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Nur 873 > Cardiovascular Dysfunction > Flashcards

Cardiovascular Dysfunction Flashcards

0
Q

Cardiac catheterization

A
  • diagnostic (for rhythms and pressures)
  • interventional (angioplasty or closure of defects)
  • right side cath more common in kids b/c it is safer and structural defects allow left side heart access
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1
Q

ECG

A

15 lead in children

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2
Q

Cardiac Cath pre-procedure care (assessment includes)

A

Good height-for proper catheter selection
Good weight-med doses
Assess pulses and mark before they leave because pulses may be difficult to assess after
Assess for any signs of infection, no acne in the insertion area

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3
Q

Cardiac cath post-procedure care

A

Potential complications:

  • Color and LOC
  • VS and Resp status
  • pulses (distal to site can be weaker for first few hours) just make sure they’re equally weak
  • dressing for bleeding (1 in above site)
  • fluid intake (both IV and PO)
  • hypoglycemia
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4
Q

Discharge planning

A
  • pressure dressing for 24 hours
  • no tub bath 48 hrs
  • rest the night then resume normal activity
  • teach s&s of infection
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5
Q

Developmental consideration

A

Heart size- ventricles are equal in size at birth
Less compliance- during infancy muscle fibers of the heart are less developed and less organized resulting in limited functional capacity (can’t pump harder just faster)
Normal O2 sat is 95-100%
Infants and small children have thin chest walls with little to no subcutaneous fat and muscle

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6
Q

Ductus Venosus (where is it? What’s it do?)

A
  • Shunt of blood past the liver to the heart

- Allows 1/2 blood to bypass the liver

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7
Q

Foramen Ovale

A
  • opening between the L&R atrium

- let’s blood move back and forth

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8
Q

Ductus Arteriosus (where is it what’s it do?)

A
  • Pulmonary artery to aorta

- Allows blood to bypass lungs

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9
Q

Fetal shunts

A

All close at birth or shortly after in response to:

  • decreased maternal hormone prostaglandin E
  • increased O2 sat
  • pressure changes in the heart (pulmonary starts to fall, as systemic pressures rise)
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10
Q

General clinical findings for cardiac defects

A
  • Dyspnea
  • feeding difficulty and failure to
  • stridor or choking spells
  • HR over 200; Resp rate about 60 in the infant
  • recurrent Resp tract infections
  • in the older child-poor physical development, delayed milestones, and decreased exercise tolerance
  • cyanosis and clubbing of fingers and toes
  • squatting or kee-chest position (tetralogy of falow)
  • heart murmurs
  • excessive perspiration
  • signs of heart failure (edema; decreased urinary output; increased HR; JVD; poor healing)
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11
Q

Cardiac hemodynamics

A

Always go left to right

-backs up in lungs and body cyanotic-mimics CHF in s/s

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12
Q

Clinical consequences of defects causing increased pulmonary flow

A
  • Systemic pressure causes left or right shunting
  • increased blood volume on right side increases and overwhelms the lungs
  • s/s of cognitive heart failure -caused by left to right shunting
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13
Q

CHF

A

Heart can’t pump enough blood to meet body’s needs

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14
Q

CHF CAUSES:

A
  1. Volume overload
  2. Pressure overload
  3. Decreased contractility
  4. Too much cardiac demand
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15
Q

CHF occurs mostly

A

2ndary to congenital heart defects in which structural abnormalities result in an increased volume load or increased pressure load on the ventricles

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16
Q

Clinical Manifestations of CHF

A

Pulmonary venous congestion:
-tachypnea; adventitious breath sounds; nasal flaring; fatigue with play; difficulty feeding
Systemic Venous congestion:
- hepatomegaly; ascites; weight gain; edema; JVD
Impaired Myocardial Function:
-tachycardia; extended cap refill; oliguria; fatigue; restlessness; enlarged heart; cool extremities
High Metabolic Rate:
Failure to thrive or slow weight gain, sweating

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17
Q

Management if CHF

A
  • improve cardiac function
  • remove accumulated fluid and sodium
  • decrease cardiac demands
  • improve tissue oxygenation and decrease oxygen consumption
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18
Q

Digoxin admin

A

-regular intervals; -1 hour before or 2 hours after eating; do not mix with food or fluid; behind teeth or brush after administration; missed dose < 4 hours give, if > 4 hours withhold. If 2 doses missed, notify practitioner; if child vomits do not repeat dose

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19
Q

Digitalis toxicity

A

N/V; bradycardia; anorexia; visual disturbances

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20
Q

Care for Activity intolerance in CHF

A
  • Adequate rest
  • Prevent crying (have bottle ready to feed)
  • cluster care
  • short intervals of play, cuddling
  • provide neutral thermal environment
  • extra won’t help as lungs are overloaded w/ fluid
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21
Q

Care for altered nutrition in CHF

A
  • anticipate hunger
  • smaller more frequent feeding
  • burp frequently to decrease crying
  • formulas with increased calories
  • semi-erect for feeding
  • feed in a relaxed environment
  • only feed for 30-45 minutes at a time
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22
Q

Care for ineffective breathing pattern in CHF

A
  • assess resp rate, effort, and O2 sat
  • semi-fowlers to encourage full chest expansion
  • avoid constriction
  • humidified supplemental O2 during times of crying or stressful procedures
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23
Q

Care for infection risk in CHF

A
  • avoid crowded public places
  • good hand washing
  • screen visitors
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24
Q

FVE care in CHF

A
  • accurate I & O
  • weigh daily (same time, scale, and clothing
  • assess for edema
  • maintain fluid restrictions if ordered
  • provide good skin care
  • change position frequently
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25
Q

CHF-growth and development

A

Infants do catch up-slowly and overtime

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26
Q

Arterial Septal Defect

A

Patent foramen ovale - septum fails to close
CM:
-maybe asymptomatic - murmur - Does not typically mimic heart failure- increased risk of dysrhythmias with pulmonary vascular obstructive disease and emboli later in life
-

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27
Q

ASD Treatment

A
  • mild defects may close spontaneously
  • likely not life threatening and closes over time, just watch and wait and make sure they’re growing
  • open heart surgery w/ Dacron patch closure or closed during cardiac cath with septal occluder
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28
Q

Ventricular septal defects

A 
-septum fails to close between the left and right ventricles- body deprived of O2 blood and pulmonary overload
CM:
-CHF- moderate to severe, cyanosis
-murmur
-failure to thrive 
-fatigue
-recurrent respiratory infection
-right ventricular hypertrophy
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29
Q

VSD therapeutic mgmt:

A
  • Pulmonary artery banding- restrict blood flow back through
  • may close by age 3 (if child grows well then it’s a watch and wait)
  • heart cath w/ septal occluder
  • surgical correction w/ a patch and repair of AV valve tissue
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30
Q

Patent ductus arterious = PDA (define)

A

Ductus arterious doesn’t close, causes a left to right shunting; blood is shunted from the aorta to the pulmonary artery, back to the lungs, causing increased pulmonary blood flow

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31
Q

PDA CM/Treatment:

A

CM: machine like murmur; can be asymptomatic or exhibit CHF signs
Treatments: Indocin- tocolytic that blocks the effects of prostaglandin E and causes hole closure
-Interventional heart cath with coil
-Left Thoracotomy or VATS- 3 small chest incisions places a clamp on the ductus

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32
Q

Coarctation of the aorta (define)

A

Narrowing of aortic arch usually distal to the ductus arteriosus and beyond the right subclavian artery-
Narrowing near the insertion of the ductus arteriosus resulting in increased pressure proximal to the defect and decreased pressure distal to the defect

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33
Q

Coarctation of the aorta (location of insertion)

A

Preductal- between subclavian artery before the ductus arteriosus
Postductal- collateral circulation develops during fetal life (distal to the ductus arteriosus)

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34
Q

Coarctation of aorta (clinical consequences and manifestations)

A
  • L-R shunting, increased pulmonary blood flow leading to CHF
  • Increased Blood Flow to head and upper extremities
  • Decreased blood flow to trunk and lower extremities
  • CM: bounding upper extremities, decreased lower extremities (cool mottled skin, decreased BP, delayed healing, ulcers, H/A, epistaxis often, aortic aneurysms, possible stroke
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35
Q

Coarctation of the aorta (therapeutic management)

A
  • Prostaglandin E to maintain PDA
  • Balloon angioplasty
  • Surgery- within first two years (closer to 2 years b/c 1/2 adult height
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36
Q

Aortic Stenosis (define)

A

Aortic valve is narrowed or thicker and disrupts blood flow out

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37
Q

Aortic stenosis (consequences)

A
  1. Obstruction tends to be progressive
  2. Sudden ishchemic episodes, or low CO, results in sudden death. Activity needs to be limited
  3. Surgical repair rarely results in normal valve
  4. Increased risk of Bacterial Endocarditis
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38
Q

Aortic Stenosis

A

CM:
Infants- faint pulses, hypotension, tachycardia, poor feeding(decreased CO)
Children- exercise intolerance, chest pain, dizziness when standing for long periods

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39
Q

Aortic stenosis (treatment)

A

Balloon dilation; surgery- aortic valvotomy or replacement

-mortality high in neonates, low for older kids

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40
Q

Pulmonic Stenosis (define)

A

Narrowing of the pulmonic artery resulting in decreased right side outflow

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41
Q

Pulmonary atresia (define)

A

Complete fusion, resulting in no blood flow to lungs- not compatible with life unless there is another way for blood to get to the lungs

42
Q

Pulmonic stenosis (CM)

A

Asymptomatic; or mild cyanosis or CHF, murmur

Increased risk of BE due to pooling of blood

43
Q

Pulmonic Stenosis (treatment)

A

Balloon angioplasty; surgery

44
Q

CHF (CM)

A

Tachypnea; diaphoresis; eating problems; edema; rales; crackles

45
Q

Cyanotic heart defects (define)

A

R to L blood shunting, heart is messed up badly, blood mixing, baby is blue due to deoxygenated blood going to body; blood shunts from right to left because defects cause a great pressure on the right side of the heart

46
Q

Cyanotic heart defects (sx)

A

Cyanosis; polycythemia (increases clotting risk); digital clubbing; altered ABG’s

47
Q

Cyanotic heart defects (General interventions)

A

Provide good skin care (delayed healing); supplemental O2; monitor and prevent dehydration

48
Q

Cyanotic Heart Defects (considerations)

A

Alteration in oxygenation; anxiety caused by cyanosis; dehydration; prevention and accurate assessment of resp infections; keep them from stress/crying; soft preme nipples; education to parents that organs are still profuse; good hand washing; gown and glove; screen visitors

49
Q

Tetralogy of fallow (4 things going on)

A
  1. R vent hypertrophy
  2. Overriding aorta
  3. Ventricular septal defect
  4. Pulmonic stenosis
50
Q

ToF (TET spell)

A

Pulmonic stenosis gets worse causing pooling in R ventricles and goes to overriding aorta- more deoxygenated blood to body

51
Q

ToF (CM)

A

Murmur with a thrill; polycythemia; hypoxic episodes; clubbing; activity intolerance; poor growth; metabolic acidosis

52
Q

ToF (treatment)

A

Surgery done in stages (6 mo old)

  1. Blalock- taussig shunt
  2. VSD repair
  3. Pulmonary valvotomy
53
Q

Squatting position

A

Knee to chest intervention for TET spell ;

Increases systemic resistance; decreased venous return to lungs- body is able to divert blood to organs

54
Q

Hypercyanotic spells (guidelines)

A

Employ calm, comforting approach; knee-chest position; 100% O2 by face mask; give morphine; IV fluid replacement and volume expansion if needed; repeat morphine PRN

55
Q

Infundibular muscle

A

Goes from R vent to pulmonary artery- morphine relaxes the muscle to promote more blood to lungs- narcan for morphine antidote

56
Q

Tricuspid atresia (define)

A

Tricuspid valve does not develop and there is no communication between right atrium and ventricle (without another defect (ASD or VSD) life is not compatible)

57
Q

Tricuspid atresia (CM and treatment)

A

Cyanosis

Treatment: prostaglandin E to maintain foramen ovale; digoxin and diuretics; palliative surgical repair to increase the pulmonary blood flow

58
Q

Transposition of the great arteries (define)

A

Aorta goes to the R side and pulmonary artery goes to L side

59
Q

Transpiration of the great arteries (consequences)

A

-must have another defect that allows blood mixing for life to be compatible

60
Q

Transposition of the great Arteries (CM, Treatment)

A

CM: increasing cyanosis as the foramen ovale closes

Treatment: arterial switch procedure in the first few weeks of life; prostaglandin E to keep foramen ovale patent

61
Q

Truncus arteriosus (define)

A

Pulmonary artery and aorta fail to divide and a single large vessel empties both vents

62
Q

Truncus arteriosus (CM and Treatment)

A

CM: cyanosis; CHF; heart murmur
Treatment:
Surgical repair within the first few months of life; digoxin and diuretics to not overload the lungs

63
Q

Hypoplastic left heart syndrome (HLHS) define

A

Aortic valve atresia; mitral atresia or stenosis; small or absent left vent; severe hypo plasma of ascending aortic arch

64
Q

HLHS (consequences)

A

Underdevelopment of the left side of heart-

Small left ventricle, aortic atresia

65
Q

HLHS (s/s)

A

Cyanosis, weak peripheral pulses, cool extremities, resp distress, often no murmur

66
Q

HLHS (management)

A
  • Prostaglandin E to keep PDA open
  • Fontan procedure- direct blood flow to pulmonary artery from RA
  • Norwood procedure- anastomoses of main PA to the aorta, shunt from RV to PA
  • eventually need a transplant
67
Q

HLHS (complications from heart surgery)

A

CHF; dysrhythmias; cardiac tamponade; atelectasis; pneumothorax; pulmonary edema; cerebral edema; brain damage; hemorrhage or anemia

68
Q

HLHS (discharge plan)

A

Wound care; call clinic if fever; med teaching- how to give lasix and digoxin; BE prophylaxis- amoxicillin before dentist or surgery; self limit activity- don’t let them play where they can get hurt, but no need to restrict play; do not pick up child beneath arms until incisions have healed; call doctor if: decreased UOP, infection or fever

69
Q

Bacterial Endo BE (define) and etiology

A

Inflammatory process resulting from infection of the valves of heart and inner lining
-comes from strep infection, in the ear, UTI, or central line placement

70
Q

BE CM:

A

Low grade intermittent fever; anorexia; malaise; splinter hemorrhages under nails; Osler nodes; janeway spots; new heart murmur or change in existing ones; weight loss

71
Q

BE therapeutic mgmt

A

IV antibiotics for 2-8 weeks; surgical removal of thrombi or deposits; prevention of infection w/ prophylactic antibiotics 1 hr before dental or other risky procedures

72
Q

Rheumatic Fever RF (define)

A

Systemic inflammation disease that follows a group A beat hemolytic strep infection - autoimmune reaction to strep infection

73
Q

Incidence of RF

A

More commune in males and late winter to early spring; most often school agers; upper resp infection weeks prior

74
Q

RF CM

A

Major: poly arthritis; carditis; chorea-irregular movement of extremities; erythema marginatum; subcutaneous nodules
Minor: arthralgia; low grade fever; elevated ASO titer

75
Q

RF therapeutic management

A

10-14 days of penicillin; prevent cardiac damage and relieve sx- (aspirin 2 weeks for inflammation; bed rest)
Prevent recurrent infection (prophylactic antibiotics)

76
Q

RF Nursing consideration

A

Prevention- sawn for strep when kid is in clinic w/ sore throat
Encourage compliance w/ antibiotics
Facilitate recovery rest, nutrition, and pain management
Provide emotional support w: chorea and pain

77
Q

Kawasaki (CM acute)

A

8-10 days
Bilateral pink eye; enlarged lymph nodes; peeling skin; patchy rash; fever-Tylenol doesn’t help; dry cracked lips; strawberry tongue

78
Q

Kawasaki (CM subacute (10-35 days)

A

Begins with resolution of fever and lasts until all signs are gone;
Vasculitis; arthritis, peeling of skin throbocytosis- high platelet; can result in emboli or blockage from platelets or scarring; at great risk for coronary aneurysm

79
Q

KD (recovery phase

A

Up to 10 weeks
Child vulnerable as coronary arteries are still damaged and repairing, the child feels okay, and is a risk for heart attack here- most dangerous phase MI signs= back pain/angina/none

80
Q

MI S/s in children

A

Abdomen pain; vomiting; restlessness; inconsolable crying; pallor; shock

81
Q

KD management

A

Aspirin for anti inflammatory (initial) and anti platelet (long term)
High dose IV IG (w/n 1st 10 days)
If coronary arteries are damaged, then on aspirin for life

82
Q

KD considerations

A

Cardiac status monitoring carefully!
-I&O -daily weight. - administer fluid with care. - watch for signs of MI

Safely give IV IG- usual blood precautions- easy to fluid overload

Watch for s/s of aspirin toxicity (ringing ears and GI bleed risk)

Skin discomfort (loose soft clothing; mouth care; cool rags)
D/C teaching: NO MMR VACCINE FOR 1 YEAR OR FLU MIST
83
Q

HTN types

A

Essential or primary = no identifiable cause

Secondary = subsequent to a known cause

84
Q

HTN incidence

A 
Primary (rare)
Secondary:
Renal disease- most likely cause- urinalysis in clinic- + for protein? = kidney probs
Coarctation of aorta
Oral contraception
Steroids
Obesity
Adrenal disorders
85
Q

HTN CM:

A

Elevated BP; dizziness; H/A; vision changes

86
Q

Therapeutic management HTN in children

A

Identify cause and treat; monitor if mild; combination of nonpharm and pharm therapy

87
Q

Mild HTN:

A

85-95%tile

88
Q

Moderate HTN

A

95-99%tile

89
Q

Severe HTN

A

> 99%tile

90
Q

Nonpharm interventions for HTN

A

Low salt diet; don’t smoke; halt birth control

91
Q

Pharm therapy for HTN

A

Beta-blocker; ACE-I; diuretic

92
Q

Hyperlipemia screening

A

Selective for risk factors- genetic; or overweight; draw lipids first thing in morning after fasting

93
Q

Hyperlipemia threshold

A

< 170 is considered to be acceptable

94
Q

Hyperlipidemia Management

A

Step diet- don’t eliminate bad foods- just limit
Pharm- colestipol or cholestryamine
Take family approach to improve child’s health- get family healthy

95
Q

Dysrhythmias diagnosis

A

24 hr holter; ECG; trans-esophageal recording

96
Q

SVT treatment

A

Vagal maneuvers; valsalva maneuver; adenosine slam; cardio version; radio frequency ablation; avoid caffeine and sudafed

97
Q

Sinus arrhythmia

A

Normal in school ager; have child hold breath and should regulate it

98
Q

Cardiomyopathy

A

Myocardial abnormalities which impairs the hearts ability to contract

99
Q

Cardiomyopathy types:

A

Dilated- ventricular dilatation with greatly decreased contractility leading to CHF
Hypertropic- increase in heart muscle mass without an increase in cavity size
Restrictive- restricted vent filling due to caused by disease CHF

100
Q

Cardiomyopathy etiology

A

Usually in children is idiopathic

101
Q

Cardiomyopathy CM

A

CHF; dysrhythmias; syncope; sudden death

102
Q

Management of cardiomyopathy

A

Digoxin; diuretics; beta blockers; calcium channel blockers; anticoagulants; transplant if meds don’t work

103
Q

Consideration for cardiomyopathy

A

Child wants to play but simply can’t and their failing health is discouraging
-include child in discussions and decisions
-psychological preparation for transplant and postoperative care
Won’t feel good and often want to halt therapy

Nur 873 (2 decks)

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