Cardiac 1

Question 1

what are the fetal cardiac structures

Answer 1

foramen ovale: closes within 24 hrs of birth (child should stay at the hospital for 24 hrs after birth to ensure closure)
ductus arteriosus- closes by day 4

Question 2

pediatric differences in cardiac

Answer 2

• heart lies more horizontal in childre
• apical impulses at the left midclavicular line (4th ICS)
• sinus arrhythmia is normal in children
• child has increased risk of heart failure

Question 3

why are children at higher risk of heart failure

Answer 3

immature heart is sensitive to volume or pressure overload

muscle fibers are less developed

Question 4

physical exam

Answer 4

observe, palpate, vital signs(HR for full min, BP on 4 extremities), auscultate chest, abdomen (hepatomegaly)

Question 5

what are the pulse rates

Answer 5

infants average 120

continues to decrease with age

Question 6

pulse strength ratings

Answer 6

0 is no pulse
1 is faint, detectable 
2 is diminished
3 is normal 
4 is bounding

Question 7

cardiac diagnostic tests

Answer 7

chest x ray, ECG, CBC, ABGs, echocardiography, MRI, cardiac cath

Question 8

what is a normal pulse ox in children

Answer 8

*pulse ox is a good noninvasive O2 sat level
95% to 98% is normal in children
*<94 in quiet infant is bad

Question 9

why is cardiac catheterization used

Answer 9

• helps determine what is happening in child’s heart

- may do some corrective procedures

Question 10

pre procedure of cardiac cath care

Answer 10

• NPO 4-6 hrs before procedure
• age appropriate teaching
• oral sedation
• obtain baseline VS and blood work
• assess skin temp, strength pulse
• complete Hx (ht, wt, allergies)

Question 11

post procedure of cardiac cath

Answer 11

• monitor for bleeding (pressure dressing 6 hrs)
• vital signs and neuro check (every 15 min for 1 hr, then 30 min for 1 hr until stable)
• maintain bed rest 4-6 hr and keep leg straight

Question 12

discharge teaching for cardiac cath

Answer 12

• teach signs of complications (bleeding infection)
• quiet play only for 24 hrs
• increase fluid intake to get dye out of system

Question 13

• this is a defect in the heart or great vessels or persistence of fetal structures after birth
• common birth defect

Answer 13

congenital heart disease

Question 14

how many CHD are there

Answer 14

> 35

Question 15

when are CHD most likely to occur

Answer 15

during first 8 wks of gestation

Question 16

genetic/environmental factors that may affect CHD

Answer 16

• fetal exposure to drugs, alcohol, and secondary to tobacco smoke
• maternal viral infection (rubella)
• maternal metabolic disorder (diabetic)
• increased maternal age
• genetic factors (family hx)
• chromosomal abnormalities (trisomy)

Question 17

clinical manifestations of congential heart disorder

Answer 17

• *first indication of CHD is HEART MURMUR
• symptoms in newborn as soon as umbilical cord is cut or within first few days of birth
• may remain asymptamatic for a while
• classified by change in blood flow (increase or decreae in pulmonary)

Question 18

describe what artiral septal defect (ASD) is

Answer 18

• defect from atria allowing blood to flow from LA to RA

- foramen ovale fails to close*** (increased pulmonary BP)

Question 19

s/s of ASD

Answer 19

dyspnea, fatigue, poor growth, systolic **ejection murmur

Question 20

what can ASD lead to

Answer 20

congestive heart failure (can go into it)

Question 21

treatment of ASD

Answer 21

surgical closure with patch or closure device cna be inserted during cardiac cath

Question 22

describe what patent ductus arteriosus is (PDA)

Answer 22

-failure of fetal ductus arteriossus to close first few weeks of life

Question 23

what is the fetal ductus arteriosus

Answer 23

• artery connecting aorta and pulmonary artery

- oxygenated blood shunted from aorta into pulmonary artery

Question 24

s/s of PDA

Answer 24

• *machine like murmur and thrill in pulmonic area

- tachycardia, widened pulse pressure, bounding pulse

Question 25

treatment for PDA

Answer 25

• Indocin (successful in closing FDA) OR

- cardiac cath to occlude

Question 26

what is ventricular septal defect (VSD)

Answer 26

• defect between ventricles, allowing blood to flow from LV to RV Increase in pulmonary BP)
• congestive heart failure is common

Question 27

s/s of VSD

Answer 27

tachypnea
dyspnea
poor growth
reduced fluid intake
systolic murmur at left lower sternal border

Question 28

treatment for VSD

Answer 28

• prophylatic antibiotics to prevent endocarditis

- may have spontaneous closure or surgical patch/sutures may be needed