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AN305 > 3Cardiac Part 2 > Flashcards

3Cardiac Part 2 Flashcards

1
Q

Defects that decrease pulmonary blood flow

A

Tetralogy of fallot

Tricuspid atresia

(Right to left shunt)

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2
Q

Hypoxemia

S/s
Polycythemia

A

Fatigue
Clubbing
Cyanosis
Exertional dyspnea

Polycythemia:
-kidney produce erythropoietin to stimulate bone marrow to produce more RBCs

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3
Q

What is polycythemia:

What we are worried about

A

Kidneys produce erythropoietin to stimulate bone marrow to produce more RBC’s

Over production—>
causes sluggish blood (thick)—>
Causes thromboembolism (clots)

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4
Q

Tetralogy of fallot (TOF)

Defects included

A

Pulmonary stenosis
Right ventricular hypertrophy (bc of stenosis)
VSD
Overriding aorta (more centered in middle)

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5
Q

Tetralogy of fallot (TOF)

S/s
Tx

A

Murmur
Cyanosis
TET spells

Tx:
-palliative repairs (blalock taussig BT shunt): connects subclavian artery to pulmonary artery

-complete repair (fix all defects)

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6
Q

Hypercyanotic episodes (TET spells)

-caused by

A

Crying
Feeding
Exercise
Straining

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7
Q

Hypercyanotic episodes (TET spells)

S/s 8 DLITTIPS

A

Diaphoresis
Loss of consciousness
Irritability and crying
Tachycardia
Tachypnea
Increased cyanosis
Poor tissue perfusion
Seizures (if last too long have no O2 to brain)

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8
Q

Hypercyanotic episodes (TET spells)

1st intervention
Tx

A

1st intervention:
-knee to chest position
(increase systemic pressure forcing blood to go to lungs)

Tx:
-reduce crying/calm child (pacifier, swaddle)
-give oxygen
-administer morphine or propranolol

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9
Q

Tricuspid atresia

What is it
Common to see

A

Failure of tricuspid valve to develop

Common to see VSD

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10
Q

Tricuspid atresia

S/s
Tx

A

Cyanosis
Marked cyanosis once PDA closes
Tachypnea
Difficulty feeding
Murmur

Tx:
-PFO
-palliative BT shunt
-several surgeries

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11
Q

Mixed defects
(significant mixing of oxygenated and deoxygenated blood)

A

Transposition of the Great Arteries/Vessels
Truncus Arteriosus
total anomalous pulmonary venous return (TAPVR)
Hypoplastic left heart syndrome (HLHS)

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12
Q

Transposition of the Great Arteries (TGA)

What is it
What is needed

A

Pulmonary artery and aorta swapped

-need PDA and PFO to be compatible with life other wise blood would be pumped out to rest of body and never oxygenated.
-RV pushing blood to aorta instead of pulmonary artery

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13
Q

Transposition of the Great Arteries (TGA)

S/s
Tx

A

Cyanosis
Tachypnea
Worsens as PDA closes

Tx:
Keep PDA open (other wise uncompatible with life)
-administer Prostaglandin E (IV) to keep open
-PFO stretched
-surgical repair 4-7 DOL (days of life)

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14
Q

Truncus Arteriosus

What is it

What may be present

A

One major artery leaves the heart with one valve
(Aorta and pulmonary artery are one)

VSD may be present (murmur)

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15
Q

Truncus Arteriosus

S/s
Tx

A

Cyanosis
Tachynea, retractions, crackles
Activity intolerance
Poor feeding/growth

Tx:
-surgical repairs: 1st few weeks of life (cant go home at first)

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16
Q

Total anomalous pulmonary venous return (TAPVR)

What is it
What does that lead to
Is it compatible with life (can it be)

A

Pulmonary vein should connect to left atrium, instead it connects to right atrium/superior vena cava

Right sided hypertrophy
Pulmonary HTN/edema

Incompatible with life unless: PFO/ASD present

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17
Q

Total anomalous pulmonary venous return (TAPVR)

S/s
Tx

A

Cyanosis
Murmur
Tachypnea
Hepatomegaly (bc it causes right sided HF if not treated)

Tx:
-surgical repair

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18
Q

Hypoplastic left heart syndrome (HLHS)

What is it

Goal

A

-Structures on L side underdeveloped
-Mitral/aortic valves closed or very narrow
-LV nonfunctional (minimal CO)

Goal:
-create the R side of heart to do all the pumping

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19
Q

Hypoplastic left heart syndrome (HLHS)

S/s
Tx

A

-Tachycardia, low BP (only using R side of heart)
-Pallor, progressive cyanosis

Tx:
-KEEP PDA OPEN (has to be open to be compatible)
-palliative care/surgery
-heart transplant

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20
Q

Cath procedures nursing management

Pre-procedure

A

Assessments (physiologic/psychosocial)

VS, H&H, capillary refills
baseline temp/color
Baseline pedal and popliteal pulses

Parents psychosocial needs

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21
Q

Cath procedures nursing management

Post procedures

A

Bed rest 4-6 hours (lay flat)
Prevent flexion of the hip (if they used the leg)
Quiet activities
Monitor perfusion

22
Q

Surgery nursing management

Presurgery

Prepare for surgery

A

Presx:
-prostaglandin E therapy (keep PDA open)
-infective endocarditic prophylaxis (IV ABX)
Monitor for development of CHF/growth/hydration

Prepare for sx:
-education for child and parents
-tour the units

23
Q

Surgery nursing management

Post-sx
General nursing unit

A

Post-sx:
-ICU intitally (hemodynamics/labs/assessment)
-monitor CO/strict I/O (DW tell us fluid retention)
-infective endocarditic prohpylaxis (IV ABX)

General nursing unit:
-monitor for s/s of sx complications:
—bleeding, infection
—arrhythmias
—low cardiac output

24
Q

Post op goals

Critical care unit
Pain management

A

Critical care unit:
-ventilator management
-nutrition
-electrolyte balance (K,Mg)

Pain management:
-around the clock analgesics
-transition to oral
-early mobility

25
Q

Post op goals

Resp function

Fluids and nutrition

A

Resp function:
-cough and deep breath (incentive spirometer)
-splinting the chest

Fluid and nutrition:
-strict I/O
-promote oral fluids
-encourage favorite foods
-encourage bowel elimination

26
Q

Acquired heart conditions

A

Infective Endocarditis

Kawasaki disease

Rheumatic fever

27
Q

Infective endocarditis

What is it
What causes it

A

Infection of inner lining of the heart and valves

Endocardium injury from turbulent blood flow—>
Tigger deposition of plts and fibrin—>
Vegetation on leaflets causing regurgitation and HF—>bacteria/fungi attach to injured site (vegetation) and colonize

28
Q

Infective endocarditis

risk factors

A

-congenital heart disease (CHD) or acquired heart disease

-valvular disorders

-indwelling catheters

29
Q

Infective endocarditis

S/s
Complications

A

FEVER
Flu-like symptoms (fatigue/myalgias/arthralgias)
-new murmur
-tachycardia
LATE SIGN: CHF—>hepatosplenomegaly

Complications:
CHF/MI/Embolism

30
Q

Infective endocarditis

Diagnosis

A

Blood culture: bacteria or fungus

CBC: leukocytosis (too many WBCs)

CRP/ESR

ECHO/EKG (cardiomegaly, abnormal valve function, area of vegetation)

31
Q

Infective endocarditis

Tx

A

Prevention with prophylactic oral ABX for high risk kids before procedures:
-Amoxicillin

IV ABX preferred tx (several weeks)
-Ampicillin, Gentamycin, Vancomycin

might need PICC line if going home in ABX

32
Q

Kawasaki Disease

More common in who
What is it (age)
What vessels affected

A

Most common in boys and pacific islanders

Acute febrile, systemic vascular inflammation
(Usually under 5y/o)

Small and midsized arteries affected:
-coronary artery dilation (vessel gets larger and has weak spots leading to ANEURYSMS)

33
Q

Kawasaki Disease

Acute Phase: what vessesl affected
How long acute phase last
S/s (11) AIRRPPSSBCD
Risk (2)

A

small capillaries become inflamed (1-2weeks)

-Abrupt fever (last 5 days) -high fever w/ no response to meds
-irritability
-Red eyes
-Red cracked lipa
-puffy hands and feet
-palms and soles of feet become red
-strawberry tongue
-signs of myocarditis/CHF
-bilateral joint pain
-cervical lymphadenopathy
-desquamation of perineum

Risk: aneurysm/ coronary thrombosis

34
Q

Kawasaki disease

Subacute phase: what is it
S/s (2 new thing, 3 continues from acute phase)

A

Inflammation spreads to large vessels

New:
-fever resolves
-peeling hands and feet

Continues:
-irritability
-arthritis
Risk of aneurysm and coronary thrombosis

35
Q

Kawasaki disease

Lab and diagnostics

A

No specific diagnostic test : based on symptoms

Things we can do:
-CBC (elevated wbc, thrombocytosis)
-elevated CRP/ESR
-EXHO/EKG (want baseline as we follow them in life)

36
Q

Kawasaki disease

Nursing management
Diet
Promoting comfort

A

Vs, cardiac monitor
Assess for HF (I/O, DW)
Offer liquids and soft, non-acidic/bland foods
(mash potatoes, apple sauce, pudding)

Promote comfort:
-oral hygiene, lip balm
-cool cloths to skin/lotion

37
Q

Kawasaki disease

Meds

A

IV immune globulin (IVIG)
- given early in illness
-repeat if client still febrile
-monitor for allergic reaction

Oral ASA: only time we give ASA to peds
—80-100 mg/kg/day during fever devided every 6 hours
—3-5 mg/day once afebrile

38
Q

IV immun globulin is treated like what
-what we do

ASA:
Why we give it

A

IVIG: treated like a blood product
-consent
-allergic reaction
-specific intructions from pharmacy

ASA:
-thrombocytosis (prevent clots)

39
Q

Kawasaki disease

Discharge planning
-cant leave until
-educate parents
-follow up care needed

A

Cannot leave until afebrile/taking oral fluids

Educate parents:
-irritability likely to persist 2 months
-arthritis/skin conditions persist several weeks
-healthy heart diet
-administration of ASA
-notify if fever returns

F/u care:
-monitor for heart disease as child ages
—ECHO/EKG, BP, Blood Cholesterol

40
Q

Rheumatic Fever

What is it
Occurs when
Age

A

Autoimmune response to Group A beta-hemolytic steptococcus

Occurs 2-4wks following untreated/partially treated strep throat

5-15y/o usually

41
Q

Rheumatic Fever

Normal s/s
-other things affected

A

Hx of URI/strep throat
Fever

Other things:
-carditis
-arthritis
-rash
-CNS involvement

42
Q

Rheumatic Fever

Carditis

FSET
PC

A

What were most worried about

Inflammation of heart muscle and heart tissue (cardiomegaly)
-fatigue, SOB, exercise intolerance, tachycardia,
-pericardial friction rub, CP

43
Q

Rheumatic Fever

Arthritis

A

Swelling
Reddness and pain in the joints

Mainly:
-knees
-ankles
-elbows
-wrists

44
Q

Rheumatic Fever

Rash

A

Erythema marginatum on trunk and extremities
-pink
-nonpruritic

Appears and disappears rapidly

Nontender subcutaneous nodules over bony prominences

45
Q

Rheumatic Fever

CNS involvement

A

Chorea: involuntary purposeless muscle movements

-muscle weakness
-difficulty performing fine motor activities
-irritable, labile emotions

46
Q

Rheumatic Fever

Labs & diagnostics 5

A

Throat culture
Blood antistreptolysin O titer: elevated
CBC, CRP, ESR
CXR (cardiomegaly)
ECHO/EKG: monitor dyrhythmias, change in heart function

47
Q

Rheumatic Fever

Modified Jones criteria

A

Used to diagnose Rheumatic Fever

Either:
2 major criteria
1major criteria plus 2 minor

48
Q

Rheumatic Fever

Nursing management (what are we trying to manage 5)

A

Manage:
-acute strep infection
-fever
-inflammation
-preventing cardiac damage
-preventing reoccurance

49
Q

Rheumatic Fever

Meds

A

ABX: used for acute step infection
(10 days of penicillin)

Corticosteroids/NSAIDS

Infectious Endocarditis prophylaxis (3 choices)

50
Q

Rheumatic fever tx

Infectious Endocarditis prophylaxis (one of these 3)

A

-2 daily doses of oral penicillin V
-monthly IM injection of penicillin G
-daily oral dose of sulfadiazin

AN305 (17 decks)

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