Cardiac Issues Flashcards
What side is deoxygenated blood on?
Right side of heart
what two holes need to close after baby is born?
foramen ovale and ductus arteriosus
what are things you investigate in a child’s cardiac hx?
poor weight gain
poor feeding habits and fatigue during feeding
frequent respiratory tract infections
exercise intolerance
What is the most common cardiac disease?
Congenital heart disease
what are two major clinical consequences of congenital heart disease?
heart failure and hypoxemia
What is the foramen ovale?
an opening between the atria that allows blood flow from right to left atrium
What is ductus arteriosus?
opening that allows blood flow between pulmonary artery and aorta
When are the four chambers of the heart formed during gestation?
between 2 and 8 weeks
Where is the heart located in infants?
high in chest below the 4th intercostal
How do you do a cardiac assessment on a child?
obtain full med hx
birth complications
past med hx of parents
prenatal care
assess feedings and growth and development
dizziness
assess vitals
look for edema, clubbing, click or murmurs
between the ages of 1-6 the heart is […]
4x the size of birth
between the ages of 6-12 the heart is […]
10x the size of birth
What prenatal factors can predispose children to congenital heart disease?
maternal rubella, alcohol use, age older than 40, and type 1 diabetes
what are the 4 main groups of congenital heart defects?
1.) defects that result in increased pulmonary blood flow
2.) obstructive defects
3.) defects that decreased pulmonary blood flow
4.) mixed defects
What is atrial septal defect?
A hole located in septum between left and right atrium > which causes an increase in blood volume to the right atrium > which causes mixture of oxygenated and deoxygenated blood in right atrium
As a nurse what are you gonna do for Atrial Septal Defect?
assess feeding and growing
auscultate for loud and harsh heart sounds
What is a Ventricular septal defect?
opening between right and left ventricle that causes increased pulmonary blood flow which causes pulmonary hypertension
What are ventricular septal defect cues? What do you need to consider?
Symptoms may start at 4-8 weeks of age
infant may tire easily when feeding
failure to thrive
decreased appetite
fever
muscle joint pain
systolic murmur
frequent pulmonary infections
a chest radiography reveals cardiomegaly
VSD cues
Ventricular septal defect
loud/harsh murmur at the left sternal border
a thrill may be felt on chest
wet lung sounds if pulmonary edema present
What is the treatment for ASD and VSD?
low does aspirin after cathe lab procedure for ASD
surgery
closure in cathe lab
diuretics
Patent Ductus Arteriosus
ductus arteriosus fails to close at birth which causes blood flow in pulmonary artery from aorta instead of systemic circulation causing pulmonary vascular congestion
Patent ductus arteriosus cues
machine like hum murmur
bounding pulse
rales on auscultation
large gap between systolic and diastolic BP readings
patent ductus arteriosus treatment
Lasix
Extra calories for infants formula or breastmilk
Indomethacin
What is indomethacin?
NSAID normally used for arthritis but for PDA infants it causes constriction and closure of the PDA defect
Aortic Stenosis and what does it cause?
obstruction/narrowing of the aortic valve between the left ventricle and aorta
causes decreased cardiac output and left ventricular failure
Symptoms of aortic stenosis for infants
Hypotension, tachycardia, poor feeding
Symptoms of AS for children
activity intolerance, dizziness, chest pain,
Treatment for AS
dilation in cath lab
beta blockers or calcium channel blockers
Pulmonary stenosis and what does it cause?
Narrowing of pulmonary valve/artery causing obstruction from right ventricle to pulmonary arteries
Results in a backup of blood to right atrium
Pulmonary stenosis symptoms
systolic ejection murmur, cyanosis depending on size of narrowing, lead to heart failure
PS treatment
Pulmonary Stenosis
balloon angioplasty in cath lab
What is tetralogy of fallot
Combination of 4 heart defects present at birth
What are the 4 major defects of tetralogy of fallot?
1.) Pulmonary stenosis
2.) Right ventricular hypertrophy
3.) Overriding Aorta
4.) Ventricular Septal Defect
What is an overriding aorta?
enlarged aortic valve so it sits over both sides of ventricles instead of only the left ventricle
What is right ventricular hypertrophy?
enlargement/thickening of right ventricular muscle walls due to increased pressure
When is tetralogy of fallot diagnosed?
Within the first weeks of life and when infant is showing signs of cyanosis
What are cues of TOF?
color changes during feeding or crying
hyper cyanotic spells, dyspnea, agitation, hypoxemia
What is a Tet spell what do you do?
dyspnea, agitation, hypoxemia
If this occurs you place infant in a knee-chest position
What do you assess for TOF?
increased work of breathing
decreased o2 sat
clubbing of fingers (older child)
What is a lab result for children with a Hx of TOF?
POLYCYTHEMIA
what is transposition of the great arteries and what does it cause?
defect where the pulmonary artery and aorta are not in their normal position
Aorta is connected to right vent instead of left
Pulmonary artery is connected to left vent instead of right
Causes poorly oxygenated vital organs
When is transposition of the great arteries diagnosed?
the first few days of life when infant has cyanosis
septal defect or PDA must exist to oxygenate blood
What is the main medication given for TGA before corrective surgery is performed and what does it do?
PROSTAGLANDIN E1
-maintains ductal patency and ensure adequate systemic blood flow
What is Truncus arteriosus and what does it cause?
Failure of the septum formation resulting in a single vessel between the left and right ventricle
Causes mixed blood which increases blood flow to lungs and decreases systemic circulation
Cues of Truncus Arteriosus
HF, murmur, cyanosis, delayed growth, fatigue, lethargy, poor feeding
What is hypoplastic left heart syndrome? What does it cause?
Defect where all structures on left side of heart are underdeveloped
Cannot supply blood for systemic circulation and blood is pumped thru PDA
Symptoms of Hypoplastic left heart syndrome
HF, cyanosis, lethargy, cold hands and feet
When PDA closes there is a decrease in cardiac output which results in cardiac collapse
Treatment of Hypoplastic left heart syndrome
3 separate reconstruction surgeries,
poor prognosis
What is coarctation of aorta?
narrowing of the lumen of the aorta leading to obstruction
What can result from coarctation of aorta?
aortic rupture, aneurysm, and stroke
Symptoms of COTA
Elevated BP
bounding pulse in upper extremties
low BP and cool skin in lower extremities
HF in infants
Dizziness
headaches
Rheumatic Fever
An inflammatory disease that is a reaction to BETA-HEMOLYTIC STREPTOCOCCUS (GABHS)
How do you get rheumatic fever?
within 2-6 weeks of a untreated upper resp infection
Symptoms of rheumatic fever
tachycardia
heart murmur
muffled heart sounds
chest pain
What are 4 major signs of rheumatic fever?
large joints with painful swelling
Fever of 38.2 - 38.8 (100.8 - 102.0)
Erythema marginatum (non itchy rash)
Narrowed mitral value causing heart murmur
How is rheumatic fever diagnosed?
throat culture for GABHS
elevated CRP/ESR
blood antistreptolysin O titer
What is the nursing care for rheumatic fever?
bedrest during acute phase
administer antibiotics
Assess for chorea which is sudden involuntary muscle movement
monitor rash
Infective bacterial endocarditis and what does it cause?
infection of inner lining of the heart that can enter the bloodstream
What bacteria can cause bacterial endocarditis?
S. viridans, C. albicans, S. aureus
S/s of bacterial endocarditis
fever
malaise
arthralgias
diaphoresis
weight loss
splinter hemorrhages under fingernails
what is the nursing care for bacterial endocarditis?
high dose antibiotics for 2-8 weeks and may require a picc line
What kids are high risk if they have bacterial endocarditis?
children with artificial heart valves, hx, unrepaired heart disease, repaired congenital heart disease and residual
what is Kawasaki disease?
an acute systemic inflammation of small and medium blood vessels
what are the symptoms during the acute phase of kawasaki disease?
name 3 specific to this disease
rash
fever for 5+ days/unresponsive to meds
chills
*red eyes with no drainage
*red chapped lips
*strawberry tongue
swelling hands and feet
enlarged lymph nodes
What is happening in the subacute phase of kawasaki?
resolved fever
peeling of palms and soles
temp arthritis
irritability
what is happening in the convalescent phase of kawasaki and when does it fully resolve?
no s/s
abnormal lab values
resolves in 6-8 weeks of onset
what is the nursing care for kawasaki?
monitor vitals
I&O
Daily weight
cardiac status
IV fluids
oral care
keep room dark and quiet
what are the main meds and dosages for kawasaki treatment?
Gamma globulin 2g/kg over 8-12 hrs
Asprin 80-100mg/kg/day q6hrs
then 3-5mg/kg/day until platelets stabilize
What is the education for kawasaki?
Follow up
irritability may last for 2 months
parent may have to perform ROM as arthritis may last up to several weeks
avoid live immunizations for 11 months
What is the nursing care preop for catheterization?
Asses for allergies to dye or shellfish
keep NPO 4-6 hrs
mark pedal and radial pulses
skin prep for older children
What is the nursing care post cathe lab?
continuous pulse ox
ABCs
I&O
push fluids to flush out contrast
Assess insertion site
Heart Failure
Volume overload
pressure overload
decreased contractility
