Know Ithe Iformula Ifor Icalculating Ithe Idaily Ifluid Irequirements Ibased Ion Ikg Iweight Iof Ia Ichild Ipg.947
➢ 1-10kg I= I100ml/kg
➢ 11-20kg I= I1000ml I+ I50ml/kg Ifor Ieach Ikg I> I10kg
➢ > I20kg I= I1500ml I+ I20ml/kg Ifor Ieach Ikg I> I20 Ikg
Cardiovascular Iconcepts IChapter I34:
• Review IVSD, Icoarctation Iof Ithe Iaorta Isymptoms, Iexpected Ilabs, Inursing Idiagnoses
➢ Ventricular ISeptal IDefect I(VSD): Iis Ian Iabnormal Iopening Ibetween Ithe Iright Iand Ileft Iventricles.
20-60% Iof IVSDs Iclose Ispontaneously I(spontaneous Iclosing Iis Imore Ilikely Ito Ihappen Iduring Ithe Ifirst Iyear
Iof Ilife Iin Ichildren Ihaving Ismall Ior Imoderate Idefects).
➢ Signs Iand Isymptoms Iof IVSD: Imurmur, Ipoor Ifeeding Iand Ifailure Ito Ithrive, Ifast Ibreathing Iand Ifatigue I&
SOB. IIt Iis Iclassified Iunder Iincreased Ipulmonary Iblood Iflow I(acyanotic Idefect).
➢ Diagnostic Itests I(9th Iedition Itable I34-1 I<procedures Ifor Icardiac Idiagnosis> Ipg I1346 Iis Ia Igood Itable):
IRadiologic Iimaging I(chest IX-ray), IElectrocardiography, IEchocardiography, ICardiac Icatheterization I(most
Iinvasive), ICardiac Imagnetic Iresonance Iimaging.
➢ Coarctation Iof Ithe Iaorta Isymptoms I(obstructive Idefect): I is Ia Inarrowing Iof Ithe Iaorta. IWhen Ithis Ioccurs,
your Iheart Imust Ipump Iharder Ito Iforce Iblood Ithrough Ithe Inarrow Ipart Iof Iyour Iaorta. ISymptoms Iinclude:
IPale Iskin, Iirritability, Iheavy Isweating, Idifficulty Ibreathing, Imurmur, Ia Iweak Ior Idelayed Ipulse, Ihigh Iblood
Ipressure, Iand Idifficulty Ifeeding I(failure Ito Ithrive).
➢ Nursing Idiagnoses:
o Fluid Ivolume Iexcess Irelated Ito Iedema Isecondary Ito ICHF
o Impaired Igas Iexchange Irelated Ipulmonary Icongestion Isecondary Ito Iincreased Ipulmonary Iblood Iflow
o Imbalanced Inutrition: ILess Ithan Ibody Irequirements Irelated Ito Irespiratory Idistress, Ifeeding Idifficulties
o Interrupted IFamily IProcesses Irelated Ito Ipresence Iof Ia Ichild Iwith I a Ilife Ithreatening Iillness
o Activity Iintolerance Irelated Ito Irespiratory Idistress, Ifatigue
o Decreased ICardiac IOutput Irelated Ito Istructural Idefect, Imyocardial Idysfunction, Ialtered Ihemodynamics
o I Ineffective Ibreathing Ipattern Irelated Ito Ipulmonary Icongestion, Idecreased Icardiac Ioutput
, • Care Iof Ithe Ichild Iwith Ia Icardiac Idefect I& Iprevention Iof Istroke
➢ Feeding Iinterventions:
o Small Ifrequent Ifeedings Iwith I24 Ical Iformula I(more Icalories, Iless Iwork)
o Neutral Ienvironmental Itemperature
o Limit Ifeeds Ito I30 Iminutes
➢ Position Iupright Ito Ifeed, Iand Iposition Ion IR Iside Iafter Ifeeding, IHOB I↑ I30-45 Idegrees
➢ Monitor Ifor Ifeeding Itolerance
➢ Consider Igavage Ifeedings
➢ Make Isure Ithe Ipatient Iis Iwell Irested Ito Iconserve Ienergy
➢ Provide Ioxygen Iand Imake Isure Ithey Iare Igetting Ienough Iperfusion
• Tet Ispells Iin ITOF I(tetralogy Iof IFallot) Iand Inursing Icare Iof Itet Ispells
➢ TOF I(cyanotic Ior Idecreased Ipulmonary Iflow): I4 Idefects Imake Iup Ithis Icongenital Iheart Idefects.
1) A Ihole Iin Ithe Iwalls Ibetween Ithe Itwo Isides Iof Ithe Iheart
2) Narrowing I(stenosis) Iof Ithe Imain Iartery
3) Abnormal Ithickening Iof Ithe Iright Iventricle
4) Abnormality Iin Ithe Iposition Iof Ithe Imain Iartery.
➢ Nursing ICare:
1) Place Iinfant Iin Iknee-chest Iposition
2) Employ Ia Icalm, Icomforting Iapproach
3) Administer I100% Ioxygen Iby Iface Imask
4) Give Imorphine Isubcutaneously Ior Ithrough Iexisting Iintravenous Iline
5) Begin Iintravenous Ifluid Ireplacement Iand Ivolume Iexpansion, Iif Ineeded
6) May Igive Ipropranolol
7) Repeat Imorphine Iadministration.
➢ Blalock ITaussig IShunt I(may Ibe Idone Ias Iwell)
o Teaching Iafter Isurgery Iincludes:
▪ 1) IGood Ihand Ihygiene
▪ 2) IConserve Ienergy
▪ 3) IMay Ineed Itube Ifeedings
▪ 4) IAvoid Iinfectious Ipeople
▪ 5) IDigoxin, Idiuretics, Ipossibly IASA Ito Iprevent Iplatelet Iaggregation
▪ 6) IReport Iincreased Icyanosis Ipost-op, Iwhich Iindicates Ishunt Iocclusion
▪ 7) IAvoid Idehydration!!
• Cardiac Icatheterization Iand Icare Iand Iassessment Ibefore I& Iafter Iprocedure
➢ Cardiac ICatheterization: Ia Iradiopaque Icatheter Iis Iinserted Ithrough Ia Iperipheral Iblood Ivessel Iinto
Ithe Iheart. IThe Icatheter Iis Iusually Iintroduced Ithrough Ia Ipercutaneous Ipuncture Iinto Ithe Ifemoral Ivein.
➢ Nursing ICare: Ipossible Icomplications Iinclude Iacute Ihemorrhage Ifrom Ithe Ientry Isite, Ilow Igrade
fever, Inausea, Ivomiting, Iand Iloss Iof Ipulse Iin Ithe Icatheterized Iextremity I(usually Iresulting Ifrom Ia Iclot,
Ihematoma, Ior Iintimal Itear), I& Itransient Idysrhythmias. ITherefore Iit Iis Iessential Ithat Ithe Inurse Iemploy
Igood Inursing Ijudgment Iand Iphysical Iassessment Ibefore Iand Iafter Iprocedure.
➢ Pre-procedural Icare: Icomplete Inursing Iassessment Iincluding Iheight I& Iweight. IObtain Ia Ihistory Iof
allergic Ireactions Isince Isome Iof Ithe Icontrast Iagents Iare Iiodine Ibased. ISevere Idiaper Irash Iis Ia Ireason Ito
I I I I I
Fluid I& IElectrolytes IChapter I29:
• Signs Iand Isymptoms Iof Ifluid Ioverload I Ipg. I1056 pg. I949 I& I956-957
Generalized Iedema, Ipulmonary Iedema I(moist Irales I& Icrackles), IHepatomegaly, Islow Ibounding Ipulse, Iweight
Igain, Ilethargy, Ielevated Ivenous Ipressure, Iseizures, Icoma. ILab Ifindings: IDecreased Iserum Ielectrolytes, Ilow Iurine
Ispecific Igravity, Idecreased Ihematocrit, Ivariable Iurine Ivolume.
• Signs Iand Isymptoms Iof Ifluid Ideficit pg. I1056 pg. I949 I& I951-955
Top I3: I#1 IPoor Iskin Iturgor I#2 Iabnormal Irespirations= ITachypnea I#3 IProlonged Icapillary Irefill I>2 Isecs
ITachycardia, Idry Iskin I& Imucous Imembranes, Isunken Ieyes I& Ifontanels, Iirritability, Ilethargy, Ithirst, Iweight Iloss,
Idiminished Iurine Ioutput, Iand Ialtered Ilevel Iof Iconsciousness, Idisorientation. ILab Ifindings: IHigh Iurine Ispecific
Igravity, Iincreased Ihematocrit, Iincreased IBUN, Iincreased Iserum Iosmolality
• Hypo Iand Ihyperkalemia I& IFoods Ithat Icontain Ipotassium Pg. I1359 pg. I1271
➢ Hypokalemia:
o < I3.5 ImEq/L
o Abnormal IEKG; Inotched Ior Iflattened IT Iwaves, Idecreased IST Isegment, Ipremature
Iventricular Icontractions
o I Muscle Iweakness, Icramping, Istiffness, Iparalysis, Ihyporeflexia, Ihypotension, Icardiac Iarrhythmias,
gallop Irhythm, Itachycardia Ior Ibradycardia, Iileus, Iapathy, Idrowsiness, Iirritability, Ifatigue
➢ Hyperkalemia:
o > I5.5 ImEq/L
o Variable Iurine Ivolume
o Flat IP Iwave Ion IECG, Ipeaked IT Iwaves, Iwidened IQRS Icomplex, Iincreased IPR Iinterval
o I Muscle Iweakness, Iflaccid Iparalysis, Itwitching, Ihyperreflexia, Ibradycardia, Iventricular Ifibrillation
Iand Icardiac Iarrest, Ioliguria, Iapnea—respiratory Iarrest
➢ Foods Ithat Icontain Ipotassium: IFoods Iwith Ithick Iskin: IOranges, Ibanana, Inuts, Isquash, Icarrots, Ibroccoli,
kale, Itomatoes, Ibeans, Iavocado, Ifish, Imushrooms
• Signs Iand Isymptoms Iof Ihypo I& Ihypernatremia pg. I1056 Ipg. I949-950
➢ Hyponatremia I(less Ithan I135 ImEq): Ianorexia, Inausea, Ivomiting, Iweakness, Ilethargy, Iconfusion,
Imuscle Icramps, Itwitching, I& Iseizures.
➢ Hypernatremia I(more Ithan I145 ImEq): IThirst, Ihyperpyrexia I(Extremely Ihigh Ifever), Isticky Imucous
membranes, Idry Imouth, Ioliguria I(diminished Iurine Ioutput) Ihallucinations, Ilethargy, Iirritability, I&
Iseizures.
• Types Iof Idehydration: IIsotonic, Ihypotonic, Ihypertonic I(see IEcollege:DocSharing: IPowerpoints: IGI
Idysfunction)
➢ Babies= IECF I> IICF I(75% Iwater) Ileads Ito Imore Irapid Iloss
➢ Isotonic IDehydration: IThis Iis Ithe Iprimary Iform Iof Idehydration Ioccurring Iin Ichildren I(Na Iremains
Inormal Isince IH2O Iloss Iand Ielectrolyte Iloss Iare Iequal. ILeads Ito Ishock) IH2O Iloss I= Ielectrolyte Iloss I
Ihypovolemic Ishock. IThe Imajor Iloss Iis Ifrom Ithe IECF. ISymptoms Iare Irelated Ito Ihypovolemic Ishock
➢ Hypotonic IDehydration: I Dehydration Ioccurs Iwhen Ithe Ielectrolyte Ideficit Iexceeds Ithe Iwater Ideficit.
Water Imoves Ifrom IECF Ito IICF Iwhich Ifurther Iincreases Ithe IECF Ivolume Iloss Iand Ileads Ito Ishock. I(Na
Ilevel Iusually Iless Ithan I130 ImEq/L) IElectrolyte Iloss I>H2O Iloss I Ishock I& Iseizures I(low Isodium)
, ➢ Hypertonic IDehydration: IDehydration Iresults Ifrom Iwater Iloss Iin Iexcess Iof Ielectrolyte Iloss Iand Iis
Iusually Icaused Iby Ia Iproportionately Ilarger Iloss Iof Iwater Ior Ia Ilarger Iintake Iof Ielectrolytes. IThis Itype Iof
Idehydration Iis Ithe Imost Idangerous Iand Irequires Imuch Imore Ispecific Ifluid Iof Itherapy. I(Na Ilevel Iusually
Igreater Ithan I150 ImEq/L ICauses Ilethargy, Iseizures, Ihyperirritability Ito Istimuli Ilosing Ifluid Ifrom Ithe IICF)
IH20 Iloss I> Ielectrolyte Iloss I Ineuro.
• Nursing Icare Iof Idehydration: Ioral I& Iintravenous Irehydration, I reintroduction Iof Iregular Idiet
The Imajor Igoals Iin Ithe Imanagement Iof Iacute Idehydration Iinclude I1) Iassessment Iof Ifluid Iand Ielectrolyte
Iimbalance, I2) Irehydration I3) Imaintenance Ifluid Itherapy, Iand I4) Ireintroduction Iof Ian Iadequate Idiet. ITreat Iinfants
Iand Ichildren Iwith Iacute Idiarrhea Iand Idehydration Ifirst Iwith Ioral Irehydration Itherapy I(ORT). IORT Iis Ione Iof Ithe
Imajor Iworldwide Ihealth Icare Iadvances. IIt Iis Imore Ieffective, Isafer, Iless Ipainful, Iand Iless Icostly Ithan IIV
Irehydration. IOral Irehydration Isolutions I(ORSs) Ienhance Iand Ipromote Ithe Ireabsorption Iof Isodium Iand Iwater.
These Isolutions Igreatly Ireduce Ivomiting, Ivolume Iloss Ifrom Idiarrhea, Iand Ithe Iduration Iof Ithe Iillness.IRehydration
Iwith Ioral Isolutions Ican Ibe Iused Iover I4-6hours Iof Imild Ito Imoderate Idehydration.
IV Irehydration I(Normal Isaline I20ml/kg; Ilactated Iringers I20ml/kg I Iinfuse Iover I20minutes. IYou Ineed Ia Idoctor’s
Iorder Ito Ido Ia Ibolus) Iif Isevere Iand Iunable Ito Itake Iby Imouth I(PO). IReintroduction Iof Iregular Idiet Iafter
Irehydration.
• Know Ithe Iformula Ifor Icalculating Ithe Idaily Ifluid Irequirements Ibased Ion Ikg Iweight Iof Ia Ichild Ipg.947
➢ 1-10kg I= I100ml/kg
➢ 11-20kg I= I1000ml I+ I50ml/kg Ifor Ieach Ikg I> I10kg
➢ > I20kg I= I1500ml I+ I20ml/kg Ifor Ieach Ikg I> I20 Ikg
Cardiovascular Iconcepts IChapter I34:
• Review IVSD, Icoarctation Iof Ithe Iaorta Isymptoms, Iexpected Ilabs, Inursing Idiagnoses
➢ Ventricular ISeptal IDefect I(VSD): Iis Ian Iabnormal Iopening Ibetween Ithe Iright Iand Ileft Iventricles.
20-60% Iof IVSDs Iclose Ispontaneously I(spontaneous Iclosing Iis Imore Ilikely Ito Ihappen Iduring Ithe Ifirst Iyear
Iof Ilife Iin Ichildren Ihaving Ismall Ior Imoderate Idefects).
➢ Signs Iand Isymptoms Iof IVSD: Imurmur, Ipoor Ifeeding Iand Ifailure Ito Ithrive, Ifast Ibreathing Iand Ifatigue I&
SOB. IIt Iis Iclassified Iunder Iincreased Ipulmonary Iblood Iflow I(acyanotic Idefect).
➢ Diagnostic Itests I(9th Iedition Itable I34-1 I<procedures Ifor Icardiac Idiagnosis> Ipg I1346 Iis Ia Igood Itable):
IRadiologic Iimaging I(chest IX-ray), IElectrocardiography, IEchocardiography, ICardiac Icatheterization I(most
Iinvasive), ICardiac Imagnetic Iresonance Iimaging.
➢ Coarctation Iof Ithe Iaorta Isymptoms I(obstructive Idefect): I is Ia Inarrowing Iof Ithe Iaorta. IWhen Ithis Ioccurs,
your Iheart Imust Ipump Iharder Ito Iforce Iblood Ithrough Ithe Inarrow Ipart Iof Iyour Iaorta. ISymptoms Iinclude:
IPale Iskin, Iirritability, Iheavy Isweating, Idifficulty Ibreathing, Imurmur, Ia Iweak Ior Idelayed Ipulse, Ihigh Iblood
Ipressure, Iand Idifficulty Ifeeding I(failure Ito Ithrive).
➢ Nursing Idiagnoses:
o Fluid Ivolume Iexcess Irelated Ito Iedema Isecondary Ito ICHF
o Impaired Igas Iexchange Irelated Ipulmonary Icongestion Isecondary Ito Iincreased Ipulmonary Iblood Iflow
o Imbalanced Inutrition: ILess Ithan Ibody Irequirements Irelated Ito Irespiratory Idistress, Ifeeding Idifficulties
o Interrupted IFamily IProcesses Irelated Ito Ipresence Iof Ia Ichild Iwith I a Ilife Ithreatening Iillness
o Activity Iintolerance Irelated Ito Irespiratory Idistress, Ifatigue
o Decreased ICardiac IOutput Irelated Ito Istructural Idefect, Imyocardial Idysfunction, Ialtered Ihemodynamics
o I Ineffective Ibreathing Ipattern Irelated Ito Ipulmonary Icongestion, Idecreased Icardiac Ioutput
, • Care Iof Ithe Ichild Iwith Ia Icardiac Idefect I& Iprevention Iof Istroke
➢ Feeding Iinterventions:
o Small Ifrequent Ifeedings Iwith I24 Ical Iformula I(more Icalories, Iless Iwork)
o Neutral Ienvironmental Itemperature
o Limit Ifeeds Ito I30 Iminutes
➢ Position Iupright Ito Ifeed, Iand Iposition Ion IR Iside Iafter Ifeeding, IHOB I↑ I30-45 Idegrees
➢ Monitor Ifor Ifeeding Itolerance
➢ Consider Igavage Ifeedings
➢ Make Isure Ithe Ipatient Iis Iwell Irested Ito Iconserve Ienergy
➢ Provide Ioxygen Iand Imake Isure Ithey Iare Igetting Ienough Iperfusion
• Tet Ispells Iin ITOF I(tetralogy Iof IFallot) Iand Inursing Icare Iof Itet Ispells
➢ TOF I(cyanotic Ior Idecreased Ipulmonary Iflow): I4 Idefects Imake Iup Ithis Icongenital Iheart Idefects.
1) A Ihole Iin Ithe Iwalls Ibetween Ithe Itwo Isides Iof Ithe Iheart
2) Narrowing I(stenosis) Iof Ithe Imain Iartery
3) Abnormal Ithickening Iof Ithe Iright Iventricle
4) Abnormality Iin Ithe Iposition Iof Ithe Imain Iartery.
➢ Nursing ICare:
1) Place Iinfant Iin Iknee-chest Iposition
2) Employ Ia Icalm, Icomforting Iapproach
3) Administer I100% Ioxygen Iby Iface Imask
4) Give Imorphine Isubcutaneously Ior Ithrough Iexisting Iintravenous Iline
5) Begin Iintravenous Ifluid Ireplacement Iand Ivolume Iexpansion, Iif Ineeded
6) May Igive Ipropranolol
7) Repeat Imorphine Iadministration.
➢ Blalock ITaussig IShunt I(may Ibe Idone Ias Iwell)
o Teaching Iafter Isurgery Iincludes:
▪ 1) IGood Ihand Ihygiene
▪ 2) IConserve Ienergy
▪ 3) IMay Ineed Itube Ifeedings
▪ 4) IAvoid Iinfectious Ipeople
▪ 5) IDigoxin, Idiuretics, Ipossibly IASA Ito Iprevent Iplatelet Iaggregation
▪ 6) IReport Iincreased Icyanosis Ipost-op, Iwhich Iindicates Ishunt Iocclusion
▪ 7) IAvoid Idehydration!!
• Cardiac Icatheterization Iand Icare Iand Iassessment Ibefore I& Iafter Iprocedure
➢ Cardiac ICatheterization: Ia Iradiopaque Icatheter Iis Iinserted Ithrough Ia Iperipheral Iblood Ivessel Iinto
Ithe Iheart. IThe Icatheter Iis Iusually Iintroduced Ithrough Ia Ipercutaneous Ipuncture Iinto Ithe Ifemoral Ivein.
➢ Nursing ICare: Ipossible Icomplications Iinclude Iacute Ihemorrhage Ifrom Ithe Ientry Isite, Ilow Igrade
fever, Inausea, Ivomiting, Iand Iloss Iof Ipulse Iin Ithe Icatheterized Iextremity I(usually Iresulting Ifrom Ia Iclot,
Ihematoma, Ior Iintimal Itear), I& Itransient Idysrhythmias. ITherefore Iit Iis Iessential Ithat Ithe Inurse Iemploy
Igood Inursing Ijudgment Iand Iphysical Iassessment Ibefore Iand Iafter Iprocedure.
➢ Pre-procedural Icare: Icomplete Inursing Iassessment Iincluding Iheight I& Iweight. IObtain Ia Ihistory Iof
allergic Ireactions Isince Isome Iof Ithe Icontrast Iagents Iare Iiodine Ibased. ISevere Idiaper Irash Iis Ia Ireason Ito
