Cardiovascular Book

Question 1

** what is preload
afterload
how do these two things work with contractility in terms of stroke volume

Answer 1

preload: end diastolic volume
afterload: amount of resistant the heart must overcome
the volume of blood ejected by the ventricle with each contraction

Question 2

** 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

Answer 2

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

Question 3

** what causes congetintal heart defects

Answer 3

drugs, age, chromosomal

Question 4

**ASD

Answer 4

left to right atria,soft ejection murmur with fixed wide splitting of O2

Question 5

** VSD

Answer 5

left to right ventricle, systolic murmur (3rd-4th intercostal) at sternal border, thrill may be present

Question 6

** PDA

Answer 6

aorta to pulmonary artery, mcahnery murmr during systole and diastole, thrill over pulmonic artery

Question 7

**TOF

Answer 7

pulmonary stenosis, right ventriclar hypertrophy, VSD, aortic overriding, tet spells (knee to chest morphine), boot shaped heart

Question 8

**CoA

Answer 8

narrowing of descending aorta increase in BP in arms/neck decreasd BP in legs, PGE to keep PDA open

Question 9

**HLHS

Answer 9

mitral and aortic valves are absent or stenosed with abnormally small left ventricle and small aorta, no murmur, PGE to keep PDA open

Question 10

** TGA

Answer 10

aorta and pulmonary swtiched, egg shaped heart, cyanosis dosent improved with O2 PGE to keep PDA open

Question 11

** are there specific nursing consdeirations for the disorder

Answer 11

PDA may give PGE and may not give O2 as itcan close
tet spell wants knees to chest

Question 12

** 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?

Answer 12

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

Question 13

** 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?

Answer 13

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

Question 14

**review how you would care for a patient who is returning from cardiac Cath

Answer 14

vital signs, bleeding, infection, pressure dressing

Question 15

why do infants have greater risk of heart failure than older children

Answer 15

due to sensitivity to volume or pressure overload

Question 16

less compliance of the heart muscle means

Answer 16

stroke volume cannot increase substantially

Question 17

how do kids increase CO

Answer 17

increase HR

Question 18

polycythemia

Answer 18

increase RBC response to chronic hypoxemia

Question 19

children respond to severe hypoxemia with

Answer 19

bradycardia

Question 20

PDA

Answer 20

aorta to pulmonary artery

Question 21

s/s of PDA

Answer 21

dyspnea
tachycardia
CHF
machinery murmur
thrill in pulmonic area

Question 22

ASD

Answer 22

left to right atrium

Question 23

ASD s/s

Answer 23

CHF
easy tiring
soft systolic ejection murmur

Question 24

VSD

Answer 24

left to right ventricle

Question 25

VSD s/s

Answer 25

CHF systolic murmur thrill

Question 26

TOF

Answer 26

pul stenosis, RV hyperthropy, VSD, overriding of aorta

Question 27

TOF s/s

Answer 27

polycythemia m acid knee to chest systolic murmur thrill

Question 28

TOF radiology

Answer 28

boot shaped

Question 29

TGA

Answer 29

pulmonary artery and aorta switch

Question 30

s/s of TGA

Answer 30

cyanosis soon after birth and doesn't improve with O2 rapid resp rate systolic murmur - S2 is louder

Question 31

TGA radiology

Answer 31

egg on a string

Question 32

CoA

Answer 32

narrowing of the descending aorta which obstructs the systemic flow

Question 33

s/s of CoA

Answer 33

decrease BP in legs bounding pulse in UE weak pulse in LE poor feeding CHF loud S2 systolic ejection murmur

Question 34

HLHS

Answer 34

mitral or aortic valves are missing or stenosised with a abnormally small left ventricle and small aorta

Question 35

S/S of HLHS

Answer 35

progressive cyanosis and CHF - reiterations, and decrease perierpal pulses pulmonary edema no murmur acidosis

Question 36

HLHS murmur

Answer 36

none

Question 37

most common cardiomegaly

Answer 37

dilated

Question 38

what is occurring in dilated cardiomegaly

Answer 38

4 chambers dialate and systolic contraction is weakened

Question 39

dilated cardiomeg s/s

Answer 39

weakness external dyspnea

Question 40

dilated cardiomeg treatment

Answer 40

diuretics, dig, ACEI

Question 41

what cardiomegaly is most common cause of sudden unexpected cardiac death in young athletes

Answer 41

hypertrophic

Question 42

what is occurring in hypertrophic cardiomeg

Answer 42

enlargement of left ventricle and ventricle septum diastolic filling is affected

Question 43

s/s of hypertrophic cardiomeg

Answer 43

dizziness chest pain

Question 44

hypertrophic cardiomeg meds

Answer 44

beta blockers ca blockers

Question 45

what is Kawasaki disease

Answer 45

acute febrile systematic vascular inflammation disorders

Question 46

why is Kawasaki disease thought to occur

Answer 46

caused by infectious agent

Question 47

3 stages of Kawasaki

Answer 47

acute subacute convalescent

Question 48

Kawasaki acute stage time frame

Answer 48

1-2 weeks

Question 49

Kawasaki acute stage s/s

Answer 49

high fever for 5 days hyperemic conjuct red throat swollen hands and feet maculopapular erythema multiform like rash on trunk and peri area

Question 50

Kawasaki sub acte time frame

Answer 50

2+ weeks

Question 51

Kawasaki subacute s/s

Answer 51

no fever cracking lips joint pain desquamation of skin on tips of fingers and toes

Question 52

Kawasaki convalescent time frame

Answer 52

6-8 weeks after disease onset

Question 53

Kawasaki convalescent s/s

Answer 53

lingering s/s of inflammation deep transverse lines may appear across nails on hands and feet

Question 54

Kawasaki treatment

Answer 54

single high dose IVIG (2g/kg) over 10-12 hours

Question 55

hypovolemic shock

Answer 55

inadequate tissue and organ perfusion resulting from inadequate blood or plasma volume in vascular space

Question 56

s/s of hypovolemic shock

Answer 56

nonspecific for early sustained tachycardia increased resp effort weak peripheral pulses pallor cold extremities decrease urine output

Question 57

hypovolemic shock treatment

Answer 57

20mL/kg over 5 mins