Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics Test II > Cardiac > Flashcards

Cardiac Flashcards

1
Q

what are the changes in blood circulation of the baby after birth?

A
  • as infant breathes and the lungs expand, blood flow to the lungs increases, pressure in the right side of the heart falls, and foramen ovale closes
  • ductus arteriosus constricts as arterial O2 levels rise
  • ductus venosus constricts when blood flow from the umbilical cord stops
    • after birth, the ductus venosus and umbilical As and V become ligaments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

cardiac assessment

A
  • ask about: meds, family hx, pregnancy and prenatal care/birth hx, gaining weight?, urine output?, color changes?, can they keep up with their friends?
  • inspection
  • palpation: palpate all pulses b/l (except carotid do one at a time)–are they equal in strength and rhythm?
  • auscultate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

non-invasive and invasive procedures to assess cardiac system

A
  • non-invasive:
    • CXR: record size and shape of heart
    • EKG
    • echocardiogram
    • CT/MRI: non-invasive unless contrast
  • invasive:
    • cardiac catheterization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cardiac cath

A
  • radiopaque catheter is inserted into large artery or vein (usually femoral) and threaded to the heart
  • use of cardiac cath:
    • diagnostic
    • interventional
    • electrophysiologic purposes
    • biopsy
      • if transplant, have to get biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

nursing implications pre-cardiac cath

A
  • NPO for 4-6 hours (need to be clear and specific about solids vs clear liquids)
  • may pre medicate prior to cath
  • stop anticoagulants
  • assess for allergies, prior sedation hx, pregnancy
  • check for baseline circulation in lower extremities and mark pedal pulses
  • prepare child and family for what will occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

nursing implications post cardiac cath

A
  • lay flat and maintain pressure dressing for 4-8 hrs
  • frequent V/S, assessment of pressure dressing and distal circulation, I/O
  • adequate hydration
  • check for hypoglycemia (b/c have been NPO for a while)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

complications of cardiac cath

A
  • hemorrhage at site of infection
  • loss of pulse in catheter extremity–distal to insertion site of catheter
  • dysrhythmias
  • fever
  • n/v
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

patient/parent education

A
  • avoid strenuous activity for several days
  • observe site for infection
  • do not submerge site in water for one week
  • may give acetaminophen/ibuprofen as needed
    • if <6 mos, acetaminophen only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

critical weight gain or loss to be concerned about

A
  • infants: 50 g/day
  • toddlers/preschoolers: 200 g/day
  • adolescents/adults: 500 g/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

congenital heart dz (CHD)

A
  • major cause of death in first year of life (other than prematurity)
  • blood flows from area of high pressure to one of low pressure and takes path of least resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hemodynamics of CHD

A
  • shunt
    • described in terms of ratio of pulmonary blood flow to systemic blood flow (Qp:Qs)–>normal is that Qp=Qs
    • effects on pulmonary vasculature–3 stimuli can cause constriction of pulmonary vessels and inc pulmonary vascular resistance
      • inc blood flow
      • blood flow to lungs under inc pressure
      • hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Eisenmenger Syndrome

A
  • situation in which a left to right shunt caused by a CHD causes increased flow thru pulmonary vasculature causing inc pressure on the right side which causes reversal of the shunt to become a right to left shunt, so deoxygenated blood goes out to periphery so child becomes hypoxic (blue)
    • leads to a progressive inc in pulm vascular resistance (PVR)
    • blood gets oxygenated by lungs, goes to left side of heart, but b/c of hole in heart, some blood foes back to R side of heart, so goes again to lungs and makes lungs work harder
  • child will need heart/lung transplant
  • occurs after a prolonged period of inc pulmonary blood flow
  • can lead to death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 major categories of CHD

A
  • inc pulmonary blood flow
  • dec pulmonary blood flow
  • obstruction of blood flow from the heart
  • mixed blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

name the defects with inc pulmonary blood flow

A
  • ASD
  • VSD
  • PDA
  • AV canal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Atrial Sepal Defect (ASD)

A
  • abnormal opening b/w the atria: L to R shunt
  • S/S in infants: activity intolerance, fatigue, orthopnea
  • mgmt:
    • spontaneous closure occurs frequently
    • supportive tx until child is in preschool
    • direct closure or patch placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ventricular Septal Defect (VSD)

A
  • abnormal opening b/w ventricles: L to R shunt
  • clinical manifestations:
    • harsh systolic murmur
    • inc ventricular and pulmonary artery pressures
    • FTT
    • dyspnea
    • recurrent episodes of CHF: retaining fluid indicated by inc weight and dec UO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

therapeutic mgmt of VSD

A
  • higher calorie, small frequent feedings
  • spontaneous closure occurs in majority by first 2 years of life
  • if small, usually asymptomatic
  • if moderate to large, will show signs of CHF and FTT
    • manage with digoxin and diuretics
    • surgical closure done before irreverible pulmonary dz or Eisenmenger syndrome occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

VSD and pulmonary artery band (PA band)

A
  • band is placed around main pulmonary artery to dec pulmonary blood flow
    • usually done in patients with multiple VSDs or complex heart anatomy
    • nurses must assess for tightening/loosening of PA band
      • if band tightens, then not getting enough blood to lungs to get oxygenated, so becomes hypoxic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

patent ductus arteriosus (PDA)

A
  • normal pathway in fetal circulation, but large channel b/w pulmonary artery and descending aorta
    • functional closure usually shortly after birth
    • permanent closure usually w/in 1st wk of life
  • L to R shunt formed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

therapeutic mgmt for PDA

A
  • PGs will maintain patency of ductus arteriosus
  • administration of indomethacin/ibuprofen will close the ductus arteriosus
  • surgical closure:
    • PDA ligation
    • visual assisted thorascopic surgery (VATS)
  • nonsurgical: w/ coils in cath lab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Atrioventricular Canal (AV Canal)

A
  • large central AV valve is created, allowing blood to flow b/w all chambers
  • inc incidence w/ Trisomy 21
  • L to R shunt formed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

name the defects with obstruction of blood flow from the ventricle

A
  • coarctation of the aorta (COA)
  • aortic stenosis
  • pulmonary stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

coarctation of aorta (COA)

A
  • localized narrowing of aorta near the insertion site of the ductus arteriosus
    • can be before or after the DA
  • results increased pressire proximal to the defect and decreased pressure distal to the defect
  • hallmark sign: differences in BP in upper and lower body
    • have to check BP on all 4 extremities
    • high pressure in head: HA, epistaxis
    • dec pressure in lower extremities: weak pulses, color change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

COA clinical manifestation and tx

A
  • clinical manifestations:
    • high BP and bounding pulses in UE, weak or absent pulses in LE (also usually cool to touch in LE)
    • BP difference of 8-10 mmHg b/w upper and lower extremities needs to be evaluated
    • oxygen saturation differences b/w UE and LE
    • infants will present w/ signs of CHF: severely acidotic, hypotensive (shock)
    • older children will present w/ dizziness, HAs, fainting, epistaxis from HTN
  • tx: open coarcation w/ stent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

aortic and pulmonic stenosis

A
  • may correct in cardiac cath with balloon placement
  • look for S/S of these narrowing down again as child ages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

name the defects with dec pulmonary blood flow

A
  • terrible “T’s”
    • tetralogy of Fallot (TOF)
    • tricuspid atresia
    • transposition of great vessels (TGV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

defects assoc with TOF

A
  • VSD
  • overriding aorta–aorta overrides VSD
    • some of deoxygenated blood to periphery
  • pulmonary stenosis
  • right ventricular hypertrophy
    • may not present at birth but will enlarge as child ages
28
Q

S/S of TOF

A
  • infants become acutely cyanotic at birth–once DA starts to close
  • worsening of cyanosis for first year
  • murmur
  • fatigue with feedings–diaphoretic and cyanotic with PO feeds
  • clubbing of fingers
  • “tet” spells–hypercyanotic episodes
    • squatting position in older children
  • polycythemia–compensatory mechanoism to inc RBC to carry oxygen
    • VERY IMPORTANT to prevent dehydration, but don’t want to contribute to HF
29
Q

“Tet” spells

A
  • hypercyanotic episodes
  • unusally occurs in the morning when waking up
  • precipitated by crying, defecation, and feeding
  • infant becomes acutely cyanotic
    • dec pulmonary blood flow and inc R to L shunting
      • so more deoxygenated blood being sent to periphery so they are blue
    • leads to an inc in oxygen requirement which infant is unable to meet
30
Q

therapeutic mgmt of TOF

A
  • stay calm as not to make child anxious/upset
  • place infants and small children in knee chest position–helps to decrease venous return from the legs which is deoxygenated
    • increases systemic vascular resistance which diverts more blood into pulmonary A
    • older children: squatting position
  • administer oxygen: NC 5 L
  • give morphine SQ or IV–slows RR and dec muscle spasms in heart
31
Q

treatment of TOF

A
  • palliative shunt: modified Blaclock Taussig shunt which provides blood flow to pulmonary As
    • gives time for child to grow to be able to later get open heart surgery
    • shunt MUST stay open so these kids are often on aspirin, but need to be attentive if child exposed to viral illness
  • complete repair: consists of closing VSD and resecting the infundibular stenosis, placement of pericardial patch to enlarge the right ventricular outflow tract (RVOT)
    • usually child leaves surgery on ventilatory support and chest tubes b/c want child to rest
32
Q

tricuspid atresia

A
  • tricuspid vave fails to develop, so have to keep the DA open to have blood flow to lungs
  • there is no communication b/w right atrium and right ventricle
  • pulmonary blood flow is diminished
  • tx:
    • keep PDA open with PG E1
    • stages of surgical repair
33
Q

important note about children with R to L intracardiac shunting

A
  • children are at inc risk for air from venous sytem going directly to brain and resultin in air embolism
    • all IV lines should have filters to rpevent air from entering the system
    • entire tubing and any syringes used for flushing or medication administration are checked for air
    • any air is removed and connections taped securely
34
Q

transposition of the great vessels (TGV)

A
  • pulmonary A leaves the left ventricle
  • aorta leaves the R ventricle
  • PDA must be kep open or it is not compatible with life
  • patent foramen ovale
  • manifestations:
    • cyanosis always present at birth
    • hypoxic spells–may be frequent esp when crying
    • infants with large VSDs may present with CHF
35
Q

therapeutic mgmt of TGV

A
  • oxygen of little benefit
  • may enlarge or create ASD to allow for more mixing
  • nitric oxide can be used to dec PVR, enhance pulm blood flow, and reduce cyanossis
36
Q

tx of TGV

A
  • PG E1 administered to keep PG E1 open
  • arterial switch: usually done 7-30 days after birth
    • 2 great vessels are transposed to keep their correct ventricles and coronary arteries are transferred to ascending aorta
    • ASD (all infants with TGV) and VSD closed at this time
37
Q

what are the 2 defects considered mixed defects?

A
  • TGV
  • hypoplastic left heart syndrome (HLHS)
38
Q

HLHS

A
  • severe hypoplasia of L heart structures
    • small L ventricle unable to sustain adequate CO in the presence of mitral valve stenosis/atresia or both
    • only blood flow is through the PDA
  • clinical manifestations
    • cyanosis
    • child may present in state of vascular collapse w/:
      • tachypnea
      • dyspnea
      • dec BP in all extremities
      • grunting
      • nasal flaring
      • hypothermia
39
Q

therapeutic mgmt of HLHS

A
  • stage reconstruction
    • Norwood Procedure: anastomosis of pulm A to aorta to create new aorta
      • also create large ASD
    • Glenn Shunt: done at 6-9 mos to help get blood to lungs
    • Fontan procedure
  • heart transplant
40
Q

w/ L to R shunt

A
  • mostly pulmonary issues
    • tachypneic
    • resp illness
    • dyspnea
41
Q

w/ the terrible T’s and HLHS

A
  • usually have to keep DA open to make sure blood getting to lungs and out to periphery
42
Q

who should transport a pt?

A
  • the person with the highest ability to do something if something goes wrong
43
Q

cyanosis

A
  • when there is venous arterial shunting or obstruction of blood flow to the lungs
44
Q

heart failure

A
  • occurs when CO is unequal to body requirements
  • body dams up in heart and pulm vasculature becomes engorged
  • S/S: edema, shortness of breath, dec urine output, inc weight
  • mainly occurs due to structural defects
    • inc pulm blood flow
    • obstructive defects
45
Q

mgmt of HF

A
  • improve cardiac fcn: digoxin, ACEI
  • remove excess fluid
    • furosemide, HCTZ, spirinolactone
    • may require K+ supplements
    • fluid restriction
  • dec cardiac demand
    • limit physical activity, minimize crying
    • keep metabolic needs to a minimum: small frequent feeds
    • cluster care
  • improve tissue oxygenation: positioning, suctioning
  • tx underlying cause
46
Q

digoxin

A
  • 3 major actions:
    • inotropic: inc force of contraction
    • chronotropic: dec HR
    • dromotropic: slows conduction of impulses thru AV node
      • indirectly enhances diuresis
  • used in peds b/c of rapid onset/short half life
  • ECG done before first dose
    • bolus given IV or PO in divided doses over 24 hrs to bring child’s levels to therapeutic range
47
Q

digoxin as high alert med

A
  • infants very raraly receive more than 1 mL in a single dose
    • higher dose sign of error
    • compare with another RN
  • hypokalemia–>inc risk of dig toxicity
  • hyperkalemia–>dec effects of digocin
    • keep potassium in normal range
48
Q

ACE inhibitors

A
  • ACEI block the conversion of Ang I to Ang II–vasodilation occur
  • effects:
    • dec PVR, SVR, BP
    • reduced afterload
    • dec R and L atrial pressures
    • reduces secretion of aldosterone–reduces preload by preventing volume expansion from fluid retention and dec risk of hypokalemia
      • for this reason, this addition of potassium supplements to children taking diuretics is not necessary–may cause hyperkalemia
49
Q

diuretics

A
  • mainstay of therapy
  • pay close attn to F/E
  • begin to record output as soon as drug is given
  • watch for dehydration
50
Q

how to dec cardiac demands in HF

A
  • neutral thermal env
  • treat any infections (abx)
  • reduce effort of breathing: suctioning, nebulizer
  • use meds to sedate a fussy baby
  • provide rest and quiet env
51
Q

how to improve tissue oxygenation with HF

A
  • supplemental cool, humidified oxygen
    • use O2 carefully in children with complex heart defects (is a vasodilator and will dec PVR)
      • will inc blood flow to lungs
52
Q

how to d/c NG tube

A
  • must clamp tube when pulling it out so baby doesn’t aspirate the contents when crying
53
Q

rheumatic fever

A
  • systemic inflammatory dz that occurs as a result of naturally acquired immunity to group A strep infection
    • carditis often occurs
  • most common cause of acquired heart dz
  • usually seen in children b/w 6-15, peak at 8 yo
  • often seen in more than 1 family member
  • onset usually about 3 weeks after untreated URI with Group A strep
  • dx made with Jones Criteria
54
Q

clinical manifestation of rheumatic fever

A
  • positive strep test
  • arthritis: most common
  • carditis
    • tachycardia–higher than normal even with a fever
  • GI disturbances
  • dec platelet count: inc risk of bleeding
  • HAs
  • tinnitus
  • SEs of steroidal therapy if used
55
Q

tx of rheumatic fever

A
  • abx to tx strep infection and lifelong prophylaxis
    • can be on daily PO meds or monthly IM injections
  • anti-inflammatory meds: aspirin, ibuprofen
  • digoxin: b/c the valves are affects by rheumatic fever–>dec CO, so give digoxin to inc strength of contractility
56
Q

Kawasaki Dz (Mucotaneous LN Syndrome)

A
  • acute systemic vasculitis of unknown cause
  • usually in those <5 yo
  • acute dz is self limited
  • most common problem is dilatation of coronary As–>aneurysms can develop
57
Q

Kawasaki Dz clinical manifestations

A
  • acute phase: first 10 days
    • fever up to 104 (40 deg C)
    • strawberry tongue–diffuse redness of oral mucosa, erythema of lips/gums
    • erythema and edema of hands and feet
    • polymorphous exanthema
    • cervical lymphadenopathy (unilateral)
  • sub acute phase: 11-25 days
    • desquamation of hands/feet–skin sloughs off
    • rash, fever, lymphadenopathy disappear
    • CV changes occur–coronary dilations occur, so need serial echos
  • convalescent phase:
    • sed rate and platelet count return to normal
58
Q

tx of Kawasaki Dz

A
  • goal is to reduce inflammation in coronary A and prevent thrombosis
    • give single dose of IV gamma globulin and aspirin w/in 10 days of onset
      • reduces chance of coronary A inflammation
      • then dec ASA dosage, but have to continue taking for 6-8 weeks or indefinitely if inflammation in coronary As
59
Q

systemic HTN

A
  • make sure using correct size BP cuff
  • know baseline BP for that child
  • smaller they are the lower the systolic pressure
  • need to differentiate b/w primary HTN (not usual in kids) and secondary
    • main cause of secondary HTN is renal dysfunction
  • before a dx of HTN is made BP should be taken on 3 separate occasions
60
Q

significant vs severe HTN

A
  • significant: BP persistently b/w 95-99% for sex, age, height
  • severe: BP persistently at or above the 99% for sex, age, height
61
Q

mgmt of systemic HTN

A
  • lifestyle modifications
  • pharmacological agents
62
Q

hyperlipidemia/hypercholesterolemia

A
  • current research indicates that a presymptomatic phase of atherosclerosis begins in childhood
    • preventive cardiology is trying ot identify at risk kids early and intervene
  • mgmt:
    • dietary changes
    • if diet is not successful, drug therapy may be needed
      • statins
      • cholestyramine or chlestipol: bile acid binding resins
63
Q

cardiac dysrhythmias

A
  • bradycardia
  • tachycardia
  • conduction disturbances: irregular HR
  • supraventricular tachycardia: one of most common
    • HR b/w 200-300
64
Q

SVT

A
  • infants and young kids have trouble compensating for rapid HR
    • S/S: poor feeding, pallor, extreme fussiness
  • tx:
    • vagal maneuvers
    • administer adenosine
    • children w/ minimal symptoms may receive digoxin
    • transesophageal overdrive pacing or synchronized cardioversion
      • used only on kids who don’t respond ot above tx
      • has to be done in ICU
65
Q

digoxin toxicity

A
  • halos in vision
  • n/v
  • bradycardia: late sign

Pediatrics Test II (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions