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Module 5 > Cardiac Dysfunction in Children > Flashcards

Cardiac Dysfunction in Children Flashcards

1
Q

abnormalities present at birth are called

A

congenital

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2
Q

abnormalities/disease processes that occur after birth are called

A

aquired

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3
Q

what dx procedure is done first for suspected cardiac disease

A

electrocardiogram

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4
Q

what nursing care should be done post cardiac cath

A 
V/S Q15min
pulses for equality
assess pain
extremity temp and color
check insertion site
I and O
extremity straight for 4-8hrs
oral intake to flush dye out
get child to void
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5
Q

where should you apply pressure if catheter entry site is bleeding

A

1 in above entry site

*position child flat and call doc

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6
Q

what home care instructions are important for post cardiac cath

A 
keep site clean
avoid tub baths after
limit activity for 24hrs
avoid strenuous exercise
regular diet
tylenol or ibuprofen for pain
follow up
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7
Q

blood flows from area of higher pressure to lower pressure

A

left to right shunt

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8
Q

change in pressure so that blood is shunted from the right side of the heart to the left

A

right to left shunt

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9
Q

what 3 defects have left to right shunting of blood and cause increased pulmonary blood flow

A

atrial septal defect (ASD)
ventricular septal defect (VSD)
patent ductus arteriosus (PDA)

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10
Q

abnormal opening between the atria

A

atrial septal defect

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11
Q

abnormal opening between right and left ventricles

A

ventricular septal defect

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12
Q

what is VSD’s percentage of spontaneous closure

A

20-60%

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13
Q

failure of the fetal ductus arterioles to close within first few weeks of life

A

patent ductus arteriosus

*blood flows form aorta to pulmonary artery

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14
Q

why is indomethacin (indocin) given to PDA pt’s

A

prostaglandin keeps PDA open so a prostaglandin inhibitor will help it close

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15
Q

what defect has a decreased pulmonary blood flow, shunts desaturated blood right to left, and sends desaturated blood to system circulation

A

tetralogy of fallot

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16
Q

what are the 4 cardiac defects that cause tetralogy of fallot

A

VSD
Pulmonary stenosis
Overriding Aorta
Right Ventricular Hypertrophy

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17
Q

what is the “clinical picture” for Tetralogy of fallot

A 
cyanosis
tachypnea
acute episodes of cyanosis and hypoxia(hyper cyanotic spells)
clubbing
growth retardation
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18
Q

how are hyper cyanotic spells started in TOF

A

by feedings, crying, defecation, or stressful procedures

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19
Q

what are nursing interventions for hyper cyanotic spells of TOF

A

“squatting” position
calm the infant
blow by 100% oxygen
get help

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20
Q

what 3 defects are obstructive

A

coarctation of the aorta
aortic stenosis
pulmonic stenosis

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21
Q

blood exiting heart meets area of anatomic narrowing (stenosis)

A

obstructive defects

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22
Q

narrowing of the aorta at or near the insertion of the ductus arteriosus

A

coarctation of the aorta (COA)

  • increase pressure proximal to the defect
  • decreased pressure distal to the defect
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23
Q

what is the “clinical picture” of a pt who has coarctation of the aorta

A

elevated BP in arms/bounding pulses in arms
decreased BP in legs/weak or absent pulses in lower extremities
cool lower extremities

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24
Q

what defect will we take 4 different sites of BP in newborns

A

coarctation of the aorta

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25
Q

narrowing of the aortic valve causing left vent enlargement, decreased cardiac output, increased left atrial pressure

A

aortic stenosis

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26
Q

what is the “clinical picture” for a NEWBORN with aortic stenosis

A 
decreased cardiac output
faint pulses
hypotension
tachycardia
poor feeding
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27
Q

what is the “clinical picture” for a CHILD with aortic stenosis

A

exercise intolerance
chest pain
SOB
syncope

28
Q

what cardiac defect is the only one that has activity restrictions

A

aortic stenosis

29
Q

narrowing of pulmonary artery that decreases pulmonary blood flow, and causes right vent hypertrophy

A

pulmonic stenosis

30
Q

what cardiac defect is “mixed”

A

hypoplastic Left Heart Syndrome (HLHS)

31
Q

underdevelopment of the left side of the heart

“single ventricle”

A

HLHS

32
Q

why will a HLHS pt be on a prostaglandin drip

A

to keep PDA open because this is the only way they are getting blood flow systemically

33
Q

what is the “clinical picture” for HLHS

A 
mild cyanosis
HF
lethargy
cold hands and feet
once PDA closes it leads to cardiac collapse
34
Q

is it normal to see HLHS pt with O2 sats of 70-80%

A

yes

*theres not an actual correction of this defect and they don’t have a long term life expectancy

35
Q

heart can’t pump enough blood out to the rest of the body to meet the body’s demand for energy

A

congestive heart failure

36
Q

what are S/S of CHF

A 
difficulty feeding (ftt)
tachypnea at rest
dyspnea
retractions
activity intolerance
weight gain r/t fluid retention
hepatomegaly
37
Q

what classes of meds improve cardiac function

A 
digitalis glycoside (digoxin)
ACE inhibitors (capto, enla, and lisinopril)
Beta Blockers (caredilol)
38
Q

improve contraction of the heart (take a good strong beat)

A

digoxin

39
Q

reduce after load and easier for heart to pump

A

ace inhibitors (prils)

40
Q

decrease HR and BP causing vasodilation

A

carvedilol

41
Q

before giving digoxin what should be done

A

apical pulse for 1 min
*infant= don’t give below 90-110bpm
older child= don’t give below 70bpm

42
Q

what are S/S of digoxin toxicity to watch for at home

A

nausea, vomiting, anorexia, bradycardia, dysrhythmias

43
Q

what is important to teach parents about digoxin

A 
do NOT mix with fluids or food
if dose is missed don't double up
if child vomits don't give extra dose
keep locked in safe place
call poison control in accidental overdose
44
Q

what are side effects of ACE inhibitors

A

hypotension
dry cough
renal dysfunction

45
Q

what are used to decrease accumulated fluid volume treatment

A

Diuretics: furosemide, chlorothiazide, spironolactone

46
Q

what are clinical manifestations of chronic hypoxemia

A

polycythemia and clubbing

47
Q

infection of the valves and inner lining of the heart caused by bacteria that enter the blood stream and settle in the heart lining, heart valve, or blood vessel

A

infective endocarditis

48
Q

what are the most common organisms that cause infective endocarditis

A

strep viridans and staph aureus

49
Q

who are at higher risk for IE

A

children who have undergone surgical repair or palliative surgery

50
Q

what is the “clinical picture” of IE

A 
hx of dental procedure, urinary or intestinal tract procedure
unexplained fever
weight loss
lethargy
malaise
anorexia
new murmur or change in existing
51
Q

what is the tx for IE

A 
blood cultures (to see what type it is)
abx (IV 2-8wks)
EKG monitoring 
*could cause stoke because it could break off and lodge somewhere 
it is fatal if left untreated
52
Q

how can IE be prevented

A

maintaining good oral hygiene

53
Q

inflammatory disease that occurs from GABHS

A

rheumatic fever

54
Q

what are risk factors for RH

A

hx of group A strep infection
fam hx
environmental factors

55
Q

when is the onset of RF

A

2-4wks after a strep throat infection

*ASO titer to find out if it was strep or not

56
Q

what is the “clinical picture” of RF

A 
MAJOR: carditis
polyarthritis
erythema marginatum
chorea
subQ nodules
MINOR: arthralgia
fever
elevated ESR and CRP
57
Q

what is the dx criteria for RF

A

modified jones criteria= 2 MAJOR manifestations or 1 MAJOR and 2 MINOR manifestations *plus + for strep

58
Q

what is the tx for RF

A

abx 10day course then prophylactic (PO daily or IM monthly)
asprin to reduce fever, control inflammation
bedrest during acute illness

59
Q

acute systemic vasculitis

A

kawasaki disease

*principal are of involvement is coronary artery aneurysms

60
Q

what are risk factors for KD

A

younger than 5
males
asians or asian decent

61
Q

what is the dx criteria for KD

A

no specific test but will have elevated CRP, ESR and CBC (platelet count)

62
Q

what lab is different between KD and RF

A

KD has high platelet count

63
Q

what is the acute phase of KD (first 10 days)

A 
fever 5+days
VERY IRRITABLE
red on hands and feet
strawberry tongue
Bilateral conjunct inflammation
polymorphous rash
64
Q

what is the subacute phase of KD (greatest risk for developing coronary artery problems) 11-25 days

A

desquamation of fing and toe
cont irritability
thrombocytosis (>600,000-800,000

65
Q

what is the convalescent phase of KD

A

all clinical signs resolved
blood val normal
beau’s lines on finger and toe nails

66
Q

what is the tx for KD

A

high doses of IV gamma globulin (reduces incidence of coronary artery abnorms)
ASA

67
Q

what nursing interventions can we do for KD pts

A

cool cloths, unscented lotions, loose clothing, mouth care including lubricant for lips
clear liquids and soft foods during acute phase
quiet environment so they can rest

Module 5 (18 decks)

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