Cardiac

Question 1

1 indicator of heart dysfunction

Answer 1

murmur

Question 2

hemodynamic characteristics of CHD

Answer 2

increased pulmonary blood flow
decreased pulmonary blood flow
obstruction of blood flow out of the heart
mixed blood flow

Question 3

increased pulmonary blood flow defects

Answer 3

abnormal connection between septums
increased blood to the right side of the heart
decreased systemic blood flow, increased blood to lungs
risk for right sided heart failure
includes..
atrial septal defect
ventricular septal defect
atrioventricular septal defect
patent ductus arteriosus

Question 4

gold standard diagnosis for heart stuff

Answer 4

echocardiogram

Question 5

atrial septal defect

Answer 5

a form of increased pulm blood flow
hole between left and right atria
can be asymptomatic or have a murmur with atrial dysrythmia

Question 6

ventricular septal defect

Answer 6

a form of increased pulm blood flow
hole between left and right ventricles

Question 7

atrioventricular septal defect

Answer 7

a form of increased pulm blood flow
most common with Downs
blood mixing in all chambers
cyanosis!

Question 8

patent ductus arteriosus (PDA)

Answer 8

form of increased pulm blood flow
ovale of pulmonary artery and aorta never closes
machine murmur will be present, bounding pulses, wide pulse pressure
give NSAIDs to inhibit prostaglandins and make it close

Question 9

obstructive heart defects

Answer 9

causes decreased cardiac output
includes…
coarctation of aorta
aortic stenosis
pulmonic stenosis

Question 10

coarctation of aorta

Answer 10

narrowing of aorta
CM: increased head and neck pressure, HA, JVD, HTN in arms, bounding pulses in arms, hypotension in legs, faint pulses in legs

Question 11

aortic stenosis

Answer 11

narrowing of aortic valve causing left ventricular enlargement and decreased CO
CM: faint pulses, cyanosis, tachycardia, poor feeding

Question 12

pulmonic stenosis

Answer 12

narrowing of pulmonic valve
heart failure symptoms

Question 13

decreased pulmonary blood flow

Answer 13

blood has a hard time leaving right side of the heart via the pulmonary artery
CM: cyanosis and hypoxemia
includes…
tetralogy of fallot
tricuspid artresia

Question 14

tetralogy of fallot

Answer 14

form of decreased pulm blood flow
pulmonic stenosis,
overriding aorta,
ventricular septal defect,
right ventricular hypertrophy
CM: episodic cyanosis (tet spells), lack of O2 improvement after birth
RN interv: calm pt down, encourage knees to chest and lean forward

Question 15

tricuspid atreseia

Answer 15

form of decreased pulm blood flow
narrowing of tricuspid valve, blocking blood flow from right to left ventricle
CM: tachycardia, dyspnea, clubbing

Question 16

mixed defects

Answer 16

oxygenated and deoxygenated blood mix, leading to decreased O2 saturation in systemic blood
includes…
transposition of the great arteries
hypoplastic left-sided heart syndrome

Question 17

transposition of the great arteries

Answer 17

form of mixed defect
pulmonary artery and aorta are switched
CM: extreme cyanosis, heart enlargement
need emergency surgery
give prostaglandins to keep ductus arteriosus open

Question 18

hypoplastic left sided heart syndrome

Answer 18

form of mixed defect
left ventricle is underdeveloped
CM: cyanosis, heart failure symptoms
need surgery w/in few weeks
give prostaglandins to keep ovale open

Question 19

impaired myocardial function

Answer 19

decreased CO
CM: tachycardia, fatigue, weakness, decreased urine output, hypotension, pale cool extremities

Question 20

pulmonary congestion

Answer 20

heart cant pump out all blood, fluid leaking
CM: tachypnea, dyspnea, cyanosis, exercise intolerance, resp distress

Question 21

systemic venous congestion

Answer 21

blood backed up
CM: JVD, peripheral and periorbital edema, weight gain, ascites, hepatomegaly

Question 22

diagnoses

Answer 22

echocardiogram
chest xray
cardiac cath

Question 23

pre-cardiac cath

Answer 23

assess and mark pulses
baseline O2 sats
NPO
assess for iodine or shellfish allergy

Question 24

post-cardiac cath

Answer 24

check pulses distal to site
lay flat with pressure on site
vitals Q15 min
monitor I+O
monitor blood glucose
monitor dressing for bleeding and hematoma
monitor color and temp of extremities

Question 25

digoxin

Answer 25

improves contractility
give 1 hr before meals
give at same time every day
hold for less than 60bpm

Question 26

digoxin toxicity

Answer 26

N/V
poor appetite

Question 27

diuretics

Answer 27

decrease blood and fluid volume
may need to replace K (NOT with potassium sparing diuretics)

Question 28

ace inhibitors

Answer 28

vasodilate and reduce stenosis
monitor for cough

Question 29

bacterial endocarditis

Answer 29

bacterial infection of inner lining of heart
caused by strep, staph, fungus
often w valve replacements
can lead to bacteremia

Question 30

endocarditis

Answer 30

CM: new murmur, low grade fever, malaise, weight loss, anorexia
draw blood cultures
treat w abx or antifungals

Question 31

rheumatic fever

Answer 31

inflammatory disease caused by GABHS
2-4 weeks after start of strep infection
CM: swelling of skin and joints

Question 32

rheumatic heart disease

Answer 32

damage to valves from RF
dx by jones criteria (must have + strep test or rising ASO test, 2 major and 1 minor)
treat: penicillin G IM x1, penicillin V PO x10 days, sulfa PO for 10 days

Question 33

kawasaki disease

Answer 33

autoimmune response affecting skin, lymph nodes, and heart
most common under age 5
3 phases:
acute- sudden high fever above 103, unresponsive to abx and antipyretics
subacute- end of fever thru end of all signs
convalescent- signs resolved but labs still abnormal, takes about 6-8 weeks for labs to be normal

Question 34

dx of kawaski

Answer 34

MUST have fever for 5+ days and four of below symptoms..
-erythema of palms and soles, peeling of hands and feet
-rash
-1+ swollen lymph nodes
-oral conjunctivitis
-strawberry tongue, mouth erythema, lip peeling

Question 35

Kawasaki treatment

Answer 35

IVIG (IV immunoglobulin)
daily low dose aspirin for a few months then 3-5mg/kg/day antiplatelet (to prevent coronary artery clot)
followup echos

Question 36

hyperlipidemia treatment

Answer 36

restrict cholesterol and fat intake
increase whole grains, fruits, veggies
exercise 60min a day for 5 days/week
meds: colestipol or cholestyramine

Question 37

systemic hypertension

Answer 37

essential- idiopathic
secondary- usually to renal disease, CVD, or endocrine or neurologic disorders
treat: beta blockers, diuretics, Ca channel blockers, ACE inhibitors, angiotensin receptor blockers