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Sophomore 1 Test 3 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

What is the ductus venosus?

A

Shunts blood from the liver to the inferior vena cava in utero

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2
Q

What is the foramen ovale?

A

Bypasses the right side of the heart by opening the right and left atrium in utero. This decreases pulmonary blood flow

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3
Q

What is a patent foramen ovale called?

A

PFO

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4
Q

What is the ductus arteriosus?

A

Connects the aorta and pulmonary artery to allow majority of blood to bypass the lungs in utero (contains mixed blood).

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5
Q

What is a patent ductus arteriosus called?

A

PDA

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6
Q

What happens to circulation when the neonate takes it’s first breath?

A

The pressure changes in systemic and pulmonary circulation which leads to the fetal heart structure changing or closing in response to pressure changes and increased oxygen content.
* 3 shunts should close

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7
Q

Normal Direction of Blood Flow Through the Heart

A
  1. Superior and inferior vena cavas to the right atrium
  2. Tricuspid valve into right ventricle
  3. Pulmonary valve into the pulmonary artery to the lungs where CO2 is exchanged for O2
  4. Pulmonary veins to the left atrium
  5. Through the bicuspid valve into the left ventricle
  6. The aortic valve to the body where O2 is exchanged for CO2 in the cells
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8
Q

Efficiency of pediatric heart compared to adult heart

A

The pediatric heart rate is higher than adults. They are not as efficient, so in order to have a suitable CO their heart needs to work harder to achieve it.

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9
Q

Normal HR for infants

A

90 - 160

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10
Q

Normal HR for toddler/preK

A

80-125

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11
Q

Normal HR for school age child

A

70-100

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12
Q

Normal HR for adolescents

A

60-100

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13
Q

Normal BP for infant

A

averages 80/40

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14
Q

Normal BP for toddler/preK

A

Averages 80-100/64

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15
Q

Normal BP school age children

A

94/56 - 112/60

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16
Q

Normal BP for adolescents

A

100/50 - 120/70

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17
Q

ECG

A

Recording heart’s electrical activity

  1. Child should be quiet and still
  2. Skin free of lotions and oils
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18
Q

Holter Monitor

A

24 hour EKG reading on a recorder worn by the patient

  1. Continue normal daily activities
  2. Snug undershirt can help hold it
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19
Q

CXR

A

Picture of size and position of heart and lungs

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20
Q

ECHO

A

Ultrasound generates picture of heart and vessels

  1. Assess structure, valve function, chamber size, and blood flow direction
  2. Child must be quiet and still
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21
Q

Pulse Oximetry

A
  1. Most common non-invasive method of monitoring arterial oxygen saturation (SpO2)
  2. Sensor placed on a finger, toe, hand, or foot
  3. Movement and temperature will affect reading
  4. Sensor will burn if left in place too long
  5. Change the position per facility policy
  6. Pre ductal: right hand
  7. Post ductal: left foot
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22
Q

Describe cardiac catheterization

A
  1. Catheter generally passed through femoral vein or artery toward heart
  2. Dye injected into catheter to identify detailed images of structures and blood flow patterns
  3. O2 saturations and pressures in heart chambers and arteries can be measured
  4. Conduction and cardiac output are evaluated
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23
Q

Nursing Implications for Cardiac Catheterization

A
  1. Know weight to determine dye amount
  2. Pre medicate as ordered
  3. NPO before
  4. Check for iodine/shellfish allergy
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24
Q

Pre-procedure cardiac catheterization

A
  1. Teach - may feel warmth, heart racing
  2. Use play therapy based on age
  3. Mark peripheral pulse sites and document strength of all sites
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25
Q

Potential Complications of Cardiac Catheterization

A
  1. Hemorrhage
  2. Dysrhthmias
  3. Thrombus or embolus formation, impaired perfusion to leg, PE, or CVA
  4. Infection
  5. Reaction to dye
  6. Cath perforation of heart or vessels
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26
Q

Post-procedure cardiac catheterization

A
  1. Keep leg straight for 4-8 hours
  2. HOB may be raised 20 degrees
  3. Infant may lay prone in parent’s lap
  4. IVF until PO adequate
  5. Frequent VS
  6. Insertion site assessment q5-15, during early post-procedure hours
  7. Assess distal pulses frequently
  8. Assess color, temp, and cap refill frequently
  9. Diet as tolerated when awake
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27
Q

Right to Left Shunting

A

Higher pressure in the lungs causing deoxygenated blood to cross through the PFO into left side of the heart

  1. Crying can cause right to left shunting in newborn
  2. Cyanosis can be seen
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28
Q

Left to Right Shunting

A

Increased peripheral vascular pressure causing blood back through PFO into right atrium and back into lungs.
-Acyanotic

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29
Q

Classification of Congenital Heart Defects

A

Classification is based on blood flow within the heart

  1. Increased pulmonary blood flow
  2. Decrease pulmonary blood flow
  3. Obstructed blood flow
  4. Mixed blood flow
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30
Q

Increased Pulmonary Blood Flow

A

L to R shunting resulting in s/sx of CHF

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31
Q

Decreased Pulmonary Blood Flow

A

R to L shunting resulting in cyanosis and hypoexmia

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32
Q

Obstructed Blood Flow

A

Blood flow impeded from the heart

  • If on the right, cyanosis occurs
  • If on the left, s/sx of CHF
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33
Q

Mixed Blood Flow

A

Hypoxemia with or without cyanosis and s/sx of CHF often occur together

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34
Q

Tetralogy of Fallot

A
  1. Most common cyanotic lesion
  2. R to L shunt
  3. 4 different types
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35
Q

4 Defects (Tetralogy of Fallot)

A
  1. VSD - ventricle septal defect
  2. PS - pulmonary stenosis
  3. Overriding aorta
  4. Right ventricular hypertrophy
36
Q

S/Sx of Tetralogy of Fallot

A
  1. Moderate systolic murmur
  2. Mild to severe cyanosis
  3. TET spells
  4. Polycythemia
37
Q

TET Spells

A

Hypercyanotic episodes when upset

  • Hypoxia, pallor, tachypnea
  • Can become unresponsive
38
Q

Treatment for TET spells

A
  1. Use a calm, comforting approach
  2. Knee chest positioning
  3. 100% O2 by mask
  4. Morphine
  5. Supply IV fluids
  6. Administer propanolol
39
Q

Treatment for Tetralogy of Fallot

A

Prostaglandins to keep PDA open

40
Q

Tricuspid Atresia

A
  1. R to L shunt
  2. Tricuspid valve doesn’t develop = infant requires ASD or PFO to survive
  3. Mixed blood to lungs and systemic circulation
41
Q

S/Sx of Tricuspid Atresia

A

Single heart sound and murmur

42
Q

Treatment for Tricuspid Atresia

A
  1. Prostaglandins to maintain PDA and PFO
  2. Cath lab for atrial septostomy
  3. Surgery
43
Q

Atrial Septal Defect

A
  1. L to R shunt
  2. PFO fails to close, atrium stays open
  3. O2 may worsen (O2 dilates pulmonary vessels which further increases pulmonary blood flow)
44
Q

S/Sx of Atrial Septal Defect

A
  1. Most are asymptomatic
  2. Dyspnea
  3. Fatigue
  4. Poor growth
45
Q

Treatment for Atrial Septal Defect

A
  1. Spontaneous closure by age 3

2. Surgery

46
Q

Ventricular Septal Defect

A
  1. L to R shunt
  2. Opening between lower chambers of heart
  3. Characteristically loud holosystolic murmur, dyspnea, tachypnea
  4. Can cause HTN if defect is large
47
Q

S/Sx Ventricular Septal Defect

A
  1. Present with poor feeding

2. CHF

48
Q

Treatment of Ventricular Septal Defect

A
  1. Spontaneous closure by age 1

2. Surgery

49
Q

Patent Ductus Arteriosus

A

PDA is a failure of the ductus of arteriosus, a fetal circulatory structure, to close within the first weeks of life. As a result, there is a connection between the aorta and pulmonary artery.

50
Q

S/Sx of Patent Ductus Arteriosus

A
  1. Continuous machine-like murmur
  2. Widened pulse pressure
  3. Bounding pulses
51
Q

Treatment for Patent Ductus Arteriosus

A
  1. Indomethacin

2. Surgery PDA ligation

52
Q

Coarctation of Aorta

A
  1. Obstructed blood flow
  2. Narrowing of aorta along arch, as a result blood flow is impeded causing pressure to increase in the area proximal to the defect and to decrease in he area distal to it.
53
Q

S/Sx of coarctation of aorta

A
  1. Increase in BP in upper extremities
  2. Lower BP in lower extremities
  3. Pulses are weaker
  4. Possible murmur
54
Q

Treatment of Coarctation of Aorta

A
  1. Prostaglandins
  2. Cath lab dilation or stent
  3. Surgery
55
Q

Transposition of the Great Vessels/Arteries

A
  1. Mixed defect: pulmonary artery leaves the left ventricle (opposite)
  2. Two independent blood circuits present
  3. PDA or PFO must be present to maintain life
56
Q

S/Sx of Transposition of Great Vessels/Arteries

A
  1. Significant, progressive cyanosis
  2. Tachypnea
  3. Poor feeding
  4. Failure to thrive
57
Q

Treatment for Transposition of Great Vessels/Arteries

A
  1. Prostaglandins
  2. Cath lab
  3. Surgery
58
Q

Hypoplastic Left Heart Syndrome

A
  1. Mixed defect: left side underdeveloped
  2. Aortic valve atresia, hypoplastic LV, hypoplastic ascending aorta, mitral valve stenosis
  3. PDA is lifeline
59
Q

S/Sx of Hypoplastic Left Heart Syndrome

A
  1. Tachypnea
  2. Retractions
  3. Dyspnea
  4. Cyanosis
  5. Diminished pulses
60
Q

Treatment of Hypoplastic Left Heart Syndrome

A
  1. Prostaglandins

2. 3 stages of surgery

61
Q

How to improve oxygenation

A
  1. Assess airway patency and suction PRN
  2. Fowler or Semi-Fowler position
  3. Auscultation for adventitious sounds
  4. Monitor closely for respiratory distress
  5. Humidified supplemental O2 (know your patient)
  6. Anticipate ventilator support
62
Q

Nutritional status for patients with congenital heart disease

A
  1. Failure to thrive is common
  2. Monitor weight
  3. Higher metabolic and caloric needs
  4. Allow 20 minutes for PO attempt
    - May need NG or GT feedings
    - May hold PO attempt if increased respiratory rate
63
Q

Postoperative Care for Cardiac Patients

A
  1. Frequent VS
  2. Probably in ICU setting
  3. Inspect dressing
  4. Chest tube drainage - note color, amount, and character
  5. Monitor urine output
  6. Pain management
64
Q

Goal for treating heart failure

A

Collaboration is necessary to achieve improved cardiac function, restored fluid balance, decreased cardiac workload, and improved oxygen delivery to the tissues.

65
Q

S/Sx of heart failure

A
  1. Difficulty feeding
  2. Tires easily
  3. Tachycardia
  4. Tachypnea
66
Q

Nursing Management of Heart Failure

A
  1. Promote oxygenation
  2. Support cardiac function - digoxin, BP management, diuretics
  3. Adequate nutrition
  4. Promote rest
  5. Strict I/O
  6. Monitor electrolytes
67
Q

Acute Rheumatic Fever

A
  1. A delayed sequela of group A strep pharyngeal infection
  2. Most common ages 5-15
  3. Occurs 2-3 weeks after initial strep infection
  4. Affects the joints, central nervous system, skin, and subcutaneous tissue and causes chronic, progressive damage to the heart and valves
  5. Diagnosed based on modified Jones criteria
68
Q

Treatment of Acute Rheumatic Fever

A
  1. 10 day course of PCN
  2. Corticosteroids
  3. NSAIDs
    * PCN prophylaxis following initial recovery (monthly)
69
Q

Jones Criteria

A

Diagnosis of acute rheumatic fever requires the presence of either two major criteria or one major plus two minor criteria

70
Q

Jones Criteria (Major)

A
  1. Carditis
  2. Migratory polyarthritis
  3. Subcutaneous nodules
  4. Erythema marginatum
  5. Sydenham chorea
71
Q

Jones Criteria (Minor)

A
  1. Arthralgia
  2. Fever
  3. Elevated erythrocyte sedimentation rate or C-reactive protein
  4. Prolonged PR interval
72
Q

Kawasaki Disease

A
  1. Autoimmune response, etiology unknown

2. Acute systemic vasculitis, may result in coronary artery aneurysms and thrombosis

73
Q

S/Sx of Kawasaki disease

A
  1. Strawberry tongue
  2. Fever
  3. Bilateral conjunctivitis
  4. Rash
  5. Crusted lips
  6. Swelling of hands and feet
  7. Erythema to palms and soles
  8. Irritability
  9. Increased ESR
  10. Increased C-reactive protein
74
Q

Treatment for Kawasaki Disease

A
  1. Aspirin

2. IV immunoglobulin (IV IG)

75
Q

Nursing Management of Kawasaki Disease

A
  1. Cool baths
  2. Gentle oral care, keep lips moist
  3. Ice chips or popsicles
  4. Encourage fluids
  5. Cluster care
76
Q

When do you defibrillate?

A
  1. Ventricular fibrillation

2. Pulseless ventricular tachycardia

77
Q

When do you perform synchronized cardioversion?

A
  1. Supraventricular tachycardia

2. Ventricular tachycardia with a pulse

78
Q

3 Categories of Arrhythmias

A
  1. Bradyarrhythmias
  2. Tachyarrhythmias
  3. Absent: pulseless, cardiovascular collapse
79
Q

Sinus Brady

A
  1. Slow HR, normal rhythm
  2. HR below 60
  3. Signs of altered perfusion
  4. Ominous sign
80
Q

Causes of sinus brady

A
  1. Respiratory compromise
  2. Hypoxia
  3. Shock
81
Q

Supraventricular Tachycardia

A
  1. Very regular rhythm and very rapid beat
  2. Narrow QRS and flat P wave
  3. Infants > 220 bpm
  4. Children > 180 bpm
82
Q

Causes of pulseless rhythms

A
  1. Hypoxemia
  2. Hypovolemia
  3. Hypothermia
  4. Electrolyte imbalance
  5. Tamponade
  6. Toxic ingestion
  7. Tension pneumothorax
  8. Thromboembolism
83
Q

Ventricular Tachycardia (with a pulse) Interventions

A
  1. Synchronized cardioversion
  2. IV amiodarone
  3. Treatment of underlying causes
84
Q

Ventricular Tachycardia (pulseless) Interventions

A
  1. CPR
  2. Defibrillation
  3. Epinephrine (or amiodarone)
  4. Treat underlying causes
85
Q

Ventricular Fibrillation Interventions

A
  1. CPR
  2. Defibrillation
  3. Epinephrine (or amiodarone)
  4. Treat underlying causes
86
Q

Asystole Interventions

A
  1. Check lead placement
  2. CPR if no pulse
  3. Epinephrine
87
Q

Pulseless Electrical Activity Interventions

A
  1. Check lead placement
  2. CPR if no pulse
  3. Treat underlying causes
  4. Epinephrine

Sophomore 1 Test 3 (4 decks)

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