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AN305 > 3Cardiac > Flashcards

3Cardiac Flashcards

1
Q

Blood flows which direction

Which side of heart has higher pressure?

A

Path of least resistance

Left side has more pressure

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2
Q

What does this mean:

PVR<SVR

A

Pulmonary vascular resistance is lower so blood can get to the lungs

Systemic vascular resistance is higher (get blood out to rest of body)

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3
Q

Two things fetus hearts have that adults dont?

A

Foramen ovale:
-connects right and left atrium

Ductus arteriosus:
-connects aortic arch and pulmonary artery

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4
Q

higher pulmonary resistance during fetal life

What is happening with the ventricles
This is why what vital is high or low

A

Larger RV

PVR drops and SVR increases causing the LV to develop/strengthen

BP lower (d/t LV muscle being weak)
HR higher (meet metabolic and oxygen requirement)

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5
Q

Little cardiac reserve causes what

Heart muscle is fully developed by when

A

LCR: risk for Heart Failure

Fully developed heart muscle by 5y/o

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6
Q

Assessment of ped heart 6

A

-Family hx (HD/HTN/cholesterol/defects)
-Prenatal care
-Birth hx
-Feeding difficulties (cant eat is a sign in infants)
-Activity intolerance (preschooler not able to keep up)

-Growth and development issues (need more calories to keep up with heart working so hard)

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7
Q

Assessment (look) for cardiac

A

Visible pulsation (chest)
Edema
JVD/engorgement
Clubbing
Skin color
WOB

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8
Q

Assessment (touch) cardiac

A

-Skin (temp, moisture, pitting edema)
-Cap refill
-Pulse (central vs peripheral)
-Palpate liver (kids with cardiac issues tend to have enlarged livers)

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9
Q

Where to feel central pulses on different ages

A

Under 1(babies): brachial

5yr old(over 1): carotid/femoral

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10
Q

Assessment (listen) cardiac

A

Vital signs
Auscultate lung sounds

Auscultate heart sounds:
-apical x1 min

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11
Q

APE vs MAN

Aortic area
Pulmonic area
Tricuspid area
Mitral or apical area

A

Aortic: Right 2nd ICS RMCL

P: Left 2nd ICS LMCL

T: Right 4th ICS

M or Apical: Left 5th ICS

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12
Q

S1 vs S2

(where best heard)
(What it represents happening)

A

S1: 4-5th ICS LMCL
-systole/contraction (hearing mitral valve shut)

S2: 2nd ICS
-diastole/relaxation (hearing aortic/pulmonic valve shut

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13
Q

CHF (congestive heart failure)

Early signs

A

Poor feeding/ Diaphoretic with feedings
activity intolerance
Tachypnea

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14
Q

CHF

Right (3) vs Left sided (2)

A

Right: (backs up systemically)
-JVD
-Swelling/Edema
-Enlarged liver

Left: (backs up into lungs)
-pulmonary congestion
-increased WOB

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15
Q

Therapeutic management of CHF

-improve cardiac function (2 meds)

A

Digoxin (increases myocardial contractility)
-monitor s/s of toxicity
-monitor K levels

ACE-inhibitors
-monitor BP
-(-pril)

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16
Q

Digoxin

Toxicity s/s
K levels explained

A

Toxicity:
-halos (vision)
-bradycardia
-N/V
(Baby cant tell you this so HR is a good way to check)

K levels:
-digoxin binds to potassium receptors
-if hyperkalemic=causes digoxin to be less effective
-if hypokalemic=digoxin toxicity

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17
Q

Therapeutic management of CHF

Remove extra fluid

A

Diuretics (lasix-furosemide, spironolactone)

-monitor K (causes us to pee out potassium)
Decreased potassium

18
Q

Normal K level

A

3.5-5

19
Q

Therapeutic management of CHF

Treating underlying cause
Lessen workload on heart
Nutrition

A

Lessen workload on heart
-promote rest
-cluster care

Nutrition:
-increase calorie intake (heart working harder)
-150Kcal/kg/day
-24-28kcal/oz

20
Q

Congenital heart disease

What is it
Age

A

Defext of heart or great vessels

Before week 8 of gestation

21
Q

Congenital heart disease diagnostic tests(7) XEECCCC

A

X-ray (cardiomegaly)
ECG or holter monitor (short vs long picture)
Echocardiogram
CT/MRI
CBC/H&H
Cardiac Cath
CCHD (screen for heart defects)

22
Q

CCHD screening protocol

Who required to get it
Pulse ox screening
Who is the only ones screened

A

Newborns ages 28 days or less are required by law that every newborn receives the:
-NEWBORN SCREENING TEST

Pulse oximetry screening (as close to 48hrs of age as possible)

For asymptomatic newborns only

23
Q

CCHD screening

How to perform 3
Where to put pulse ox

A

-Quiet area
-Infant should not be crying or cold (decreased oxygen)
-Infant must be on Room Air (not receiving o2)

Pulse oximetry reading on right hand (pre-ductal)
And
Either foot (post-ductal

24
Q

Congenital heart disease

Chart (acyanotic) -pink skin

A

Acyanotic:

—increased pulmonary blood flow
-atrial septal defect
-ventricular septal defect
-patent ductus arteriosus
-atrioventriuclar canal

—obstruction to blood flow from ventricles
-coartctation of aorta
-aortic stenosis
-pulmonic stenosis

25
Q

Congenital heart disease

Chart (cyanotic) -blue skin

A

Cyanotic:

—decreased pulmonary blood flow
-tetralogy of fallot
-tricuspid atresia

—mixed blood flow
-transposition of great arteries
-total anomalous pulmonary venous return
-truncus arteriosus
-hypoplastic left heart syndrome

26
Q

Defects that increase pulmonary blood flow:
acyanosis(pink)

A

PDA (patent ductus arteriosus)
ASD (atrial septal defect)
VSD (ventricular septal defect)
AV canal (atrioventricular canal)

Left to right shunt

27
Q

Defects that increase pulmonary blood flow
(general manifestations)
Long term risks

A

-tachypnea
-tachycardia
-feeding difficulties/activity intolerance

-long term- pulmonary vascoconstriction/HTN/CHF
—if not addressed

28
Q

Defects that increase pulmonary blood flow

—patent ductus arteriosus (PDA)
What is it

A

Ductus arteriosus should be close when born

Some systemic blood slips back to pulmonary artery leading to increased blood flow back to lungs

29
Q

Defects that increase pulmonary blood flow

—atrial septal defect (ASD)
What is it
S/s

A

Hole between two atrium
!not foramen ovale!

S/s:
-systolic murmur
-usually asymptomatic
-dyspnea/activity intolerance
-poor feeding/growth

30
Q

Defects that increase pulmonary blood flow

—atrial septal defect (ASD)
Tx

A

If small it may close on its own
—if not closed by age 3 = sx

Sx: sutured shut/patched

31
Q

Defects that increase pulmonary blood flow

—ventricular septal defect (VSD)
What is it
-s/s

A

Hole between ventricles

S/s:
Same as ASD

-Systolic murmur
-asymptomatic
-dypnea/ activity intolerance
-poor feeding/growth

32
Q

Defects that increase pulmonary blood flow

—ventricular septal defect (VSD)
Tx

A

Same as ASD

-may close on own
-if not sx to suture or patch

33
Q

Defects that increase pulmonary blood flow

—atrioventricular canal (AV canal)
What is it
-s/s

A

Hole in middle of heart connecting both atriums and ventricles

S/s:
Large L to R shunt
Same as ASD/VSD

-murmur
-asympomatic
-dypnea/activity intolerance
-poor feeding/growth

34
Q

Defects that increase pulmonary blood flow

—atrioventricular canal (AV canal)
Tx

A

Patch closure/valve reconstruction

35
Q

Defects that obstruct blow flow
-acyanotic (pink)

A

Aortic stenosis
Pulmonic stenosis
Coarctation of the aorta

36
Q

Defects that obstruct blood flow

—aortic stenosis
What it looks like and causes

A

Stenosis of aorta
-restricts blood flow from LV to aorta
-decreased CO
-LV hypertrophy (working harder and grows)

37
Q

Defects that obstruct blood flow

—aortic stenosis
S/s (2 different, 3 similar to others)

Tx

A

S/s:
-Tachycardia/HOTN
-Chest Pain
-systolic murmur
-activity intolerance
-difficulty feeding

Tx:
Cardiac cath - balloon dilation

38
Q

Defects that obstruct blood flow

—pulmonic stenosis
What is it and causes

A

Stenosis of pulmonic valve
-resticts blood flow from RV to PA
-RV hypertrophy (has to work harder and grows)
-PFO (patent foramen ovale) could reopen due to high pressures

39
Q

Defects that obstruct blood flow

—pulmonic stenosis
S/s (3 common, 1 unique)
Tx

A

S/s:
-asymptomatic sometimes
-murmur
-dyspnea, fatigue

-if severe (hypercyanotic spells) (even though its technically acyanotic)

Tx:
-pallitative blalock tussig shunt (connects major arteries to pulmonary artery
-cardiac cath: ballon dilation

40
Q

Defects that obstruct blood flow

—coarctation of the aorta
What is it
S/s

A

Narrowing of aorta (after the aortic branch)

S/s:
-stronger pulses & higher BP in BLE
-weak/absent pulses & lower BP in BLE
-systolic murmur

41
Q

Defects that obstruct blood flow

—coarctation of the aorta
Tx

A

-Ballon angioplasty
-Aortic resection

AN305 (15 decks)

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