Cardiac Flashcards
1
Q
What is the ductus venosus?
A
Shunts blood from the liver to the inferior vena cava in utero
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
3
Q
What is a patent foramen ovale called?
A
PFO
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).
5
Q
What is a patent ductus arteriosus called?
A
PDA
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
7
Q
Normal Direction of Blood Flow Through the Heart
A
- Superior and inferior vena cavas to the right atrium
- Tricuspid valve into right ventricle
- Pulmonary valve into the pulmonary artery to the lungs where CO2 is exchanged for O2
- Pulmonary veins to the left atrium
- Through the bicuspid valve into the left ventricle
- The aortic valve to the body where O2 is exchanged for CO2 in the cells
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.
9
Q
Normal HR for infants
A
90 - 160
10
Q
Normal HR for toddler/preK
A
80-125
11
Q
Normal HR for school age child
A
70-100
12
Q
Normal HR for adolescents
A
60-100
13
Q
Normal BP for infant
A
averages 80/40
14
Q
Normal BP for toddler/preK
A
Averages 80-100/64
15
Q
Normal BP school age children
A
94/56 - 112/60
16
Q
Normal BP for adolescents
A
100/50 - 120/70
17
Q
ECG
A
Recording heart’s electrical activity
- Child should be quiet and still
- Skin free of lotions and oils
18
Q
Holter Monitor
A
24 hour EKG reading on a recorder worn by the patient
- Continue normal daily activities
- Snug undershirt can help hold it
19
Q
CXR
A
Picture of size and position of heart and lungs
20
Q
ECHO
A
Ultrasound generates picture of heart and vessels
- Assess structure, valve function, chamber size, and blood flow direction
- Child must be quiet and still
21
Q
Pulse Oximetry
A
- Most common non-invasive method of monitoring arterial oxygen saturation (SpO2)
- Sensor placed on a finger, toe, hand, or foot
- Movement and temperature will affect reading
- Sensor will burn if left in place too long
- Change the position per facility policy
- Pre ductal: right hand
- Post ductal: left foot
22
Q
Describe cardiac catheterization
A
- Catheter generally passed through femoral vein or artery toward heart
- Dye injected into catheter to identify detailed images of structures and blood flow patterns
- O2 saturations and pressures in heart chambers and arteries can be measured
- Conduction and cardiac output are evaluated
23
Q
Nursing Implications for Cardiac Catheterization
A
- Know weight to determine dye amount
- Pre medicate as ordered
- NPO before
- Check for iodine/shellfish allergy
24
Q
Pre-procedure cardiac catheterization
A
- Teach - may feel warmth, heart racing
- Use play therapy based on age
- Mark peripheral pulse sites and document strength of all sites
25
Potential Complications of Cardiac Catheterization
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
26
Post-procedure cardiac catheterization
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
27
Right to Left Shunting
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
28
Left to Right Shunting
Increased peripheral vascular pressure causing blood back through PFO into right atrium and back into lungs.
-Acyanotic
29
Classification of Congenital Heart Defects
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
30
Increased Pulmonary Blood Flow
L to R shunting resulting in s/sx of CHF
31
Decreased Pulmonary Blood Flow
R to L shunting resulting in cyanosis and hypoexmia
32
Obstructed Blood Flow
Blood flow impeded from the heart
- If on the right, cyanosis occurs
- If on the left, s/sx of CHF
33
Mixed Blood Flow
Hypoxemia with or without cyanosis and s/sx of CHF often occur together
34
Tetralogy of Fallot
1. Most common cyanotic lesion
2. R to L shunt
3. 4 different types
35
4 Defects (Tetralogy of Fallot)
1. VSD - ventricle septal defect
2. PS - pulmonary stenosis
3. Overriding aorta
4. Right ventricular hypertrophy
36
S/Sx of Tetralogy of Fallot
1. Moderate systolic murmur
2. Mild to severe cyanosis
3. TET spells
4. Polycythemia
37
TET Spells
Hypercyanotic episodes when upset
- Hypoxia, pallor, tachypnea
- Can become unresponsive
38
Treatment for TET spells
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
Treatment for Tetralogy of Fallot
Prostaglandins to keep PDA open
40
Tricuspid Atresia
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
S/Sx of Tricuspid Atresia
Single heart sound and murmur
42
Treatment for Tricuspid Atresia
1. Prostaglandins to maintain PDA and PFO
2. Cath lab for atrial septostomy
3. Surgery
43
Atrial Septal Defect
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
S/Sx of Atrial Septal Defect
1. Most are asymptomatic
2. Dyspnea
3. Fatigue
4. Poor growth
45
Treatment for Atrial Septal Defect
1. Spontaneous closure by age 3
| 2. Surgery
46
Ventricular Septal Defect
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
S/Sx Ventricular Septal Defect
1. Present with poor feeding
| 2. CHF
48
Treatment of Ventricular Septal Defect
1. Spontaneous closure by age 1
| 2. Surgery
49
Patent Ductus Arteriosus
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
S/Sx of Patent Ductus Arteriosus
1. Continuous machine-like murmur
2. Widened pulse pressure
3. Bounding pulses
51
Treatment for Patent Ductus Arteriosus
1. Indomethacin
| 2. Surgery PDA ligation
52
Coarctation of Aorta
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
S/Sx of coarctation of aorta
1. Increase in BP in upper extremities
2. Lower BP in lower extremities
3. Pulses are weaker
4. Possible murmur
54
Treatment of Coarctation of Aorta
1. Prostaglandins
2. Cath lab dilation or stent
3. Surgery
55
Transposition of the Great Vessels/Arteries
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
S/Sx of Transposition of Great Vessels/Arteries
1. Significant, progressive cyanosis
2. Tachypnea
3. Poor feeding
4. Failure to thrive
57
Treatment for Transposition of Great Vessels/Arteries
1. Prostaglandins
2. Cath lab
3. Surgery
58
Hypoplastic Left Heart Syndrome
1. Mixed defect: left side underdeveloped
2. Aortic valve atresia, hypoplastic LV, hypoplastic ascending aorta, mitral valve stenosis
3. PDA is lifeline
59
S/Sx of Hypoplastic Left Heart Syndrome
1. Tachypnea
2. Retractions
3. Dyspnea
4. Cyanosis
5. Diminished pulses
60
Treatment of Hypoplastic Left Heart Syndrome
1. Prostaglandins
| 2. 3 stages of surgery
61
How to improve oxygenation
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
Nutritional status for patients with congenital heart disease
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
Postoperative Care for Cardiac Patients
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
Goal for treating heart failure
Collaboration is necessary to achieve improved cardiac function, restored fluid balance, decreased cardiac workload, and improved oxygen delivery to the tissues.
65
S/Sx of heart failure
1. Difficulty feeding
2. Tires easily
3. Tachycardia
4. Tachypnea
66
Nursing Management of Heart Failure
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
Acute Rheumatic Fever
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
Treatment of Acute Rheumatic Fever
1. 10 day course of PCN
2. Corticosteroids
3. NSAIDs
* PCN prophylaxis following initial recovery (monthly)
69
Jones Criteria
Diagnosis of acute rheumatic fever requires the presence of either two major criteria or one major plus two minor criteria
70
Jones Criteria (Major)
1. Carditis
2. Migratory polyarthritis
3. Subcutaneous nodules
4. Erythema marginatum
5. Sydenham chorea
71
Jones Criteria (Minor)
1. Arthralgia
2. Fever
3. Elevated erythrocyte sedimentation rate or C-reactive protein
4. Prolonged PR interval
72
Kawasaki Disease
1. Autoimmune response, etiology unknown
| 2. Acute systemic vasculitis, may result in coronary artery aneurysms and thrombosis
73
S/Sx of Kawasaki disease
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
Treatment for Kawasaki Disease
1. Aspirin
| 2. IV immunoglobulin (IV IG)
75
Nursing Management of Kawasaki Disease
1. Cool baths
2. Gentle oral care, keep lips moist
3. Ice chips or popsicles
4. Encourage fluids
5. Cluster care
76
When do you defibrillate?
1. Ventricular fibrillation
| 2. Pulseless ventricular tachycardia
77
When do you perform synchronized cardioversion?
1. Supraventricular tachycardia
| 2. Ventricular tachycardia with a pulse
78
3 Categories of Arrhythmias
1. Bradyarrhythmias
2. Tachyarrhythmias
3. Absent: pulseless, cardiovascular collapse
79
Sinus Brady
1. Slow HR, normal rhythm
2. HR below 60
3. Signs of altered perfusion
4. Ominous sign
80
Causes of sinus brady
1. Respiratory compromise
2. Hypoxia
3. Shock
81
Supraventricular Tachycardia
1. Very regular rhythm and very rapid beat
2. Narrow QRS and flat P wave
3. Infants > 220 bpm
4. Children > 180 bpm
82
Causes of pulseless rhythms
1. Hypoxemia
2. Hypovolemia
3. Hypothermia
4. Electrolyte imbalance
5. Tamponade
6. Toxic ingestion
7. Tension pneumothorax
8. Thromboembolism
83
Ventricular Tachycardia (with a pulse) Interventions
1. Synchronized cardioversion
2. IV amiodarone
3. Treatment of underlying causes
84
Ventricular Tachycardia (pulseless) Interventions
1. CPR
2. Defibrillation
3. Epinephrine (or amiodarone)
4. Treat underlying causes
85
Ventricular Fibrillation Interventions
1. CPR
2. Defibrillation
3. Epinephrine (or amiodarone)
4. Treat underlying causes
86
Asystole Interventions
1. Check lead placement
2. CPR if no pulse
3. Epinephrine
87
Pulseless Electrical Activity Interventions
1. Check lead placement
2. CPR if no pulse
3. Treat underlying causes
4. Epinephrine
