Cardiovascular Dysfunction Flashcards by Jessie Lincoln

Digoxin Use

Improving force and contractility
Slowing heart rate and conduction
Available in elixir form

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Digoxin Toxicity

Narrow margin for safety
Symtoms: bradycardia, dysrhythmias, anorexia, N/V
When in doubt: Send for level assessment

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Digoxin Nursing Responsibilities

Calculate correct dose
Check apical pulse prior to admin
Order to specify HR to be held
Infant 90-110 & Young children 70
Spontaneous throwing up- possible toxicity

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Congenital Heart Disease

Increased pulmonary blood flow- Ventricular Septal Defect
Obstruction to systemic flow- Coarctation of the Aorta
Decreased pulmonary blood flow- Tetralogy of Fallot
Mixed blood flow- Transposition of the Great Arteries

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Ventricular Septal Defect

Defects allows blood totravel from high pressure L to lower pressure R
Increased pulmonary blood flow
High risk for respiratory infections
Excess fluid, Murmur from hole, Blood is shunting
Care similar to heart failure

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Coarctation of the Aorta

Blood exiting the heart meets an area of obstruction due to stenosis
Obstruction to blood flow
BP higher is upper extremities, lower in lower extremities
Decreased C.O.

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Coarctation of the Aorta Symptoms

Leg pain especially with exercise, dizziness, HA, epistaxis

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Coarctation of the Aorta Treatment

Surgery, Balloon angioplasty

6-8mo post op still have hypertension

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Tetralogy of Fallot

Four Abnormalities
1. Pulmonic Stenosis
2. Ventricular Septal Defect
3. Overriding Aorta- blood comes from both left and right ventricle
4. Right Ventricular Hypertrophy- thickening of muscle
DECREASED pulmonary blood flow
Sending un-oxygenated blood back to the body

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Tetralogy of Fallot Symptoms

N/V, diarrhea, possible murmur
CYANOSIS
Boot shaped heart
Polycythemic- increases risk for thromboembolic events (stroke)
Clubbing 
High Hgb, Hct, RBCs
Low plasma

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Tetralogy of Fallot Treatment for Parents

Place infant in knee to chest position
Use a calm approach
Apply 100% O2
Give morphine IV or Subq
Give IVF to rebalance 1-5cc/kg
Repeat morphine as needed

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Transposition of the Great Arteries

A mixed defect as blood flow pattern- blood from body comes to right atria to right ventricle to aorta out to body
TOTALLY un-oxygenated blod returning to the body

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Transposition of the Great Arteries Treatment

Surgery within 1st week of life
Punch a hole between atria if Patent foramen ovale and Patent ductus arteries are not open
PFO and PDA give blood a place to mix

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Heart Failure

Inability of the heart to pump adequate amount and flow of blood to meet the body’s demands
From volume overload, pressure overload, decreased contractility or presence of high cardiac output demands

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Heart Failure Symptoms

Tachycardic
Cool and pale
Excess fluid 
Weight loss- infants
Weight gain- child
Diaphoretic- mostly in infants

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Heart Failure Causes

Congenital heart defects account for 90% of CHF in 6-12 months of life from volume overload
Acquired heart disease or decreased contractility- shock anemia, asphyxia, electrolyte imbalances, ischemia
Cardiomyopathy, Rheumatic Heart disease and Kawasaki disease

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Heart Failure- Secondary Disease

Mostly secondary

Consequence of underlying cardiac issues

Heart Failure Treatment

Medications for cardiac function- Digoxin, ACE Inhibitors (captopril or enalapril) and beta blockers (carvedilol)
Medication to decrease fluid and Na- Loop diuretic (furosemide), thiazide (chlorothiazide) and spironolactone
Decrease cardiac demands- monitor temp, semi fowlers
Improve tissue oxygenation- supplemental O2, URI, pulmonary HTN.

Bacterial Endocarditis

Infection of the valves or inner lining of the heart

Causes: Strepto viridans, Staphlo aureus and Candida albicans

Bacterial Endocarditis Symtoms

Low grade fever, pale, anorexia, recent weight loss, malaise, night sweats and chills, Janeway spots, murmur, dental history

Bacterial Endocarditis Treatment

Administration of high dose antibiotic therapy for 2-8 weeks- Nafcillin is common
Follow up cultures to see progress
Support to preserve cardiac function
PIC lines, prophylactic antibiotics for dental work

Bacterial Endocarditis Prevention

PREVENTION IS KEY!
Educate parents for high risk children- antibiotics before dental care, good oral health, signs and symptoms of the disease, IV therapy for long term antibiotics

Rheumatic Fever

Inflammatory disease occurs 2-6 weeks after streptococcal pharyngitis
Carditis

Rheumatic Fever Symptoms

Polyarthritis
Chorea- involuntary movement
Sore Throat

Rheumatic Fever Treatment

Penicillin or erythomycin to treat infection Antibiotic therapy is carditis is present Aspirin is sued to reduce fever and discomfort from polyarthritis Strep test Passive ROM, good rest and nutrition and education

Kawasaki Disease

Acute systemic vaculitis and often preceding upper respiratory infection

Kawasaki Disease Symptoms

Fever, red conjunctivae, strawberry tongue, desquamating and edematous palms of hands and soles of feet Irritability is most challenging

Kawasaki Disease Heart Damage

Coronary artery damage that can lead to aneurysms or MI Decreased LV function CHF

Kawasaki Disease Treatment

IV Ig High dose in 1st 7-10 days of illness helps to decrease chance of coronary artery issues Aspirin therapy until the platelet count is normal

Kawasaki Disease Nursing

Monitor VS w/temp and cardiac status. Symptom relief with cool wash clothes, mouth care, chapstick, passive ROM in bathtub if arthritis present in large joints, emotional support, and medication administration

Rheumatic Fever Nursing

Prevention! Strep test given to all with a sore throat and with a positive test to give all doses of the antibiotic. Medications as ordered, passive ROM in tub for painful joints, promote rest, good nutrition and provide emotional support for family and child

Cardiomyopathy

Abnormality in myocardium which impacts the ability for the muscle to contract

Type of Cardiomyopathy

Dilated- most common- dilation of LV that tends to decrease contractility and reduce ejection fraction Hypertonic- increase in muscle mass w/o increase cavity size Restriction- rare

Cardiomyopathy Symptoms

``` Tachycardia Dsypnea Hepatoslenomegly Fatigue Poor growth ```

Cardiomyopathy Treatment

``` Control heart failure Carvedilol Treat dysrhythmias Anti-coagulants to decrease risk of thromboembolism IV inotropes, IV afterload reducer LV assist device, ECMO Heart Transplant ```

Sympathetic and Parasympathetic

Sympathetic- increase HR | Parasympathetic- decrease HR

Cardiac Output

Increase HR -- Increase CO -- Decrease Filling time

Diagnostic Tools

Chest Xray- Heart size, have to hold your breath EKG- Cant see as much, arrhythmia in children ECHO- 1st to do, not painful, a window to the heart

Cardiac Catheterization

Dye to view heart structures and functioning

Cardiac Catheterization PreOP

NPO Stop anticoagulants Age-appropriate prep (teaching about it) General anesthesia

Cardiac Catheterization PostOP

Lying flat, leg straight 4-8hr Check dressings for signs of bleeding- put pressure above site and call DR Frequent pulse, CRT, warmth checks on extremities Frequent VS