3340: PEDS CARDIOVASCULAR Flashcards
S/S of Heart Disease in Children?
Frequent Respiratory Infections and Dyspnea Activity Intolerance Difficulty and Fatigue during Feedings Failure to thrive, Low weight Pallor, cyanosis, clubbing
Feeding Interventions for Children with Heart Disease?
Provide periods of uninterrupted rest
NTE
Feed child slowly and more often (30min Q3H)
Hold infant upright
Place infant on right side after feeding, HOB (30-45)
When does pallor and cyanosis usually occur in a child with heart disease?
during feeding
What are the two reasons for Pediatric CHF?
Structural Problems
Weakness of Actual Heart Muscle
What is the most common cause of Pediatric CHF?
Congenital Heart Defects
S/S of R sided HF
Periorbital and Facial Edema Enlarged Liver or Spleen Ascites Wheezing Neck Vein Distension (JVD)
S/S of L sided HF
Tachypnea Dyspnea Crackles Intercostal/Sternal Retractions Wheezing
Causes of R sided HF
Left to Right Shunts (VSD, ASD)
Causes of L sided HF
Right to Left Shunts (PDA, COA)
What type of heart failure do most pediatric CHF patients have?
Combination of Right and Left
3 early signs of CHF in infants/children
Tachypnea
Poor feeding
Diaphoresis during feeding
Medications for Pediatric HF
Positive Inotropes
Diuretics
After-load reducing drugs
Digoxin (Lanoxin)
Increases the force of muscular contraction in the heart
Slows and strengthens the heart
Positive inotropic action
Monitor: Dig level, K+, Mg2+, Ca2+
S/S of Digoxin Toxicity
Nausea Vomiting Anorexia Bradycardia Dysrhythmia
When do you hold Digoxin and call HCP?
If infant/toddler HR is <100
If child HR is <70
If contraindicated
Furosemide (Lasix)
Loop diuretic that blocks sodium reabsorption in the ascending loop of henle
Decreases preload by increasing water excretion
SE: electrolyte imbalances (decreases K+ and Mg2+),
Spironolactone (Aldactone)
Potassium-sparing diuretic
Decreases preload
3 Components of Stroke Volume
- Preload
- Afterload
- Contractility
In fetal circulation what does the Ductus Venosus Connect?
IVC to Umbilical Vein
The Ductus Venosus allows what to be bypassed in the fetus?
The Liver
In fetal circulation what does the Foramen Ovale do?
allows most of then load received from the IVC to be shunted directly to the left atrium.
The Foramen Ovale bypasses what in the fetus?
The Lungs
supply the heart and brain with oxygenated blood
Where is the Ductus Arteriosus located?
Between the aorta and pulmonary artery (connects them)
An opening the dividing wall (septum) between the two upper chambers of the heart
Atrial Septal Defect
An opening in the dividing wall (septum) between the two lower chambers of the heart
Ventricular Septal Defect
A blood vessel between the aorta and the pulmonary artery the does not close after birth is know as a
Patent Ductus Arteriosus
the aorta is connected to the right ventricle, and the pulmonary artery is connected to the left ventricle — the opposite of a normal heart’s anatomy. As a result, there are two separate and parallel circulations. The condition is lethal unless some communication exists between the systemic and pulmonary circulations after birth.
Transposition of the Great Arteries
is a narrowing or pinching of the aorta, the main blood vessel carrying oxygen-rich blood from the left ventricle of the heart to all of the organs of the body.
Coarctation of the Aorta
most of the structures on the left side of the heart are small and underdeveloped. The most critical defect is the small, underdeveloped left ventricle.
Hypoplastic Left Heart Syndrome (HLHS)
is a narrowing of the aortic valve that decreases blood flow into the aorta, the main artery carrying blood out of the heart.
Aortic Stenosis
is a rare disorder in which the heart’s pulmonary valve — or the area just before or after the valve — is narrowed. This means less blood can flow from the heart to the lungs.
Pulmonary Stenosis
This is a rare congenital heart defect in which a single blood vessel comes out of the right and left ventricles, instead of the normal two vessels (pulmonary artery and aorta):
Truncus Arteriosus
What are the 4 classic components of Tetralogy of Fallot?
- VSD
- Pulmonary Stenosis
- Overriding Aorta
- Right Ventricular Hypertrophy
is an inflammatory autoimmune disease that can develop in people who have had strep throat, scarlet fever or other infections caused by group A Streptococcus bacteria. It often damages heart valves, leading to lifelong heart disease.
Rheumatic Fever
is a rare but serious illness that causes heart problems in children. It is a form of a condition called vasculitis (inflammation of the blood vessels). If the disease affects the coronary arteries, it can lead to severe heart problems including myocarditis (inflammation of the heart muscle), dysrhythmia (abnormal heart rhythm), and aneurysm (weakening and bulging of the artery wall).
Kawasaki Disease
The nurse is caring for a child following cardiac catheterization. Which nursing action should have the highest priority?
Monitor the insertion site for bleeding. If bleeding is present, apply gloves and then apply direct pressure for 15-30min or until hemostasis
Left-sided HF: blood and fluid back up into
Lungs
Right-sided HF: blood and fluid back up into
Rest of Body
3 early signs of CHF in infants/children
Tachypnea
Poor Feeding
Diaphoresis during feeding
4 s/s of high bP in arteries of the lungs in infant/children
Syncope
Lethargy
Chest Pain
Dizziness
High blood pressure that occurs in the arteries of the lungs is known as
Pulmonary HTN
cardiac lecture: CPR
Cyanotic Heart Defect
Pulmonic Pressure > Systemic
Right to Left Shunt
This medication slows and strengthens the heart, increasing the contractility of the myocardium. Signs of toxicity include nausea, vomiting, poor appetite, and bradycardia:
Digoxin
This medication’s primary effect is to decrease intravascular fluid volume by increasing water excretion. It does so by affecting the loop of Henle in the kidney. Side effects include low blood pressure, hypokalemia, hypomagnesemia, and metabolic alkalosis:
Furosemide (Lasix)
This medication decreases the amount of volume being returned to the right side of the heart from systemic circulation. It does so by opposing the effects of the hormone aldosterone. Side effects include decreased blood volume and too much potassium in the blood:
Spironolactone (Aldactone)
This medication decreases the amount of resistance the left side of the heart has to overcome in order to eject blood. It does so by decreasing the production of angiotensin II, a potent vasoconstrictor. This, in turn, relaxes smooth muscles in peripheral blood vessels, causing vasodilation. Side effects include hypotension and hyperkalemia
Captopril (ACE Inhibitors)
This medication, taken orally, helps the blood vessels in the lungs to relax so blood and oxygen can flow more freely. It is a selective inhibitor of phosphodiesterase type 5 (PDE5).It is used to treat pulmonary hypertension:
Sildenafil
This medication is given to help treat inflammation in both Kawasaki disease and rheumatic fever. It can also decrease pain and joint inflammation, as well as reduce the fever. Children and teenagers recovering from chickenpox or flu-like symptoms should never take this medication, due to the risk of Reye’s syndrome:
Aspirin
