Cardiac Flashcards
1
Q
What are the four structures of fetal circulation?
A
- umbilical vein, umbilical arteries
- foramen ovale
- ductus arteriosus
- ductus venosus
2
Q
True or false: lungs are used in utero.
A
false; lungs are like deflated balloons until the newborn takes its first breath
3
Q
what important thing happens when a newborn takes its first breath?
A
the lungs expand and all the fetal circulation structures that were used in utero should be closed or begin to close
4
Q
The ductus venosus does what important job?
A
connects umbilical vein to inferior vena cava causing blood to bypass the liver
5
Q
Which fetal circulation structure is permanently closed when the clamp is placed on the umbilical cord?
A
ductus venosus
6
Q
what is an early sign to look for in an infant that would indicate cardiac dysfunction?
A
poor feeding
7
Q
what are some other pediatric indicators of cardiac dysfunction?
A
- poor feeding: infant
- tachypnea
- tachycardia
- failure to thrive, poor weight gain
- activity intolerance: older kiddos
- developmental delays especially gross motor
- positive family history of cardiac disease
8
Q
what are some common gross motor milestones that may be delayed if cardiac dysfunction is indicated?
A
- crawling: infant
- walking: toddler and preschool
- exercise: toddler and preschool
9
Q
what are some important family history questions consider with cardiac disease/dysfunction?
A
- prenatal care
- delivery process (was it traumatic?)
- substance abuse
10
Q
what is the key thing we’re listening for in an infant or child who we suspect has some type of cardiac dysfunction?
A
murmurs; however, they are hard to detect
11
Q
what are some key assessments of cardiac function?
A
- history: prenatal and postnatal
- color
- auscultation
- pulses
- blood pressure (in all 4 extremities)
- capillary refill
- abdomen (distention)
12
Q
with which cardiac condition is it imperative to check BP in all four extremities and why?
A
coarctation of the aorta because lower extremities will have a lower BP than upper extremities
13
Q
what are some types of diagnostic testing that is done to detect cardiac issues?
A
- chest X Ray
- ECG
- echocardiography
- cardiac catheterization
14
Q
what are some potential complications that can occur during a cardiac catheterization?
A
- hemorrhage (#1)
- arrhythmias
- vascular damage
- vasospasms
- thrombus
- embolus
- infection
- catheter perforation
15
Q
what are some primary nursing care skills that should be done for cardiac catheterization?
A
- mark distal pulses before procedure
- check insertion site dressing Q 15 minutes for the first 2 hours
- monitor heart rate, vitals, and pulses Q 15 minutes initially (pt will be on tele)
- maintain affected extremity in straight, flat position
- keep the patient on bed rest (typically 6 hours)
16
Q
What is the number one thing that should be monitored after a patient has a cardiac catheterization, and if this particular thing occurs what should be done?
A
- monitor for bleeding and arrhythmias
- oozing, swelling , check under the patient
- if bleeding occurs, apply pressure, and call for help (cardiologist)
17
Q
Cardiac catheterization emergency management of bleeding from the site is to apply pressure ____ inch(es) above the insertion site.
A
1 inch
18
Q
what are some post cardiac catheterization teaching highlights?
A
- for a parent of a child who recently had a cardiac catheterization should include monitoring the site
- the child should avoid strenuous exercise, but may return to school
19
Q
what are the two types of cardiac defects?
A
- congenital
- acquired
20
Q
what are the types of congenital cardiac defects?
A
anatomic , resulting in abnormal function
21
Q
what are the causes of acquired cardiac defects?
A
-disease process: \+infection \+autoimmune response \+environmental factors \+familial tendencies
22
Q
what are the hemodynamic characteristics and classifications of congenital heart disease? (4)
A
- increased pulmonary blood flow
- decreased pulmonary blood flow
- obstruction of blood flow out of the heart
- mixed blood flow
23
Q
Increased pulmonary blood flow defects have left to right shunting lesions and cause what?
A
- increase blood volume on right side a heart
- increased pulmonary blood flow
- decrease systemic blood flow
24
Q
what is 1 cause of increased pulmonary blood flow defects (left to right shunting)
A
- abnormal connection between two sides of the heart
- either the septum or the great vessels
25
what are the three types of increased pulmonary blood flow defects?
- atrial septal defect (ASD)
- ventricle septal defect (VSD)
- patent ductus arteriosus (PAD)
26
where does atrio septal defect occur and what are the common characteristics?
- foreman ovalle
- two times more common in females
- can be asymptomatic until dyspnea and fatigue occur on exertion
- may have a murmur
27
what are the common characteristics of ventricle septal defect?
- this is the most common congenital lesion
| - majority of these close spontaneously
28
what are the characteristics of Patent ductus arteriosus?
- this is most common in pre-term infants
| - acyanotic
29
when do we want the patent ductus arteriosus to be closed?
1 hour after birth; however, no longer than six hours after birth
30
what happens if the atrial septal defect is not asymptomatic or does not close on its own?
- chronic increased pulmonary blood flow leads to pulmonary vascular obstructive disease
- atrial dysrhythmias caused by atrial enlargement
- surgery or non-surgical cardiac catheterization is done to prevent pulmonary vascular obstructive disease as an adult
31
what are the three types of decreased pulmonary blood flow defects (right to left shunting)?
- Tetralogy of Fallot
- tricuspid atresia
- transposition of the great vessels
32
Decreased pulmonary blood flow defects carry _____________ blood to the body causing cyanosis.
non-oxygenated
33
what are the four things the categorize a defect as Tetralogy of Fallot?
- pulmonic stenosis
- right ventricular hypertrophy
- overriding aorta
- ventricular septal defect
34
True or false: a patient with Tetralogy of Fallot will be extremely cyanotic so giving them oxygen will help.
false; oxygen will not help because hemodynamics of this patient differ
35
what are common characteristics of Tetralogy of Fallot?
- most frequent cyanotic lesion
- boot shaped heart
- may need prostaglandin aid to keep PDA open
- clubbing
- cyanotic spells - Tet spells or hyper-cyanotic spells
- polycythemia (keep hydrated)
36
How do we treat cyanotic spells that occur in patients with Tetralogy of Fallot?
put the patient in a needed chest baby position or have the patient squat during Tet spells because this increases the blood flow to the lungs
37
what is a patient who has Tetralogy of Fallot most at risk for?
- clots/embolus
- seizures
- sudden death
38
What are the three types of obstructed defects?
- coarctation of the aorta
- aortic stenosis
- pulmonic stenosis
39
what happens in a patient who has coarctation of the aorta?
- there is a decreased blood flow to the lower part of the body
- BP in upper extremities will be higher than in the lower extremities (check BP in all 4 extremities)
40
What are the two types of congestive heart failure in children?
- Pulmonary congestion (left sided)
| - systemic venous congestion (right sided)
41
What are some signs and symptoms of pulmonary congestion (left sided)?
- tachypnea
- dyspnea
- respiratory distress (increased RR)
- exercise intolerance
- cyanosis
- crackles
42
what are some signs and symptoms of systemic venous congestion (right sided)?
- peripheral and periorbital edema
- weight gain
- ascites (abdominal distention)
- hepatomegaly
- neck vein distention
43
what are signs and symptoms of impaired myocardial function?
- tachycardia (#1- even at rest)
- gallop rhythm
- fatigue
- weakness
- restlessness
- pale
- cold extremities
- decrease BP
- decreased UOP
44
the earliest sign of heart failure is __________ which is defined as an infant having a sleeping heart rate of greater than ____ bpm.
tachycardia
| >160 bpm
45
what are some overall signs and symptoms of congestive heart failure in children?
- all infants energy is used to maintain heart rate and breathing
- poor weight gain
- tired easily during feedings
- developmental delay
46
what are the four types of medications used to treat congestive heart failure in children and enhance myocardial function?
- oral positive inotropic agents -digoxin -improve contractility
- ace inhibitors -reduce after load on the heart
- beta blockers
- diuretics
47
Nursing interventions to increase cardiac output and what to monitor for.
- administer digoxin as prescribed
- monitor serum potassium levels
- monitor pulse
- maintain neutral thermal environment
- plan frequent rest periods
- cluster care/activities to allow for uninterrupted sleep
48
nursing interventions pertaining to what to monitor for with the oxygenation
- monitor respiratory rate and lung sounds
- monitor oxygen saturation
- provide oxygen in the humidification if prescribed
- observed for diaphoresis, a sign of increase respiratory effort
- position and semi-Fowler to relieve orthopnea
49
What are some nursing interventions to assess fluid volume?
- strict I&Os
- daily weight
- measure abdominal girth daily
- observe for peripheral edema
- administer diuretics as ordered
- monitor electrolytes
50
what are some nursing interventions to assess nutrition?
- maintain nutritional status with small, frequent, high caloric feeds
- 20 Cal increase to 24 Cal/oz
- limit feedings to 20-30 minutes
- infant may require tube feedings to conserve energy
- provide pacifier for sucking needs if tube feeding
51
What are the three types of cardiac arrhythmias in children ?
- sinus tachycardia
- supra ventricular tachycardia
- bradycardia
52
what are some nursing considerations for sinus tachycardia?
- fever
- stress
- pain
- agitation
- hypovolemia (shock)
- congestive heart failure
53
what is the management for sinus tachycardia?
identify and treat underlying cause
54
what is the abnormal heart rate associated with sinus tachycardia for both infants and children?
```
infant = <220 BPM
child= <180 BPM
```
55
what is the abnormal heart rate associated with super ventricular tachycardia for both infants and children?
```
infant = >220 BPM
child = >180 BPM
```
56
what are nursing considerations for stable supra ventricular tachycardia?
- initiate vagal response ( ice to face, have patient bear down , have patient blow through straw)
- suction the nasopharynx
57
what medication is administered for stable super ventricular tachycardia?
- adenosine 0.1mg/kg double dose after first dose (Max first dose of 6mg)
- give IV as a slam technique( push in adenosine and immediately push in normal Saline after)
58
what are some common causes of bradycardia in a neonate?
- suctioning
- reflux
- apnea of prematurity
59
what are some other common causes of bradycardia (besides suctioning, reflux, and apnea of prematurity)?
- hypoxemia (give O2 first)
- hypothermia
- head injury
- heart block
- heart transplant
- toxins\ poisons\ drugs
- increased vagal tone
- central line in right atrium
60
What do we do if cardiogenic shock is caused by bradycardia or tachycardia?
manage arrhythmias per algorithms
61
what do we do if cardiogenic shock is caused by congenital heart disease or heart surgery?
- administer 5-10mL NS/LR bolus and repeat as necessary after listening to the lungs
- vasoactive infusion
62
What are some signs and symptoms to assess low cardiac output?
- poor neurological status
- acidosis
- high lactate
- poor perfusion (long capillary refill time)
- modeled skin
- weak\ thready pulses
- hands and feet cool to touch
- poor UOP
63
What are the common causes of infective (bacterial) endocarditis?
- streptococcal
- staphylococcal
- fungal infections
64
how do patients often present if they have infective endocarditis?
with insidious, low grade fever
65
what do we give prophylactically before dental work and before surgeries to decrease the risk of infective endocarditis from happening?
prophylactic antibiotics
66
what is rheumatic fever?
inflammatory disease that occurs after Group A B-haemolytic streptococcal pharyngitis (strep throat)
67
what are some major things throughout the body that can be affected by rheumatic fever?
- joints
- skin
- brain
- heart
- serous surfaces
68
What is the most common complication of rheumatic fever if there is significant damage to the heart valves?
rheumatic heart disease
69
what are some clinical manifestations of rheumatic fever?
- carditis (chest pain, SOB)
- fever
- tachycardia (even during sleep)
- polyarthritis (migratory large-joint pain)
- erythema marginatum ( rash started trunk)
- subcutaneous nodules over Bony prominences
- Chorea (irregular involuntary movements)
70
what are some lab findings that are associated with rheumatic fever?
- elevated erythrocyte sedimentation rate
| - elevated ASO (antistreptolysin O) titer -rise and titers begins about seven days post onset of infection
71
What is Kawasaki Disease?
In acute systemic vasculitis of unknown cause
72
what is the most common adverse result in coronary artery disease that occurs in 75% of cases in children less than five years old?
Kawasaki disease
73
what are the three phases of Kawasaki Disease?
- acute
- subacute
- convalescent
74
what is the acute phase of Kawasaki disease?
abrupt onset of high fever, lasting at least five days, unresponsive to antipyretics and antibiotics
75
what is the sub-acute phase of Kawasaki disease?
resolution of fever through end of all KD clinical signs
76
what is the convalescent phase of Kawasaki disease?
clinical signs resolved, but laboratory values not returned to normal; Completed with normal values ( 6 to 8 weeks)
77
what are some clinical manifestations during the acute phase of Kawasaki disease?
- cervical lymphadenopathy
- red, cracked lips
- strawberry tongue
- erythematous palms
- reddened, dry eyes
- hands and feet edematous
- palms and soles erythematous
- very irritable and inconsolable
- arthritis in small joints
78
what inflammatory markers on labs are elevated during the acute phase of Kawasaki disease?
C-reactive protein , erythrocyte sedimentation rate
79
What are the clinical manifestations during the sub-acute phase of Kawasaki disease?
- begins with the resolution of fever
- risk of coronary thrombosis
- Pilling of hands and feet
- arthritis in large weight bearing joints
- irritability persisting
80
what are the clinical manifestations during the convalescent phase of Kawasaki disease?
- clinical signs resolve
- may still have elevated sed rate and CRP
- may still have arthritis
81
what is the treatment for Kawasaki disease?
- high dose IVIG (decreases inflammation and prevents arrhythmias)
- high dose aspirin (prevent arrhythmias and clotting)
82
What is some priority nursing care that needs to be done for a child who has Kawasaki disease?
-management of risk for fluid imbalance
-assess for signs of heart failure
+decrease UOP
+gallop rhythm
+tachycardia
+respiratory distress
-provide quiet, restful environment (decrease stimuli and cluster care)
-mouth care-lubricating ointments for lips
-ROM in bath for arthritis pain
-acetaminophen for fever
-clear liquid's/soft foods
-cool cloths
-gentle lotions
83
What is some education that needs to be provided to the family of a child who has Kawasaki disease?
- irritability may persist for two months or more
- take temperature daily after discharge
- continue passive range of motion during bath to ease arthritis pain
- avoid live vaccines for 11 months post administration of IVIG
- avoid children with viral illness (Reye’s syndrome) related to use of aspirin
- know signs of aspirin toxicity if given
84
In pediatrics, hypertension is generally secondary to structural abnormalities or underlying pathogenic conditions such as?
- renal disease (most common)
- cardiovascular disease
- endocrine or neurological disorders
85
at what age should blood pressure screenings begin?
three years of age
86
what are some labs to draw if a child has hypertension ?
- CBC
- BMP
- urinalysis/culture
- drug screen
- renal ultrasound
- EKG
- sleep study (sleep apnea, lack of sleep)
87
what are some treatment options for hypertension?
- non-pharmacological intervention first (start with diet and exercise)
- pharmacological (ace inhibitors and betablockers)
88
what is the major adverse reaction of ace inhibitors, and is the reason we need to monitor female adolescents closely?
Teratogenic
89
what are some adverse reactions of beta blockers?
- mood disturbances
- depression
- lipid abnormalities
90
children ____ years of age and older should be screened for hyperlipidemia if they have any risk factors that indicate the need for a lipid profile.
2 years
91
what are the four common risk factors indicating a need for a lipid profile (hyperlipidemia)?
- obesity (BMI in 95th percentile or higher)
- hypertension
- a parent or grandparent with a cholesterol level of 240mg/dL or higher
- early cardiovascular disease in a first or second degree relative
92
what are the numbers that indicate an elevated cholesterol in children (total and LDL)?
- total cholesterol >200mg/dL
| - LDL >130mg/dL
93
when should a full lipid profile be drawn in children?
after a 12 hour fast
94
do not do a lipid panel within ___ weeks of a febrile illness.
3 weeks
95
what is the first line treatment for hyperlipidemia?
dietary (restrict intake of cholesterol and fats)
96
if there is no response to diet changes for hyperlipidemia, what two medications should be considered?
- lovastatin
| - cholestyramine
