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Undeleted > Cardiovascular Conditions (peds) > Flashcards

Cardiovascular Conditions (peds) Flashcards

1
Q

upon baby’s first breath out of mom’s vag…

A

pulmonary resistance goes down, blood shifts to normal pathway

little leakage RA > LA possible but not other way because of pressure difference

FO and DA closing

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2
Q

post-cardiac cath care

A

accurate assessment CRITICAL:

  • CVS: vitals q 15 minutes
  • PVS: skin temp, cap refill, pulses
  • pressure dressing over insertion
  • lie flat 4-8 hours (decrease bleed risk)
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3
Q

possible cardiac cath complication

A

hemorrhage

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4
Q

congestive heart failure in kids due to…

A

congenital cardiac defect (ALWAYS)

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5
Q

right sided heart failure due to…

A

suboptimal RIGHT ventricle

blood backs up to right atrium

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6
Q

right sided heart failure leads to…

A
  • increased venous pressure

- increased systemic venous engorgement > edema

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7
Q

left sided heart failure due to…

A

suboptimal LEFT ventrical

blood backs up to left atrium

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8
Q

left sided heart failure leads to…

A
  • impacts pulmonary veins, leads to pulmonary congestion

- can lead to increased pulmonary pressure, pulmonary edema

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9
Q

CHF s/s

A
  • impaired myocardial function
  • pulmonary congestion
  • systemic venous congestion
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10
Q

CHF s/s: impaired myocardial function looks like…

A
  • tachycardia at rest, easily fatigued, exercise intolerance
  • decreased CO manifesting as…
    decreased perfusion, cold extremities, weak pulses, prolonged cap refill, low BP, mottled skin
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11
Q

CHF s/s: pulmonary congestion looks like

A
  • tachypnea, hypoxemia secondary to fast, shallow respiration
  • ** decreased feeding tolerance, poor weight gain r/t tachypnea ***
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12
Q
  • significant CHF manifestation in children
A

decreased feeding tolerance, poor weight gain, due to tachypnea

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13
Q

CHF s/s: systemic venous congestion

A
  • weight gain due to edema
  • dependent edema: LE, scrotum, generalized
  • distended neck veins (not usually in babies)
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14
Q

infant CHF looks like…

A
  • poor weight gain (nutrition)
  • activity intolerance
  • developmental delay, especially gross motor
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15
Q

significance of developmental delay in infant CHF

A
  • postnatal brain growth is 50% year 1

- may see motor and cognitive delays due to chronic hypoxemia

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16
Q

therapeutic management of peds CHF

A
  • medication to increase cardiac function
  • remove excess fluid
  • decrease cardiac demand
  • increase tissue oxygenation (decrease O2 demand and O2 supplement)
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17
Q

** decreasing cardiac demands in babez **

A
  • regulate thermal environment (warm room)
  • decrease cold stress in infants because shivering requires tons of energy
  • treat/prevent infections
  • fever and infection leads to increased BMR
  • rigorous aseptic technique at all times!!!!!!!!
  • maximize chest expansion (HOB 45 degrees)
  • provide rest (decrease environmental stimulation)
  • schedule periods of UNINTERRUPTED rest
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18
Q

head bobbing in babies (what is it? what do you do?)

A

the baby is working hard to breathe. FIX POSTURE -> fix chest expansion.

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19
Q

digoxin is…

A
  • positive inotropic (more effective heart contraction, increases CO and therefore perfusion)
  • safe for infants and children!!
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20
Q

lasix (furosemide) is…

A
  • diuretic; removes excess fluid
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21
Q

lasix nursing care includes…

A

strict I/O, daily weights (same: time, scale, amount of clothing)

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22
Q

possible fluid restriction in acute CHF

A
  • plan over 24 hours, engage family, allow kids to monitor I/O

infants do not usually need fluid restriction as bigger issue is not taking enough in!!

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23
Q

** significance of nutrition in kids with CHF **

A
  • increased caloric needs, profound fatigue
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24
Q

** nutrition interventions for kids with CHF **

A
  • increase calories
  • decreased work of feeding (larger hole in bottle nipple)
  • feed at first sign of hunger
  • limit length of time with feeding (30 min max)
  • rest before, during, after feeds
  • use of NG/G tube
  • hold oral feed if fatigued or tachypneic
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25
Q

** increased pulmonary blood flow: aka & examples **

A

aka acyanotic

  • ASD
  • VSD
  • PDA
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26
Q

** decreased pulmonary blood flow: aka & examples **

A

aka cyanotic

  • tetralogy of fallot
  • tricuspid of atresia
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27
Q

patent ductus arteriosis is…

A

ductus arteriosis does not close between aorta and pulmonary artery after birth

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28
Q

patent ductus arteriosis causes…

A

blood recirculates through lungs and returned to LA, LV -> increases workload on L heart

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29
Q

PDA manifestations

A
  • can be asymptomatic OR CHF
  • machinery type murmur
  • widened pulse pressure (difference between systolic and diastolic pressures)
  • bounding pulses
  • risk for bacterial endocarditis
30
Q

PDA management

A
  • indomethacin

- ** surgical ligation: closes PDA **

31
Q

indomethacin for PDA management is…

A

prostaglandin inhibitor that can successfully close PDA

32
Q

** surgical ligation for PDA management because… **

A

prevents return of oxygenated blood to the lungs

33
Q

PDA prognosis

A

low risk, 1% mortality

34
Q

ventricular septal defect is…

A

opening between left and right ventricles

  • can vary in size
  • can spontaneously close in 1st year of life
  • frequently associated with other defects
35
Q

ventricular septal defect causes…

A

causes L to R shunting

  • normal blood flow until reaches LV, where blood shunts through hole into RV
  • increases blood flow to lungs
  • increases pressure in R heart
  • leads to R sided hypertrophy
36
Q

most common congenital cardiac anomaly

A

VSD!!!!!!

37
Q

VSD manifestations

A
  • characteristic murmur
  • CHF is common
  • risk for bacterial endocarditis
38
Q

VSD management

A
  • palliative pulmonary banding
  • surgical repair: sutures or patch
  • non-surgical repair: closure during cardiac cath
39
Q

pulmonary banding for VSD

A

around pulmonary artery to decrease pulmonary blood flow

40
Q

VSD prognosis

A

< 2% mortality

41
Q

tetralogy of fallot is…

A
  • VSD (large)
  • pulmonic stenosis
  • overriding aortic arch
  • R ventricular hypertrophy
42
Q

tetralogy of fallot manifestation

A
  • characteristic murmur
  • ** tet spell **
  • clubbing
  • poor growth
  • risk for emboli
  • loss of consciousness
  • sudden death
43
Q

** tet spell **

A
  • tetralogy of fallot manifestation
  • acute episodes of cyanosis and hypoxia
    • O2 requirements exceed blood supply due to ** obstructed pulmonary blood flow **
44
Q

** tet spell intervention **

A

place children in knee chest position to decrease venous return from legs and increase systemic vascular resistance, thus diverting more blood into pulmonary artery

  • children will assume this position on their own if old enough!
45
Q

clubbing is a sign of…

A

chronic hypoxia

46
Q

TOF management

A
  • palliative shunt (Blalock-Taussig Shunt) from L to R subclavian artery (increase blood flow to pulmonary artery)
  • surgical repair: close VSD, correct stenosis, pericardial patch to enlarge R ventricle
    • surgery before 2 years of age (not too old!)
47
Q

TOF prognosis

A

< 3% mortality

48
Q

coarctation of the aorta is…

A

localized narrowing of aorta

49
Q

coarctation of the aorta leads to…

A
  • increased pressure proximal to defect (head and neck)

- decreased pressure distal to defect (body and LE)

50
Q

** coarctation manifestations **

A
  • high BP and bounding pulses in UE

- weak or absent femoral pulses, cool LE, lower BP in LE

51
Q

coarctation management

A
  • surgical repair before age 2 to prevent htn

- non-surgical: balloon angioplasty

52
Q

coarctation prognosis

A

< 5% mortality with isolated defect

53
Q

transposition of the great vessels is…

A
  • pulmonary artery exists LV
  • aorta exits from RV
  • no communication between sides of heart
54
Q

transposition of the great vessels must…

A

have septal defect to survive!!!! If the two closed loops stay closed, baby will die QUICKLY.

55
Q

TOGV management

A
  • prostaglandin E to keep PDA open

- surgical: arterial switch in first weeks of life

56
Q

TOGV prognosis

A

< 2% mortality

57
Q

hypoplastic left heart syndrome is…

A
  • underdeveloped left heart (LV, MV, AV, AA)

can be aware of this defect before baby is born

58
Q

hypoplastic left heart syndrome requires…

A
  • 3 surgical procedures
  • may require heart transplant
    FATAL WITHOUT INTERVENTION
59
Q

acquired cardiovascular disorders

A
  • endocarditis
  • rheumatic fever
  • kawasaki disease

(see these three the most)

60
Q

bacterial endocarditis is…

A
  • infection of valves and inner lining of the heart

- sequela of bacteremia in children with anomalies of the heart

61
Q

bacterial endocarditis portal of entry

A
  • oral: dental procedure
  • urinary tract: UTI post-catheterization
  • blood: from long term indwelling cathers
62
Q

bacterial endocarditis management

A
  • high doses of antibiotic IV for 2-8 weeks
63
Q

** bacterial endocarditis prevention **

A

attn susceptible children!!!

  • parent education for children at high risk
  • includes children with cardiac defects and cardiac surgery
64
Q

rheumatic heart disease looks like…

A

rheumatic fever: inflammatory disease post group A beta hemolytic strep pharyngitis

65
Q

what do you do with strep throat?

A

TREAT IT ADEQUATELY AND FULLY AND PREVENT RHEUMATIC FEVER!

66
Q

rheumatic heart disease carditis characteristics…

A
  • most commonly seen in mitral valve, causing mitral regurgitation
67
Q

rheumatic carditis may (results)…

A
  • lead to CHF

- require surgical valve repair or replacement

68
Q

Kawasaki disease is…

A
  • UNKNOWN ETIOLOGY
  • acute febrile illness affecting children younger than 5 years
  • self-limited, resolves in 6 to 8 weeks
69
Q

Kawasaki disease most serious potential complication

A

acute systemic vasculitis (inflammation of arteries) including coronary arteries

70
Q

Kawasaki disease without treatment

A

25-50% of children have cardiac sequela, especially weakening and dilation of coronary arteries or aneurysm formation leading to MI

71
Q

Kawasaki disease management

A
  • high doses of IV Ig (contains IgG antibodies extracted from plasma of donors)
  • high dose of aspirin: anti-inflammatory and blood thinner
72
Q

Kawasaki disease prognosis

A

excellent when treated!!!!

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