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N305 > 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
Post op goals Resp function Fluids and nutrition
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
Acquired heart conditions
Infective Endocarditis Kawasaki disease Rheumatic fever
27
Infective endocarditis What is it What causes it
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
Infective endocarditis risk factors
-congenital heart disease (CHD) or acquired heart disease -valvular disorders -indwelling catheters
29
Infective endocarditis S/s Complications
FEVER Flu-like symptoms (fatigue/myalgias/arthralgias) -new murmur -tachycardia LATE SIGN: CHF—>hepatosplenomegaly Complications: CHF/MI/Embolism
30
Infective endocarditis Diagnosis
Blood culture: bacteria or fungus CBC: leukocytosis (too many WBCs) CRP/ESR ECHO/EKG (cardiomegaly, abnormal valve function, area of vegetation)
31
Infective endocarditis Tx
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
Kawasaki Disease More common in who What is it (age) What vessels affected
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
Kawasaki Disease Acute Phase: what vessesl affected How long acute phase last S/s (11) AIRRPPSSBCD Risk (2)
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
Kawasaki disease Subacute phase: what is it S/s (2 new thing, 3 continues from acute phase)
Inflammation spreads to large vessels New: -fever resolves -peeling hands and feet Continues: -irritability -arthritis Risk of aneurysm and coronary thrombosis
35
Kawasaki disease Lab and diagnostics
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
Kawasaki disease Nursing management Diet Promoting comfort
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
Kawasaki disease Meds
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
IV immun globulin is treated like what -what we do ASA: Why we give it
IVIG: treated like a blood product -consent -allergic reaction -specific intructions from pharmacy ASA: -thrombocytosis (prevent clots)
39
Kawasaki disease Discharge planning -cant leave until -educate parents -follow up care needed
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
Rheumatic Fever What is it Occurs when Age
Autoimmune response to Group A beta-hemolytic steptococcus Occurs 2-4wks following untreated/partially treated strep throat 5-15y/o usually
41
Rheumatic Fever Normal s/s -other things affected
Hx of URI/strep throat Fever Other things: -carditis -arthritis -rash -CNS involvement
42
Rheumatic Fever Carditis FSET PC
What were most worried about Inflammation of heart muscle and heart tissue (cardiomegaly) -fatigue, SOB, exercise intolerance, tachycardia, -pericardial friction rub, CP
43
Rheumatic Fever Arthritis
Swelling Reddness and pain in the joints Mainly: -knees -ankles -elbows -wrists
44
Rheumatic Fever Rash
Erythema marginatum on trunk and extremities -pink -nonpruritic Appears and disappears rapidly Nontender subcutaneous nodules over bony prominences
45
Rheumatic Fever CNS involvement
Chorea: involuntary purposeless muscle movements -muscle weakness -difficulty performing fine motor activities -irritable, labile emotions
46
Rheumatic Fever Labs & diagnostics 5
Throat culture Blood antistreptolysin O titer: elevated CBC, CRP, ESR CXR (cardiomegaly) ECHO/EKG: monitor dyrhythmias, change in heart function
47
Rheumatic Fever Modified Jones criteria
Used to diagnose Rheumatic Fever Either: 2 major criteria 1major criteria plus 2 minor
48
Rheumatic Fever Nursing management (what are we trying to manage 5)
Manage: -acute strep infection -fever -inflammation -preventing cardiac damage -preventing reoccurance
49
Rheumatic Fever Meds
ABX: used for acute step infection (10 days of penicillin) Corticosteroids/NSAIDS Infectious Endocarditis prophylaxis (3 choices)
50
Rheumatic fever tx Infectious Endocarditis prophylaxis (one of these 3)
-2 daily doses of oral penicillin V -monthly IM injection of penicillin G -daily oral dose of sulfadiazin

N305 (17 decks)

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