Cardiovascular system

Question 1

What is Congestive Cardiac Failure (Heart failure)

Answer 1

The inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the metabolic and oxygen needs of the body.

Question 2

Right sided heart failure

Answer 2

Right ventricle is unable to pump blood effectively into the pulmonary artery resulting in increased pressure in the right atrium and systemic venous circulation.

Question 3

Left sided heart failure

Answer 3

The left ventricle is unable to pump blood into the systemic circulation resulting in increased pressure int the left atrium and pulmonary veins

Question 4

Clinical manifestations of impaired cardiac function

Answer 4

• Tachycardia
• Sweating
• Decreased urinary output
• Fatigue
• Pale, cool extremities
• Weak peripheral pulses
• Decreased blood pressure
• Cardiomegaly

Question 5

Clinical manifestations of pulmonary congestion

Answer 5

• Tachypnea
• Dyspnea
• Retractions
• Nasal flaring
• Cyanosis
• Wheezing
• Cough, hoarseness
• Exercise intolerance

Question 6

Clinical manifestations of systemic venous congestion

Answer 6

• Weight gain
• Hepatomegaly
• Ascites
• Neck vein distension
• Peripheral edema especially periorbital

Question 7

Therapeutic management

Answer 7

• Improve cardiac function (contractility and decrease afterload)
• Remove accumulated fluid and sodium
• Decrease cardiac demands
• Improve tissue oxygenation and decrease consumption

Question 8

Interventions to improve cardiac function

Answer 8

1) Administer digoxin (digitalis glycosides) to improve contractility, looking for prolonged PRZ interval and reduced ventricular rate

2) Administer angiotensin-converting enzyme inhibitors to reduce after on the heart, making it easier to pump. It acts by inhibits renin/angiotensin II system.

3) Administer beta blockers which causes decreased heart rate, decreased blood pressure and vasodilation. It acts by blocking beta- and alpha-adrenergic receptors.

Question 9

Side effect of ACE inhibitors

Answer 9

Cough

Question 10

Interventions for accumulated fluid and sodium

Answer 10

1) Administer diuretics

2) Strict fluid restrictions - monitor for dehydration

3) Monitor strict intake and output

4) Sodium restrictions - less often in children because of negative effects on child’s appetite and ultimate growth

Question 11

Interventions to decrease cardiac demands

Answer 11

1) Provide a neutral thermal environment to prevent cold stress in infants

2) Treat any existing infections

3) Place in semi-fowler position to reduce effort of breathing

4) Use sedative for irritable child

Question 12

Before giving digoxin, you should

Answer 12

Check child’s apical pulse. Digoxin is not given if pulse is below 90 - 110 beats/min in infants and young children or below 70 beats/min in older children.

Question 13

Signs of digoxin toxicity

Answer 13

• Nausea
• Vomiting
• Anorexia
• Bradycardia
• Dysrhythmias

Question 14

Ductus venous

Answer 14

Shunts oxygenated blood away from the liver into the inferior vena cava

Question 15

Foremen ovale

Answer 15

Allows oxygenated blood to enter the left atrium and ventricle to be pumped through the aorta to the head and upper extremities

Question 16

Ductus arteriosus

Answer 16

Shunts blood pumped to the pulmonary artery away from the lungs to the descending aorta

Question 17

What is atrial septal defect?

Answer 17

Abnormal opening between the atria that causes an increased flow of oxygenated blood into the right side of the heart leading to increased pulmonary blood flow.

Treated during cardiac catheterization and open repair with cardiopulmonary bypass

Question 18

What is ventricular septal defect?

Answer 18

The abnormal opening between the right and left ventricle. A characteristic murmur is present leading to increased pulmonary flow.

Treatment is during cardiac catheterization and open repair may be done with cardiopulmonary bypass.

Question 19

Patent ductus arteriosus

Answer 19

The failure of the fetal ductus arteriosus to close within the first weeks of life leading to increased pulmonary blood flow.

Treatment includes administration of indomethacin, prostaglandin inhibitor to close the patent ductus. Defect may also be closed during cardiac catheterization or surgical management.

Question 20

What is coarctation of the aorta?

Answer 20

Localized narrowing near the insertion of the ductus arteriosus.

Blood pressure is higher in the upper extremities than the lower extremities; bounding pulse in the arms, weak or absent femoral pulses and cool lower extremities may be present.

Management includes balloon angioplasty or surgical management consisting of resection of coarcted portion

Question 21

Tetralogy of Fallot

Answer 21

A combination of four defects:
* Ventricular septal defect
* Pulmonary stenosis
* Overriding aorta
* Right ventricular hypertrophy

Question 22

What is hypercyanotic spells?

Answer 22

Acute episodes of cyanosis and hypoxia (hypercyanotic spells), called blue spells or tet spells, occur when the infant’s oxygen requirementsexceed the blood supply, such as during periods of crying, feeding, or defecating

Question 23

Nursing management of Tet spells

Answer 23

1. Place infant in knee-chest position
2. Use a calm, comfort approach
3. Administer morphine subcutaneously or through an existing IV line
4. Administration of IV fluid replacement and volume expansion if needed.
5. Administration of prostaglandin E1 to reestablish pulmonary blood flow.

Question 24

What is infective endocarditis?

Answer 24

Infection of the inner lining of the heart (endocardium) generally involving the valves

Therapeutic management includes administration of prophylactic antibiotic therapy to high-risk patients before dental procedures. Drugs of choice include amoxicillin in penicillin allergic patients administered 1 hour before the procedure.

Question 25

What is rheumatic fever?

Answer 25

Inflammatory autoimmune disease that occurs after group a beta hemolytic streptococcal pharyngitis.

Affects connective tissues of the heart, joints, blood vessels and central nervous system.

Mostly occurs in late school age children and adolescents.

Question 26

Clinical manifestations of rheumatic fever

Answer 26

• Carditis - tachycardia, cardiomegaly, muffled heart sounds, chest pain, pericardial friction rub, prolonged PR interval
• Polyarthritis - swollen, hot, red, painful joint(s)
• Chorea - speech disturbances, emotional lability, muscle weakness, involuntary movements
• Erythema marginatum - erythematous macules with clear center and wavy, well-demarcated border
• Subcutaneous nodules - in

Question 27

What test finding is used to diagnosed rheumatic fever?

Answer 27

Elevated antistreptolysin O titer

Question 28

Treatment of rheumatic fever

Answer 28

• Eradication of hemolytic streptococci with penicillin

*Reduce fever and discomfort with analgesics

*Salicylates to control inflammatory process

• Prevention of recurrence with monthly IM benzathine penicillin G

Question 28

What is Kawasaki disease?

Answer 28

Acute systemic vasculitis of unknown cause, occurs in children under 5

Question 28

Wha is the diagnostic criteria for kawasaki disease?

Answer 28

• Acute phase - edematous, swollen palms and soles of feet and subacute phase - peeling of hands and feet
• Conjunctivitis in both eyes without exudate
• Red, ‘strawberry tongue’ (large papillae exposed)
• Polymorphous rash
• Cervical lymphadenopathy

Question 29

Treatment of kawasaki disease

Answer 29

• High dose IV gamma globulin infusion of 2g/kg over 10 - 20 minutes
• Aspirin given initially in an inflammatory dose (80 -100 mg/kg/day) every 6 hours to control fever and inflammation