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Question Answer
What class of medication is Digoxin?
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A Cardiac Glycoside
What class of medication is Digoxin?
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A Cardiac Glycoside
How does Digoxin improve cardiac function?
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It improves contractility of the heart
What cardiac condition is Digoxin used to treat?
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Heart failure
What does it mean when someone prescribes a digatilizing dose of Digoxin?
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An initial dose is given to achieve a therapeutic range, typically over a 24 hour period. From there, a smaller dose is given to maintain a therapeutic range
A child's Digoxin dose should be withheld if their heart rate is less than ________.
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70 beats per minute
An infant's Digoxin dose should be withheld if their heart rate is less than ________.
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90-100 beats per minute
What should be done prior to given a child or infant a dose of Digoxin?
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The apical heart rate must be taken one hour prior to the scheduled dose.
What are some important nursing actions when calculating a dose of Digoxin for an infant or child?
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Always double check the calculation with another RN prior to dosing, remember that Digoxin is administered in mcg, not mg. Dosage must not be rounded!
A dose of Digoxin for an infant has been missed. Should you double the next dose or just dose the child at the next scheduled time?
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NEVER double the dose. Notify the HCP and dose at the next regularly scheduled time.
What factors can increase the risk of digoxin toxicity? (3)
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Renal failure, oral antibiotics, and hypokalemia.
What are signs and symptoms of Digoxin toxicity in the pediatric population?
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Bradycardia, anorexia, nausea, vomiting. If old enough, the child may report the characteristic vision changes.
What should be done if a child is exhibiting signs and symptoms of Digoxin toxicity?
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Hold the dose, prepare to give Digibind if ordered.
What is the therapeutic range for Digoxin in the pediatric population?
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0.8-2 ng/mL
The fetal heart is the first functioning organ and develops during the _______ weeks of gestation, starting at about _____ days.
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The fetal heart is the first functioning organ and develops during the 3rd-8th weeks of gestation, starting at about 21 days.
Describe in general terms, the order of major structure development during fetal development of the heart...
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First tubular structures are developed that turn into the four chambers. Next the pulmonary artery develops, then the aorta.
Where is the foramen ovale located and what is its function?
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The foramen ovale is located in the right atrium and serves as a blood bypass for the lungs. A fetus's blood is already oxygenated by the mom.
Where is the ductus arteriosus and what is its function?
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It is a connection between the pulmonary artery and the aorta and serves as a bypass for blood around the lungs.
The foremen ovale allows more than half the blood entering the ________to cross immediately into the _________, bypassing pulmonary circulation.
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The foremen ovale allows more than half the blood entering the right atrium to cross immediately into the left atrium, bypassing pulmonary circulation.
The __________ is located between the aorta and the pulmonary artery and connects the pulmonary artery to the aorta, allowing a bypass of the pulmonary circuit. It protects the lungs from circulatory overload by shunting blood (right to left) into the descending aorta. A small portion of blood flows through the pulmonary circuit for the purpose of providing oxygen and nutrients and for removal of waste products.
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The ductus arteriosus
Describe the events that trigger the closure of the foramen ovale.
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With the baby's first breath, air pushes into the lungs, triggering an increase in pulmonary blood flow and pulmonary venous return to the left side of the heart. Pressures in the left atrium become higher than in the right atrium. Systemic vascular resistance increases and blood return to the heart via the inferior vena cava decreases. This causes an increase in pulmonary blood flow and left atrium pressure which closes the foramen ovale.
In order for the foramen ovale to close, pulmonary blood flow and pulmonary venous return increases in the ________ side of the heart.
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Left
In order for the foramen ovale to close, pressures in the _____ atrium become higher than in the ______ atrium.
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Pressures in the left atrium become higher than in the right atrium
In order for the foramen ovale to close, systemic vascular resistance ______ and blood return to the heart via the inferior vena cava ______. This causes an increase in pulmonary blood flow and left atrium pressure
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Systemic vascular resistance increases and blood return to the heart via the inferior vena cava decreases.
The ductus arteriosus becomes functionally closed within a few hours of birth, with _______ being the most important factor in its closure.
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Oxygenation-Aeration of the lungs at birth from the first breath, causes a decrease in pulmonary vascular resistance and allows pulmonary blood flow to increase and for oxygen exchange to occur in the lungs
The first few minutes of life, the baby’s heart rate is ______ bpm. It then begins to decrease to an average of _______ bpm.
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The first few minutes of life, the baby’s heart rate is 120-180 bpm. It then begins to decrease to an average of 120-130 bpm.
Which side of the infant heart has the highest pressures, right or left?
Show Answer
Left
Pulmonary artery pressures in the infant should be the same as the pressure in the __________.
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Right ventricle
What prenatal/maternal health history factors would be significant for the development of fetal cardiac problems? (4)
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Alcohol use, use of teratogenic drugs (like Dilantin), infections during pregnancy (like Rubella), and the presence of certain medical conditions (like Lupus/DM)
What are common findings in infants with cardiac problems? (4)
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Fatigue, tachypnea, sweating when feeding, and poor weight gain.


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