Cardiovascular Book Flashcards
** what is preload
afterload
how do these two things work with contractility in terms of stroke volume
preload: end diastolic volume
afterload: amount of resistant the heart must overcome
the volume of blood ejected by the ventricle with each contraction
** how do we do a cardiac assessment in chikldren? what are we looking for? what should we be hearing?what shouldnt we see or hear? how do we evaulate overall work status in infants? what would you notice in a patient with cardiac failure if the were an infant? what if they were an older child
skin color, cap refill, heart rate/rhythm, BP, working of breathing
hearing S1 S2 S3
- S3 is normal in children related to rapid filling
should not see thril or S4 abnormal, heard late in diastole or early systole
CCHD: 95-98% with less than 3% change, R hand is preductal, either foot is postudctal
poor feeding, failure to thrive, tachpnea, tachycardia, poor wt gain, activity intolerance, developmental delayed
** what causes congetintal heart defects
drugs, age, chromosomal
**ASD
left to right atria,soft ejection murmur with fixed wide splitting of O2
** VSD
left to right ventricle, systolic murmur (3rd-4th intercostal) at sternal border, thrill may be present
** PDA
aorta to pulmonary artery, mcahnery murmr during systole and diastole, thrill over pulmonic artery
**TOF
pulmonary stenosis, right ventriclar hypertrophy, VSD, aortic overriding, tet spells (knee to chest morphine), boot shaped heart
**CoA
narrowing of descending aorta increase in BP in arms/neck decreasd BP in legs, PGE to keep PDA open
**HLHS
mitral and aortic valves are absent or stenosed with abnormally small left ventricle and small aorta, no murmur, PGE to keep PDA open
** TGA
aorta and pulmonary swtiched, egg shaped heart, cyanosis dosent improved with O2 PGE to keep PDA open
** are there specific nursing consdeirations for the disorder
PDA may give PGE and may not give O2 as itcan close
tet spell wants knees to chest
** understand what Kawasaki disease is, hoe does it present, what are the complications, what do you anticipate for nursing considerations and how is it treated?
acute stage: fever (5 days) >39, conjuctival hyperermia, cervivallymphode enlargement, strawberry tongue, cracker lips, rash on trunk
subacute: cracking skin (lips, fingers, toes) cornary artery anerysm
convalsecnt: 6-8 weeks after onset of s/s
monitor fever and CV status
IVIG 2g/kg for 18hrs
** how does hypovolemic shock occur? What are the stages of hypovolemic shock? is BP a good indicator of the Childs status? How to assess the patient for adequate tissue perfusion? what is the nursing management of shock? what would you anticipate for fluid replacement in shock?
hemorrhage, plasma loss from burns, nephrotic syndrome, sepsis, decrease fluids
no BP not good indicator, early comp is a normal BP, moderate decomposition is lowered systolic
urine output
IV fluid bolus, keep child warm
isotonic fluid
**review how you would care for a patient who is returning from cardiac Cath
vital signs, bleeding, infection, pressure dressing
why do infants have greater risk of heart failure than older children
due to sensitivity to volume or pressure overload
less compliance of the heart muscle means
stroke volume cannot increase substantially
how do kids increase CO
increase HR
polycythemia
increase RBC response to chronic hypoxemia
children respond to severe hypoxemia with
bradycardia
PDA
aorta to pulmonary artery
s/s of PDA
dyspnea
tachycardia
CHF
machinery murmur
thrill in pulmonic area
ASD
left to right atrium
ASD s/s
CHF
easy tiring
soft systolic ejection murmur
VSD
left to right ventricle
VSD s/s
CHF
systolic murmur
thrill
TOF
pul stenosis, RV hyperthropy, VSD, overriding of aorta
TOF s/s
polycythemia
m acid
knee to chest
systolic murmur
thrill
TOF radiology
boot shaped
TGA
pulmonary artery and aorta switch
s/s of TGA
cyanosis soon after birth and doesn’t improve with O2
rapid resp rate
systolic murmur
- S2 is louder
TGA radiology
egg on a string
CoA
narrowing of the descending aorta which obstructs the systemic flow
s/s of CoA
decrease BP in legs
bounding pulse in UE
weak pulse in LE
poor feeding
CHF
loud S2
systolic ejection murmur
HLHS
mitral or aortic valves are missing or stenosised with a abnormally small left ventricle and small aorta
S/S of HLHS
progressive cyanosis and CHF
- reiterations, and decrease perierpal pulses
pulmonary edema
no murmur
acidosis
HLHS murmur
none
most common cardiomegaly
dilated
what is occurring in dilated cardiomegaly
4 chambers dialate and systolic contraction is weakened
dilated cardiomeg s/s
weakness
external dyspnea
dilated cardiomeg treatment
diuretics, dig, ACEI
what cardiomegaly is most common cause of sudden unexpected cardiac death in young athletes
hypertrophic
what is occurring in hypertrophic cardiomeg
enlargement of left ventricle and ventricle septum
diastolic filling is affected
s/s of hypertrophic cardiomeg
dizziness
chest pain
hypertrophic cardiomeg meds
beta blockers
ca blockers
what is Kawasaki disease
acute febrile systematic vascular inflammation disorders
why is Kawasaki disease thought to occur
caused by infectious agent
3 stages of Kawasaki
acute
subacute
convalescent
Kawasaki acute stage time frame
1-2 weeks
Kawasaki acute stage s/s
high fever for 5 days
hyperemic conjuct
red throat
swollen hands and feet
maculopapular erythema multiform like rash on trunk and peri area
Kawasaki sub acte time frame
2+ weeks
Kawasaki subacute s/s
no fever
cracking lips
joint pain
desquamation of skin on tips of fingers and toes
Kawasaki convalescent time frame
6-8 weeks after disease onset
Kawasaki convalescent s/s
lingering s/s of inflammation
deep transverse lines may appear across nails on hands and feet
Kawasaki treatment
single high dose IVIG (2g/kg) over 10-12 hours
hypovolemic shock
inadequate tissue and organ perfusion resulting from inadequate blood or plasma volume in vascular space
s/s of hypovolemic shock
nonspecific for early
sustained tachycardia
increased resp effort
weak peripheral pulses
pallor
cold extremities
decrease urine output
hypovolemic shock treatment
20mL/kg over 5 mins
