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Peds Exam 2 > Cardiac Dysfunction > Flashcards

Cardiac Dysfunction Flashcards

1
Q

Inspection of a child with cardiac problems

A 
nutritional state
color
chest deformities
unusual pulsations
respiratory excursion
digital clubbing
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2
Q

is FTT associated with heart problems?

A

yes

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3
Q

historical assessment of a child with cardiac problems

A

parental concerns
mothers health and pregnancy (DM, ETOH, Drugs?)
family history

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4
Q

what is a late sign of something going on cardiac in infants?

A

cyanosis

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5
Q

what is a cardinal sign of something going on cardiac in infants?

A

poor weight

tachycardia

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6
Q

assessment of a child with possible cardiac disorders

A

palpation and percussion

auscultation

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7
Q

what do you look for on a cxr for cardiac?

A

any abnormalities

increased heart size

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8
Q

what do you look for on an abdominal assessment for cardiac?

A

hepatomegaly

enlarged spleen

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9
Q

what do you look for in peripheral pulses for cardiac?

A

are they even?
bounding?
faint?
unilateral?

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10
Q

what diagnostic tests do you use for cardiac evaluation?

A 
chest xray - do 1st
ECG- 15 lead
CBC- check for polycythemia
echo- can be done fetally if needed
ABG
cardiac cath- to visualize heart structure
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11
Q

cardiac catheterization

A

can do diagnostically or interventional (know what is wrong and fix it)
electrophysiology (check impulse of heart, irritate specific part of heart)

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12
Q

which side of the heart is commonly used in peds for cardiac catheterization?

A

Right side

it is safer and structural defects allow access to left side of heart

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13
Q

pre procedural care of cardiac catheterization

A

assess skin ( diaper rash, any skin breaks)
NPO 4-6 hours, clarify AM needs
IV fluids if indicated (polycythemia start fluids to prevent dehydration)
developmentally appropriate psychological prep (let them know what to expect)
sedation?
mark pulses in both feet

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14
Q

post procedural care of cardiac catherterization

A 
observe for skin color
LOC
VS
respiratory status
pulses
dressings
fluid intake, IV and PO
hypoglycemia
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15
Q

what is important to know about distal pulses following a cardiac cath?

A

distal pulses to the site can be weaker for the first few hours post procedure

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16
Q

how long must a child maintain a flat lying position with legs not bent following a cardiac cath?

A

Venous 4-6 hours

Arterial 6-8 hours

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17
Q

if you suspect bleeding following a cardiac cath what do you do?

A

circle drainage, time and date
if you suspect a bleed occlude the area 1 inch above insertion site.
CALL FOR HELP, do not leave patient.

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18
Q

discharge planning following cardiac catheterization

A

pressure dressing x 24 hours
no tub baths for 48 hours
rest that night but resume normal activities afterwards
teach for s/s of infection

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19
Q

can infants hearts pump harder? why

A

no, they can only pump faster
because in infancy muscle fibers of the heart are less developed and less organized resulting in limited functional capacity

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20
Q

anatomy developmental considerations

A

heart size- ventricles are equal size at birth
normal O2- 95-100%
infants and small children have thin chest walls with little to no sub-q fat and muscle

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21
Q

ductus venosus

A

helps blood bypass lungs

blood bypasses liver

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22
Q

ductus arteriosis

A

blood escapes through here to avoid lungs, blood is shunted to descending aorta
blood bypasses lung
this closes in presence of increased oxygen concentration in blood

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23
Q

fetal blood flow

A

O2 rich blood enters fetal body through umbilical vein to liver where it divides 1/2 to liver, 1/2 to inferior vena cava via ductus venosus (1st fetal opening) after birth it closes, then to RT atrium to LT atrium through foramen ovale (2nd opening), then LT ventricle, then aorta to head and extremities, then returned to placenta via descending aorta through umbilical arteries

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24
Q

foramen ovale

A

between RT atrium

since lungs are not working blood bypasses the lungs

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25
Q

when does foramen ovale close?

A

when infant takes 1st breath and air fills lungs causing pulmonary vasodilation allows for vascular resistance to decrease.

26
Q

fetal shunts

A

all close at birth or shortly after

27
Q

why do fetal shunts close?

A

decreased maternal hormone prostaglandin E
increased O2 saturations
pressure changes within the heart

28
Q

general clinical findings for cardiac defects

A 
dyspnea on exertion
feeding difficulty - FTT
HR over 200, RR about 60 in infants
recurrent respiratory infections
cyanosis and clubbing fingers
squatting/ knee to chest position 
heart murmurs
excessive sweating
signs of HF
29
Q

types of cardiovascular disorders in children

A

congenital heart defects (CHF)

acquired cardiac disorders

30
Q

if there is a hole in the LT side of heart how does blood flow?

A

increased pressure between atrium and ventricles, blood flows from high pressure to low pressure causing a LT to RT sided shunt

31
Q

blood flow of heart

A 
RT atrium 
tricuspid valve
RT ventricle
pulmonic valve
to lungs, blood becomes oxygenated
enters LT atrium
mitral (bicuspid) valve
LT Ventricle
Aortic valve
Aorta
32
Q

2 classifications of heart defects

A

acyanotic and cyanotic

33
Q

the severity of congenital heart defects depends on the severity of these two principle consequences

A

defects that result in LT to RT shunting of blood

Defects that result in decreased pulmonary blood flow

34
Q

acynotic heart defects with increased pulmonary blood flow can indiate

A

atrial septal defect
ventricular septal defect
patent ductus arteriosis

35
Q

acyanotic heart defects with obstructive lesions, decreased blood flow to areas of the body can indicate

A

coarctation of aorta
aortic stenosis
pulmonic stenosis

36
Q

cyanotic heart defects with decreased pulmonary blood flow can indicate

A

tetralogy of Fallot

tricuspid atresia

37
Q

cyanotic heart defects with mixed blood flow

A

transposition of the great vessels
hypoplastic left heart
truncus arteriosus

38
Q

clinical consequences of defects with increased pulmonary blood flow

A

left to right shunting occurs
increased blood volume on the right side of heart increases pulmonary blood flow at the expense of systemic blood flow
*blood that should be returning to the lungs is going back to the heart

39
Q

clinical signs and symptoms of increased pulmonary blood flow

A

s/s of HF

40
Q

what is CHF?

A

inability of the heart to pump enough blood enough blood to meet the bodies demand

41
Q

CHF can be caused by

A

volume overload
pressure overload
decreased contractility (cardiomyopathy)
high cardiac output demands

42
Q

clinical manifestations of pulmonary venous congestion

A 
tachypnea
wheezing
crackles
retractions
cough
dyspnea on exertion
feeding difficulties
irritability
fatigue with play
43
Q

clinical manifestations of systemic venous congestion

A 
hepatomegaly
ascites
edema
weight gain
neck vein distention
44
Q

clinical manifestations of impaired myocardial function (cardiac output)

A 
tachycardia
weak peripheral pulses
hypotension
gallop rhythm
longer capillary refills
pallor
cool extremities
oliguira
fatigue
restlessness
enlarged heart
sweating
45
Q

clinical manifestations of high metabolic rate

A

FTT or slow weight gain, perspiration

46
Q

therapeutic management of CHF

A

improve cardiac function
remove accumulated fluid and sodium
decrease cardiac demands
improve tissue oxygenation and decrease oxygen consumption

47
Q

medications for CHF

A

Lasix (furosemide)- monitor K+
Ace inhibitors ( PRILS) stops vasoconstriction and decreases afterload, decreased BP
Digitalis (digoxin)- only oral inotropic agent works very rapid, causes heart to pump harder, increased contractility

48
Q

rules for administering digitalis

A

regular intervals
1 hour before eating or 2 hours after
apical heart rate for 1 min(hold if <90-110 for infants/children, <70 older kids)
do not mix with food/liquids
give behind teeth or brush after administering (stains teeth)

49
Q

if a child misses a dose of digitalis what do you do?

A

if <4 hours give the missed dose
>4 hours withhold med
if 2 doses are missed contact provider

50
Q

if the child vomits after administering digitalis what do you do?

A

do not repeat dose

51
Q

if the child is hospitalized and receiving digitalis what do you monitor?

A

potassium levels prior to giving digitalis

digitalis levels

52
Q

when do you hold digitalis?

A

if potassium levels are low

53
Q

s/s of digitalis toxicity

A 
nausea
vomiting
bradycardia
anorexia
neurologic and visual disturbances
*monitor child closely for dysrhythmias b/c digoxin toxicity can cause hyperkalemia
54
Q

what is the antidote for digitalis toxicity?

A

digibind (digoxin immune fab fragments)

* monitor for rapidly falling potassium levels

55
Q

nursing considerations for activity intolerance r/t CHF

A 
promote adequate rest
prevent crying
small frequent feedings (don't want to exhaust from eating)
short intervals of play
prevent shivering
supplemental oxygen if needed
56
Q

nursing considerations for altered nutrition r/t CHF

A

anticipate hunger (small, frequent meals)
feed no longer than 30 min at a time and give rest through NG
non-stimulating environment
semi-erect position for feeding
burp before starting and frequently
formula with increased calories per ounce
soft preemie nipple with moderately large opening
encourage mom to pump and feed through bottle

57
Q

nursing considerations for ineffective breathing pattern

A

assess RR, effort and O2 sats
position to encourage maximum chest expansion
avoid constriction
humidified supplemental oxygen during stressful periods such as bouts of crying or invasive procedures

58
Q

1 oz of weight gain = how many grams

A

28.35 grams

59
Q

weight gain of how many grams can indicate fluid overload?

A

50 grams

60
Q

nursing considerations for fluid volume excess of CHF

A 
accurate I and O
daily weight (same time and clothes)
assess for edema
maintain fluid restriction if ordered
good skin care
change positions frequently

Peds Exam 2 (13 decks)

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