cardiovascular part 2 (2) Flashcards
where is arterial blood pumped in a fetus in utero
right side of heart
does blood go through the fetus lungs in utero?
no, rerouted
what is the fetal vascular channel between the pulmonary artery and the descending aorta
ductus arteriosis
where does the majority of blood pumped by the right side of the heart go to?
ductus arteriosis
what is the fetal opening in the atrial septum, takes blood from right atrium to left atrium
foramen ovale
what stimulates the foramen ovale to close?
increased left atrium pressure
when does foramen ovale close
shortly after birth?
when does the ductus arteriosis close, and by when is it permanently close?
closes within 10-15 hours after birth, permanently after 10-21 days of birth
what does a patent ductus arteriosis cause?
oxygenated blood from aorta to lead into unoxygenated blood in the pulmonary artery
when does the heart develop in gestation
4th-7th weeks
when do most cardiac defects develop in utero
8th week
what are some factors that can contribute to congenital heart disease
- maternal drug/alc use
- maternal viral infections
- maternal metabolic disorders
- genetics
- increased age
- chromosomes
what is an increased pulmonary blood flow defect with a defect in the right atrium
atrial septal defect
how does blood shunt in atrial septal defect
left → right
what kind of symptoms will occur with atrial septal defect
heart failure symptoms
which defect is an opening between ventricles
ventricular septal defect
describe ventricular septal defects pressure and blood flow
increased pressure on the left side, shunts left to right, increased pulmonary blood flow
what symptoms will occur in ventricular septal defect`
heart failure symptoms
when is patent ductus arteriosis classified?
if it does not close by 21 days
where is blood shunted from and to in patent ductus arteriosis
from aorta to pulmonary artery
what kind of blood flow is in patent ductus arteriosis
increased pulmonary blood flow
where is the most pressure in a patent ductus arteriosis defect
aorta
what defect is narrowing of the descending aorta
coarctation of the aorta
what kind of blood flow does coarctation of the aorta have
obstructed systemic blood flow (restricted flow from aorta = less to the body)
where does coarctation of the aorta restrict flow from?
the left ventricle
what are signs and symptoms of coarctation of the aorta dependent on?
size of the defect
which defect is a cyanotic heart defect
tetralogy of fallot
what kind of bloodflow does tetralogy of fallot have?
decreased pulmonary blood flow
what are the 4 defects that make up tetralogy of fallot?
- right ventricular wall hypertrophy (narrowing)
- narrowing of pulminary valve (pulmonic stenosis)
- ventricular septal defect
- overriding aorta
what causes the right ventricle hypertrophy in tetralogy of fallot
pulmonic stenosis causes the right ventricle to work harder than it should
where is the shunting of blood in tetralogy of fallot
there is none
why is there decreased pulmonary blood flow in tetralogy of fallot?
pulmonic stenosis (narrow pulmonsry valve)
which procedure has a radiopaque catheter inserted into the heart from a peripheral blood vessel, has contrast media put through
cardiac cath
what can assess congenital heart defects, valve disease, and coronary heart disease
cardiac cath
where does a cardiac cath measure oxygen saturation
in the hearts chambers and great arteries
where dies a cardiac cath measure pressure gradients
pulmoanry vessels and heart chambers
how long is rpessure held on a cardiac cath afterward?
15 mins
describe dressing assessment intervals directly after a cardiac cath
every 5 min for 15 mins, every 15 mins for 1 hour, then hourly
which vital signs indicate bleeding
increased pulse and decreased bp
wha tcan contrast media cause
diuresis (watch I&O)
how long should the HOB be flat for after a cardiac cath
4-6 hours
where should pressure be held if a cardiac cath site bleeds?
an inch above the site (inch closer to heart, this is on leg)
what is when cardiac putput is inadequate to support the bodys circulatory and metabolic needs
congestive heart failure
what is congestive heart failure cuased by?
congenital heart defect or acquired heart disease
what are some clinical manifesttions of CHF in infants
- tires easily, with feeds especially
- weight loss or lack of gain
- diaphoresis (esp. feeding)
- frequent resp infections
- color changes; mottling or pallor
CHF clinical manifestations in toddler/older child
- exercise intolerance
- dyspnea
- abd pain/distention
- peripheral edema
what does pulmonary venous cingestion (left sided HF) in CHF look like?
- tachypnea, wheezing, crackles, retractions, cough, dyspnea, grunt, flare, cyanosis
what does systemic venous congestion (right sided HF) in CHF look like?
- tender/enlarged liver
- ascites
- periorbital edema
- peripheral edema
- weight gain
- neck vein distention
Which diagnostic method of congestive heart failure shows cardiac enlargement in venous congestion or signs of pulmonary edema
CXR
Which diagnostic tool of congestive heart failure confirms the diagnosis, and shows cardiac defects or ventricular dysfunction
Echocardiogram
which diagnostic method of congestive heart failure identifoes arrythmias
electrocardiogram
goals of CHF?
- treat the cause
- make the hard work more efficiently and remove excess fluid
Which medications promote fluid excretion in congestive heart failure
diuretics like furosemide
what needs supplemental when on diuretics?
potassium
Which medications for congestive heart failure are used to decrease blood pressure, therefore decreasing the workload of the heart
angiotensin converting enzyme (ACE) inhibitors (captopril), and beta blockers!!!! (propranolol)
what is the most common sign of digoxin toxicity in congestive heart failure treatment
arrythmias
which medication for congestive heart failure slows the heart rate, increases cardiac filling time and myocardial contractility to improve systemic circulation
digoxin
What kind of dosing is used with digoxin?
loading dose and then maintenance dose
Which heart rates lead to digoxin being held in infants and children?
infants = <90, children = <70
A decrease in which electrolyte increases the risk of digoxin toxicity?
potqssium
What kind of diets are recommended for infants with congestive heart failure?
High calorie formula and NG feeds
What kind of meals should an older child with CHF have?
small frwqunt meals
What position is best for CHF?
semi-fowlers
Fetal circulation includes which of the following?
1. ductus arteriosis
2. foramen ovale
3. pulmonary artery
4. pulmonary vein
1 and 2
Diagnosis and testing for CHF would include?
1. EKG, CXR, and ultrasound
2. Stress test, cardiac catheterization, EKG
3. EKG, CXR, echocardiogram, cardiac catheterization
4. Echocardiogram, cardiac catheterization
3
T or F?
cardiac catheterization puts the infant or child at risk for arrhythmias
true
early clinical manifestations for an infant with congestive heart failure could include which of the following? choose all
1. Inc weight gain
2. eager eater
3. emesis
4. poor weight gain
5. bottle feeding taking longer than 30 min
4 and 5
Two month old infant is admitted with congestive heart failure. Which would be a daily nursing intervention
1. weight
2. Elevating head of bed
3. small frequent meals
4. assessment q8h
1
