Cardiovascular Dysfunction Flashcards
What are some assessment findings that indicate poor cardiac function in children?
- Nutritional state- failure to thrive and poor weight gain
- Color- cyanosis, pallor
- Chest deformities
- Unusual pulsations
- Respiratory excursion
- Clubbing of fingers –> due to Chronic hypoxemia –> polycythemia and clubbing
What are some pediatric Indicators of Cardiac Dysfunction?
•Poor feeding
•Tachypnea/Tachycardia
•Failure to thrive (FTT)/poor weight gain/activity intolerance
Developmental delays
What four things would you do (as the nurse) to manage a child with heart failure?
1. Improve cardiac function
- Administer digoxin
- Administer ACE inhibitors
2. Remove accumulation of fluid and sodium
- Administer diuretics
- Possible fluid restriction
- Possible sodium restriction
3.Decrease cardiac demands
- Provide neutral thermal environment
- Treat any existing infection
- Reduce efforts of breathing
- Administer sedation
- Provide rest
4. Improve tissue oxygenation
- Oxygen administration
What are some manifestations of CHF in children?
-
Impaired myocardial function –>
- Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine output
-
Pulmonary congestion –>
- Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
-
Systemic venous congestion –>
- Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
How would you treat Hypercyanotic Spells?
- Place infant in knee-chest position
- Employ calm, comforting approach
- Administer 100% O2 FM
- Give Morphine SC or IV
- Begin IVF replacement
- Repeat Morphine
What is Postpericardiotomy Syndrome?
- Symptoms—fever, WBCs, pericardial friction rub, pericardial and pleural effusion
- Occurs in immediate postoperative period
- Also can occur later (days 7 to 21 postop)
- Etiology unknown
- Theories of etiology
- Viral infection, autoimmune response, reaction to blood in pericardium
- May require pericardiocentesis or pleurocentesis
What organisms can cause Endocarditis?
- Streptococci
- Staphylococci
- Fungal infections
Describe the pathophysiology of infective endocarditis
- Altered blood flow and turbulence inside the heart –>
- Damage to valvular endothelium –>
- Rough endothelium increases fibrin and deposition of platelets –>
- Microorganisms grow and form vegetation on the endocardium –>
- Lesion may invade adjacent tissues (valves and myocardium) –>
- May break off and embolize
What are the clinical manifestations of infective endocarditis?
- Insidious, malaise, low-grade fever
- New murmur or change in previous murmur (caused by the bacterial blocking something in the heart)
- Splenomegaly
- Osler nodes—red, painful nodes on pads of fingers
- Janeway spots—painless hemorrhagic spots on palms and soles
What causes Rheumatic fever?
Inflammatory disease occurs after group A β-hemolytic streptococcal pharyngitis (this starts off as a strep infection)
A selft limiting condtion that affects joints, skin, brain, serous surfaces, and heart
What are the clinical manifestations of Rheumatic fever?
- Carditis
- Polyarthritis
-
Erythema marginatum
- Transitory rash on trunk and proximal extremities
- Nonpruritic
-
Subcutaneous nodules
- Occur in crops over bony prominences
What is the treatment for rheumatic fever?
Penicillin
What is Kawasaki Disease?
Acute systemic vasculitis, from an unknown cause, that lasts abot 6-8 weeks; it is self-limiting
What are the clinical manifestations of Kawasaki Disease?
C. - conjuctivitis
R. - Rash
A. - Adenopathy
S. - Strawberry Tounge
H. - Hands/feet peeling – > edema
& Burn - High fever greater than 5 days
What causes a PDA to close?
- An ↑ in O2 in the body (the baby is breathing in his/her own air
- A ↓ prostaglandins (because the baby is cut off from the placenta)
- Giving the baby indomethacin (it is an NSAID that inhibits prostaglandins)
What are some characteristics of a PDA?
- Widened pulse pressure (because of the increase in blood flow to the lungs from the aorta)
- Can lead to ventricular hypertrophy
What is coarctation of the aorta?
- It is a narrowing in the aorta that leads to ↓ blood flow to the trunk and distal parts of the body and an ↑ in blood to the head and arms →
- ↓ pulses in the legs and ↑ pulses in the arms and neck → cooler extremities
- There is a blood pressure difference seen in the arm and leg
What is aortic stenosis and describe it
- There is stenosis in the aortic valve →
- LV hypertrophy → LHF → pulmonary backflow of blood → pulmonary congestion
- Patients have faint pulses because of the ↓ in cardiac output
- Symptoms: Angina, fatigue, Complains of exercise intolerance, chest pain, dizziness w/ standing
- They are at risk for infective endocarditis, coronary insufficiency, and ventricular dysfunction
What is pulmonic stenosis and describe it
- Pulmonic valve stenosis →
- RH Hypertrophy →
- ↑ pressure in the RH →
- RHF →
- Back flow of blood from the right heart
What are some heart defects that increase pulmonary blood flow?
- VSD
- ASD
- PDA
What are some obstructive heart defects?
- Coarctation of the aorta
- aortic stenosis
- pulmonic stenosis
What are some heart defects that decrease pulmonary blood flow?
- Tetralogy of fallot
- Tricuspid atresia
