ATI 20 - Cardiovascular Disorders Flashcards
Cardiomyopathy
disorder of heart’s muscle
- affects chamber size, wall thickness, or contraction
- leads to problems w VENTRICULAR systolic or diastolic function
most common form of cardiomyopathy
DILATED cardiomyopathy
Dilated Cardiomyopathy
ventricular stretches + dilates
» poor pumping
- genetic (myocarditis or neuromuscular disease)
- treated for CHF
most common cause of sudden unexpected death
HYPERTROPHIC cardiomyopathy
Hypertrophic Cardiomyopathy
myocardial cells become enlarged> causes scarring
|»_space;>poor filling fr still walls
Pulmonary Artery HTN
pathophysiology
- blood backs up in lungs» pulmo vasoconstriction
- rt.vent hypertrophy as RV tries to push past pressure
- cause inflammtn, hypertrophy of sm. arteries, + fibrosis
- rt to lft shunt if pressure gets too high
Pulmonary Artery HTN
symptoms
- dyspnea w activity
- chest pain
- syncope
Pulmonary Artery HTN is ____ and eventually _____
progressive + eventually fatal
Pulmonary Artery HTN
education
- avoid high altitude (hypoxia)
- adhere to med schedule
Congenital Heart Disease
occurrence
8-12 per 1,000 live birth
Congenital Heart Disease
genetic + environmental causes
- drug exposure
- maternl viral infectn
- maternl metab disorder
- incr maternl age
- multifactorial genetc pattern
- chrmsml abnorm
Congenital Heart Disease
etiology
inadequate CO
-hypertrophy followed by failure
Congestive HF
EARLY signs in INFANTS
- wt loss or lack of wt gain
- tire easily
- irritable
- diaphoresis
- freq resp infectn
Congestive HF
EARLY signs in OLDER CHILDREN
- exercise intolerance
- dyspnea
- ab pain or distention
- periph edema
- change in skin color
Congestive HF
LATE signs in INFANTS
- tachypnea
- tachycardia
- pallor/cyanosis
- nasal flaring
- grunting
- retraction
- cough
- crackles
Congestive HF
LATE signs in OLDER CHILDREN
- anorexia
- cough
- wheeze
- crackle
- fluid vol excess
- JVD
Congestive HF
nursing mgmt
- I+O
- serial ab measurment
- freq dvlpt assessment Q2-3MO
- admin meds
Congestive HF
medications [6]
1 digoxin (Lanoxin) 2 furosemide (Lasix) 3 thiazide (Diuril) 4 spironolactone (Aldactone) 5 ACEi (-pril) 6 carvedilol (Coreg)
digoxin (Lanoxin)
moa
- slows HR
- incr filling time
- incr CO
digoxin (Lanoxin)
nursing mgmt
-assess HR for brady (full 1 min)
-withhold if pulse is <90bmp for infants
<70bmp for children
-monitor for digoxin toxicity
withhold digoxin if pulse is ___ for infants; ___ for children
<90bmp
<70bmp
furosemide (Lasix)
moa
- rapid diuresis
- blocks reabsorb of Na + H2O in renal tubes
furosemide (Lasix)
nursing mgmt
- monitor pt during rapid diuresis for VS, I+O, fluid + electrolyte balance
- monitor for hypo-K + hypo-Cl
- assess digoxin toxicity if hypo-K is present
thiazide (Diuril)
moa
maintain diuresis
-decr absorption of Na, H2O, K, Cl, bicarb in renal tubules
thiazide (Diuril)
nursing mgmt
- monitor BP
- I+O
- lab for hypo-K
- assess for digoxin toxicity
spironolactone (Aldactone)
moa
K sparing diuresis
ACEi (-pril)
moa
- promote vasc relaxtn
- reduce periph vasc resistance
- reduce afterload
ACEi (-pril)
nursing mgmt
-monitor HTN w start of therapy + dosage changes
common SE: cough, hyper-K, worsening renal functn
carvedilol (Coreg)
moa
- improve lft.vent function
- vasodilatn of systmc circltn
-for chronic HF + dilated cardiomyopathy
Infective Endocarditis
clinical manifestations
- fever
- fatigue
- muscle aches
- new/change in murmur
- signs of congestive HF
Infective Endocarditis
Tx
- abx, antifungal (2-8wk)
- Tx congestive HF
- assess valve damage (surgcl valve replacement)
Congenital Heart Condition
nursing care
- limit feeding to 30min unless instructed otherwise
- careful w fluid + O2
- breastmilk preferred (possibly pumped, fortifd, or supplmtd)
- infectn prevention
- maybe transpyloric, nasogastric, gastronomy tube
___ is required before cardiac catheterization
baseline assessment
-make sure no allergies to iodine or shellfish bc contrast
cardiac catheterization
post op care
- continuous cardiac + pulse ox
- assess pulse for symmetry
- assess skin
- assess insertion site for bleed/hematoma
- prevent bleeding by keeping extremity in straight position
cool extremity that blanches after cardiac catheterization can indicate
arterial obstruction
sudden sustained incr in pulse/resp + decr in perfusn may indicate…
early hemorrhage
INCREASED pulmonary BF
clinical manifestations
- tachypnea
- tachycardia
- murmur
- *CHF**
- poor wt gain
- diaphoresis
- periorbital edema
- freq resp infection
DECREASED pulmonary BF
clinical manifestations
- *cyanosis**
- hypoxic spells
- poor wt gain
- polycythemia
OBSTRUCTION to systemic BF
clinical manifestation
- *CHF w pulmo edema**
- diminished pulse
- poor color
- delayed cap refill time
- decr UO
MIXED Defects
clinical manifestations
- *cyanosis**
- *CHF can occur w incr shunting**
- poor wt gain
- pulmo congestn
Patent Ductus Arteriosus
occurrence
common
-5-10% of all infants w congenital heart disease
normal ductus arteriosus
blood goes fr pulmo artery to aorta
- closes 10-15 hr after birth
- complete seal after 10-21 days after birth
normal closure of ductus arteriosus is triggered by…
high O2 saturation
Patent Ductus Arteriosus
pathophysiology
at birth, SVR incr + PVR decr
|»_space;reverses flow across ductus arteriosus
Patent Ductus Arteriosus
is common in…
preterm infants w resp distress syndrome or hypoxemia
Arrhythmias
**bradycardia leads to…
- hypothermia
- hypoxia
- incr ICP
-hyper-K
Arrhythmias
**supraventricular tachycardia for infants
> 220bpm
signs poor feed, irritable, pallor
-vagal maneuvers
Arrhythmias
**supraventricular tachycardia for children
> 180 bpm
-vagal maneuvers
Rheumatic Fever
**pathophysiology
inflammatory disorder of connective tissue
»autoimmune
***caused by group A beta-hemolytic streptococcus
Rheumatic Fever
**etiology/age
5-15 yo
Rheumatic Fever
**clinical manifestations
-begin 2-6wk after untreated or partially treated strep infectn w GABHS
**with Rheumatic Fever, a new mrmr may indicate…
carditis of mitral or aortic valve
Tx for carditis, inflammation in Rheumatic Fever
aspirin
Kawasaki Disease
**acute (1-2wk) clinical manifestations
- high fever >5dy
- unresponsive to antipyretics
- red throat
- red/chapped lips
- strawberry tongue
- swollen limbs
Kawasaki Disease
**subacute clinical manifestations
subacute is >2wks
- cardiac disease
- no fever
- joint pain
Kawasaki Disease
**tx
aspirin
- anti-inflammatory
- anti-platelet dose after fever decr
Shock + types
inadequate delivery of O2 to tissues
types: compensated + decompensated
Decompensated shock vs compensated shock
decomp: hypotension, delayed cap refill, pallor
comp: tachycard, normotensive or HTN
hypovolemic shock
*cause
loss of volume
vasogenic shock
*cause
vasodilation
cardiogenic shock
*cause
pump failure
obstructive shock
*cause
obstruction to flow
Rheumatic fever diagnostics
Blood antistreptisin O tiger is elevated
