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Medical Surgical Nursing 1 > Alterations in Cardiac Function > Flashcards

Alterations in Cardiac Function Flashcards

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1
Q

How does a child’s body respond to chronic hypoximeia?

A

The child’s bone marrow responds to chronic hypoxiemia by producing more red blood cells to increase the amount of hemoglobin to be oxygenated.

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2
Q

What is polycythemia?

A

An abnormal increase in the number of total red blood cells in body’s circulation. A hematocrit value of or higher is common in children with heart defects.

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3
Q

In children, what is a significant warning sign of cardiac arrest?

A

Bradycardia (slow heart rate) is a significant sign of cardiac arrest in children.

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4
Q

_____________ in children generally results from prolonged hypoxemia related to respiratory failure or shock.

A

Cardiac arrest in children generally results from prolonged hypoxemia related to respiratory failure or shock.

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5
Q

What maternal viral infections can cause congenital heart defects in children?

A

Rubella can cause congenital heat defects in a fetus, if the mother contracts the viral infection.

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6
Q

What is the first indication of a congenital heart defect?

A

A heart murmur is often the first indication of a congenital heart defect.

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7
Q

What are the clinical manifestations of heart defects that increase pulmonary blood flow?

A 
Tachypnea
Tachycardia
Murmur
CHF (congestive heart failure)
poor weight gain 
diaphoresis
Preorbital edema
frequent respiratory infections
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8
Q

What is the most common congenital heart defect?

A

Ventricular Septal Defect is the most common congenital heart defect.

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9
Q

If CHF can be managed, at what age can a VSD surgical closure be performed?

A

VSD surgical closure can be performed at 1 year of age, unless CHF cannot be managed. Surgery for these infants are performed with the first 6 mos of life.

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10
Q

What are some complications from a VSD surgery?

A

Arrhythmia, right bundle branch block, and complete heart block are some complications that can occur from VSD surgery.

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11
Q

What congenital heart defect is found in children with Down syndrome?

A

Atrioventricular Canal (endocardial cushion) AV Canal can be found in children with Down syndrome.

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12
Q

At what age is surgery performed to fix AV Canal defects?

A

Surgery to repair AV canal defect is performed between 2 and 4 months of age to prevent pulmonary vascular disease.

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13
Q

When repairing AV canal defect, how long is infective endocarditis prophylaxis required?

A

Infective endocarditis prophylaxis is required for 6 mos after the procedure.

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14
Q

What are some complications from AV canal defect repair?

A

Arrhythmia, mitral valve regurgitation, a residual valve defect, sub-aortic stenosis.

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15
Q

What medication can be given to a preterm infant who has a PDA?

A

Ibuprofen or Indomethacin can be given to preterm infants who have a PDA to stimulate closure by prohibiting prostaglandin E.

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16
Q

Postpericardiotomy syndrome?

A

Postpericardiotomy syndrome is a complication that occurs in 25-35% of children when surgery involves an incision through the pericardium leading to pericardium and pleural inflammation.

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17
Q

What causes Postpericariotomy syndrome?

A

Possibly from an autoimmune response to damage to the myocardium or pericardium or blood in the pericardial sac.

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18
Q

What are the sign and symptoms of Postpericariotomy syndrome?

A

High fever (up to 104f), sometimes severe chest pain which worsens upon inspiration.

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19
Q

What is the treatment for Postpericariotomy syndrome?

A

Mild cases are treated with bed rest and NSAID’s or indomethacin.
Severe cases may require corticosteriods, diuretics, or emergency pericardiocentisis.

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20
Q

What part of the assessment are key in determining the full impact of the heart condition on growth?

A

In infants, assessment of the length and head circumference help determine the full impact of the heat condition on growth.

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21
Q

In children with congenital heart defects, failure to gain weight is an indication of what?

A

In children with congenital heart defects, failure to gain weight is an indication of an increased metabolic rate and inability to consume adequate calories for both metabolic function and growth.

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22
Q

What are some ways a nurse can provide support to a family of a child with congenital heart defects?

A
  1. Determine what type of support system they may have
  2. Identify some resources for support (social services, pastoral services, or parents of child with similar issues)
  3. Genetic counseling if the parents are planning a future pregnancy
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23
Q

How should care of children with congenital heart defects be managed at home?

A
  1. Encourage feeding, but no more than 30 min at a time - or as directed by physician.
  2. Breast feeding is beneficial
  3. infants should be held at 45 degree angle to avoid tachypnea
  4. if infant is having trouble gaining weight supplements can be added to breast milk to increase caloric density.
  5. Transpyloric, nasogastric, gastronomy tubes may also be given at night to ensure adequate calories consumed.
  6. When tube feeds are used, also allow infant to take formula orally to provide positive oral stimulation
24
Q

While caring for an infant with congenital heart defects at home, when should the family call the physician?

A

The family should contact the physician if the infant is displaying fever, poor feeding, vomiting, and diarrhea.

25
Q

True or False?

Parents of a child with congenital heart defects should keep up on immunizations.

A

True.

Health promotion visits are important and all immunizations are provided according to schedule.

26
Q

What is the first step in assessing an infant or child for possible heart disease?

A

The first step in assessing an infant or child for possible heart disease is obtain vital signs, newborn or growth assessment, and health history.

27
Q

What signs and symptoms of cardiovascular dysfunction can be seen on inspection of the child?

A 
Respiration rate and depth
Observe overall color 
inspect the anterior chest for bulging 
observe for edema
exercise intolerance 
overall growth 
clubbing of the fingers
28
Q

_______ is one of the most frequently used tests for detecting cardiac dysfunction in children.

A

An Echo is one of the most frequently used tests for detecting cardiac dysfunction in children.

29
Q

Which is the following is a complication that the nurse might assess after a cardiac catheterization?

a. Hemorrhage at the entry site
b. Rapidly rising blood pressure
c. Hypostatic pneumonia
d. Congestive heart failure.

A

a. Hemorrhage at the entry site.

30
Q

Defects that allow blood flow from the higher-pressure left side of the heart to the lower-pressure right side of the heart (left-to-right shunt) result in increased _________ and cause __________.

A

Defects that allow blood flow from the higher-pressure left side of the heart to the lower-pressure right side of the heart (left-to-right shunt) result in increased pulmonary blood flow and heart failure.

31
Q

Defects that cause decreased pulmonary blood flow result in ________.

A

Defects that cause decreased pulmonary blood flow result in Cyanosis.

32
Q

True or False?

Babies with cyanosis who begin to cry become less cyanotic.

A

False!

Babies with cyanosis who begin to cry become MORE cyanotic.

33
Q

What are tet spells?

A

Tet spells occur in instances of hypercyanotic episodes where the infant or child is crying and become more cyanotic. Most often seen with children who have tetralogy of fallot defect.

34
Q

What is Tetralogy of Fallot?

A

Tetralogy of Fallot occurs when the overriding aorta and ventricular septal defect (VSD) allow unoxygenated blood to pass in the systemic circulation.

35
Q

What are the nursing interventions for Tet Spells?

A 
put infant in a knee to chest position to increase vascular resistance. 
apply O2
Keep the infant calm 
Give IV fluids
administer medication
36
Q

What medications are used to treat severe Tet Spells?

A

Morphine and propranol

37
Q

The ductus arteriosus starts to close after birth in the presence of _________ in the blood and other factors.

A

The ductus arteriosus starts to close after birth in the presence of higher oxygen saturation in the blood and other factors.

38
Q

Identify patient risk factors for increased morbidity and mortality related to congenital heart disease.

A
  1. Chromosomal abnormalities
  2. viruses
  3. Multiple cardiac events
  4. premature and low birth weight
    5 exposure to drugs in utero
39
Q

Which classification of acyanotic congenital heart defects is Atrial Septal Defect.

A

Atrial Septal Defect is an Increased pulmonary blood flow classification.

40
Q

Which classification of acyanotic congenital heart defects is Pulmonic stenosis?

A

Pulmonic stenosis is an obstruction to blood flow from the ventricles classification.

41
Q

Which classification of acyanotic congenital heart defects is Arotic Stenosis?

A

Arotic Stenosis is an obstruction to blood flow from the ventricles classification.

42
Q

Which classification of acyanotic congenital heart defects is Ventricular Septal Defect?

A

Ventricular Septal Defect is an increased pulmonary blood flow classification.

43
Q

Which classification of acyanotic congenital heart defects is Patent ductus arteriosus?

A

Patent ductus arteriosus is an increased pulmonary blood flow classification.

44
Q

Which classification of acyanotic congenital heart defects is Atrioventricular canal defect?

A

Atrioventricular canal defect is an increased pulmonary blood flow classification.

45
Q

Which classification of acyanotic congenital heart defects is Coarctation of the aorta?

A

Coarctation of the aorta is an obstructive to blood flow from ventricles classification.

46
Q

What type of defect has an abnormal opening between the atria, allowing blood from the higher-pressure left atrium to flow to the lower-pressure right atrium?

A

An atrial septal defect (ASD) has an abnormal opening between the the atria, allowing blood from the higher-pressure left atrium to flow to the lower-pressure right atrium.

47
Q

What type of cardiac defect put patients at risk for bacterial endocarditis and pulmonary vascular obstructive disease. Eisenmenger syndrome may develop.

A

Ventricular Septal Defect (VSD) puts patients at risk for bacterial endocarditis and pulmonary vascular obstructive disease. Causing Eisenmenger syndrome to develop.

48
Q

What is Eisenmenger syndrome?

A

Eisenmenger syndrome occurs when pulmonary vascular pressure increases due to left-to-right shunting from the ventricles. The pressure in the right increases changing the left-to-right shunt to right-to-left shunt.

49
Q

What type of cardiac defect features an incomplete fusion of the endocardial cushions creating a large central atrioventricular valve, allowing blood to flow between all four chambers of the heart.

A

Atrioventricular canal defect features an incomplete fusion of the endocardial cushions creating a large central atrioventricular valve, allowing blood to flow between all four chambers of the heart

50
Q

What type of defect causes a characteristic machine-like murmur. Administration of indomethacin has proved successful in treating this defect.

A

Patent ductus arteriosus. can be characterized by a machine-like murmur. Administration of indomethacin has proved successful in treating this defect.

51
Q

What type of defect causes the patient to have high blood pressure and bounding pulses in arms; weak or absent femoral pulses and cool lower extremities with lower blood pressure.

A

Coarctation of the aorta causes patients to have high blood pressure and bounding pulses in arms; weak or absent femoral pulses and cool lower extremities with lower blood pressure. Seen in children who are diagnosed with Turner Syndrome.

52
Q

What type of defect causes narrowing to occur at the entrance to the pulmonary artery. Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow.

A

Pulmonary stenosis causes narrowing to occur at the entrance to the pulmonary artery. Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow.

53
Q

What type of cardiac defect causes the prominent anatomic consequence to be hypertrophy of the left ventricular wall, leading to increased end-diastolic pressure.

A

Aortic stenosis causes the prominent anatomic consequence to be hypertrophy of the left ventricular wall, leading to increased end-diastolic pressure.

54
Q

What type of cyanotic classification is Tetralogy of Fallot

A

Tetralogy of Fallot is a decreased pulmonary blood flow cyanotic classification.

55
Q

What type of cyanotic classification is Tricuspid atresia?

A

Tricuspid atresia is a decreased pulmonary blood flow cyanotic classification.

56
Q

What type of cyanotic classification is transposition of great arteries?

A

Transposition of great arteries is a mixed blood flow cyanotic classification.

57
Q

A nurse is assessing a 3 year old child with Aortic Stenosis. Which of the following would the nurse expect to see?

a. Hypotension
b. Bradycardia
c. Clubbing of the nail beds
d. Weak pulses
e. Murmur

A

A nurse assessing a 3 year old child with Aortic stenosis will see the following:

a. Hypotension
d. Weak pulses
e. Murmur

Medical Surgical Nursing 1 (7 decks)

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