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NCLEX: Pediatric > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

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1
Q

An invasive procedure that can be used to diagnose a congenital heart defect and repair certain heart defects by inserting a catheter into the femoral artery and threading it up to the heart

A

Cardiac catheterization

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2
Q

Cardiac Catheterization pre-op nursing care

A

NPO for 6-8 hrs, assess for allergies to iodine or shellfish, assess kidney function (BUN, creatinine), assess and mark distal pulses

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3
Q

Cardiac catheterization post-op nursing care

A

Check insertion site for bleeding, check extremity distal from insertion site to ensure adequate circulation (pulses, cap refill, color, temp), increase fluid intake to flush contrast dye, position patient in supine position with affected extremity straight for 4-6 hours**

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4
Q

Anatomic abnormality of the heart that causes altered blood flow

A

Congenital heart defect

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5
Q

Risk factors for increased risk of CHD

A

Exposure to teratogen during pregnancy, maternal smoking and alcohol use, maternal medical conditions such as diabetes

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6
Q

S/S of CHD

A

Depends on defect present. However, many of the defects cause: HF, hypoxemia, murmurs

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7
Q

CHD nursing care

A

Provide frequent rest periods and small, frequent meals, provide O2 and high calorie formula as ordered by provider

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8
Q

CHDs that increase pulmonary blood flow

A

Atrial septal defect (ASD), ventricular septal defect (VSD), AV canal defect, patent ductus arteriosus (PDA)

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9
Q

CHD characterized by a hole in the septum that separates the left and right atria

A

Atrial septal defect (ASD)

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10
Q

S/S of ASD

A

May be asymptomatic, but can cause S/S of HF and murmur

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11
Q

A systolic murmur with a wide fix splitting of S2 may be present with what CHD?

A

ASD

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12
Q

ASD treatment

A

Closure of hole through cardiac cath or surgical patch

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13
Q

Hole in the septum between the left and right ventricles

A

Ventricular septal defect (VSD)

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14
Q

S/S of VSD

A

S/S of HF, murmur

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15
Q

A loud systolic murmur at the left sternal boarder is present with which CHD?

A

VSD

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16
Q

Treatment for VSD

A

Surgery to suture or patch the hole

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17
Q

A hole in the center of the heart that allows blood to flow between all four chambers; instead of a mitral and tricuspid valve, there is a single AV valve

A

Atrioventricular (AV) canal

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18
Q

S/S of AV canal

A

S/S of HF, loud systolic murmur

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19
Q

Treatment of AV canal

A

Surgical patch closure and valve reconstruction

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20
Q

CHD in which the fetal artery that connects the aorta and the pulmonary artery fails to close after birth

A

Patent ductus arteriosus (PDA)

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21
Q

S/S of PDA

A

Machine-hum murmur, bounding pulses, wide pulse pressure

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22
Q

PDA treatment

A

Indomethacin, coils to occlude PDA during cardiac catheterization

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23
Q

CHDs that result in decreased pulmonary blood flow

A

Tetrology of fallot, tricuspid atresia

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24
Q

CHD that is a combination of four different defects PROV: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect

A

Tetrology of fallot (TOF)

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25
Q

S/S of TOF

A

Cyanosis, hypercyanotic “tet” spells, systolic murmur

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26
Q

Intervention for tet spells

A

Place child in knee-chest position to increase blood flow to lungs

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27
Q

PDA treatment

A

Surgical repair within first year of life

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28
Q

CHD in which the tricuspid valve fails to develop

A

Tricuspid atresia

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29
Q

S/S of tricuspid atresia

A

Cyanosis, tachycardia, dyspnea, clubbing

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30
Q

Treatment for tricuspid atresia

A

Multiple surgeries including shunt placement, glen procedure, fontan procedure

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31
Q

Congenital heart defects that cause obstructed heart flow

A

Coartation of the aorta, aortic stenosis, and pulmonary stenosis

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32
Q

Narrowing of the aorta that occurs after blood is supplied to the upper extremities, but blood flow to the lower extremities is impaired

A

Coarctation of the aorta

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33
Q

S/S of coarctation of the aorta

A

Upper extremity HTN and bounding pulses, poor lower extremity perfusion causing weak pulses, cool skin, and pallor

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34
Q

Coarctation of the aorta treatment

A

Balloon angioplasty and stent placement, surgical removal of narrowed section of aorta, Antihypertensives

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35
Q

Narrowing of the aortic valve that decreases blood flow to the whole body

A

Aortic stenosis

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36
Q

S/S of aortic stenosis

A

Hypotension, decreased pulses, tachycardia, poor feeding, exercise intolerance

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37
Q

Aortic stenosis treatment

A

Balloon dilation or valvotomy

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38
Q

narrowing of the pulmonary valve which obstructs blood flow to the lungs

A

Pulmonary stenosis

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39
Q

S/S of pulmonary stenosis

A

Systolic ejection murmur**, cyanosis, cardiomegaly, HF

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40
Q

Pulmonary stenosis treatment

A

Balloon dilation of valvotomy

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41
Q

Congenital heart defects that result in mixed blood flow

A

Transposition of the great arteries (TGA), total anomolous pulmonary venous connection, truncus arteriosis, hypoplastic left heart syndrome

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42
Q

Congenital heart defect in which the aorta and pulmonary artery connections to the heart are reversed resulting in PDA or septal defect

A

Transposition of the great arteries (TGA)

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43
Q

S/S of TGA

A

HF, SOB, cardiomegaly, cyanosis, hypoxia, murmurs, fatigue, poor growth

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44
Q

TGA treatment

A

Prostaglandins to keep PDA open, surgery within 1st week of life to reverse connections and correct defect

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45
Q

Congenital heart defect in which the pulmonary veins are connected to the right side of the heart instead of the left atrium resulting in oxygenated blood being pumped right back into lungs; this defect requires ASD in order for patient to survive

A

Total anomalous pulmonary venous connection (TAPVC)

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46
Q

S/S of TAPVC

A

Cyanosis, dyspnea, poor feeding

47
Q

TAPVC treatment

A

Surgical repair to connect pulmonary veins to left atrium

48
Q

Congenital heart defect in which there is a single vessel or trunk rather than a separate pulmonary artery and aorta. Patient will also have VSD causing mixing of blood.

A

Truncus arteriosis

49
Q

S/S of truncus arteriosus

A

HF, murmurs, cyanosis, poor feeding

50
Q

Truncus arteriosis treatment

A

Surgical repair within first few months of life

51
Q

Congenital heart defect in which the left side of heart and associated structures are underdeveloped resulting in PDA and ASD

A

Hypoplastic left heart syndrome

52
Q

S/S of hypoplastic left heart syndrome

A

Cyanosis, HF, cold extremities, lethargy

53
Q

Hypoplastic left heart syndrome treatment

A

Prostaglandins to keep PDA open until surgery. Surgery done in three different stages (Norwood procedure, Glenn shunt, fontan procedure)

54
Q

General S/S of HF

A

Poor feeding, tachycardia, activity intolerance, pallor, weak pulses, cardiomegaly

55
Q

S/S of L sided HF

A

Tachypnea, dyspnea, nasal flaring, retractions, wheezing

56
Q

S/S of R sided HF

A

Peripheral edema, ascites, hepatomegaly, JVD

57
Q

Labs associated with HF

A

Elevated hBNP

58
Q

HF treatment

A

Digoxin, diuretics (furosemide), beta blockers, ACE inhibitors

59
Q

HF nursing care

A

Ensure child is upright when feeding, use a nipple with enlarged opening (decreases energy used while feeding), provide high-calorie formula, provide frequent rest periods, take pulse before administration of digoxin (Hold if below 90 bpm for infant, hold if below 70 bpm for older children)***, monitor for S/S of digoxin toxicity (N/V, bradycardia, dysrhythmias), closely monitor serum digoxin levels (therapeutic range between 0.8-2)

60
Q

S/S of hypoxemia

A

Cyanosis, tachypnea, dyspnea, clubbing, polycythemia (elevated RBC production)

61
Q

Hypoxemia treatment

A

O2, morphine, IV fluids, knee-chest position for cyanotic episodes to improve blood flow to lungs

62
Q

Infection of the inner layer of the heart

A

Infective endocarditis (IE)

63
Q

S/S of IE

A

Fever, malaise and lethargy, loss of appetite, splinter hemorrhages**, petechiae, murmur, muscle and joint pain

64
Q

Labs associated with IE

A

Elevated ESR and CRP

65
Q

IE treatment

A

IV antibiotic therapy via PICC line over 2-6 weeks, valve repair or replacement if IE resulted in valve damage

66
Q

IE family teaching

A

Prophylactic antibiotics will be needed prior to dental work or invasive procedure/surgery

67
Q

Inflammatory disorder of the heart, blood vessels, and joints

A

Rheumatic fever

68
Q

Rheumatic fever key risk factor

A

Partially treated or untreated strep throat infection

69
Q

Labs associated with rheumatic fever

A

(+) GABHS, (+) ASO titer, elevated ESR and CRP

70
Q

Diagnosis of rheumatic fever

A

Jones criteria; diagnosis requires two major criteria present OR one major and two minor criteria present

71
Q

Jones major criteria for diagnosis of rheumatic fever

A
  1. Carditis (inflammation of heart — can lead to murmurs, pericardial friction rub, cardiomegaly, arrythmias, and CHF), polyarthritis (painful swelling of joint), 2. erythema marginatum (non-pruritic rash on the trunk and limbs), 3. chorea (involuntary muscle movements, 4. non-tender subcutaneous nodules
72
Q

Jones minor criteria for diagnosis of rheumatic fever

A

Fever, arthralgia (joint pain), elevated ESR or CRP, prolonged PR interval

73
Q

Rheumatic fever treatment

A

Long-term penicillin administration, bed rest

74
Q

The systemic inflammation of the blood vessels in the body (vasculitis)

A

Kawasaki disease

75
Q

What are the three phases of Kawasaki disease?

A

Acute, subacute, and convalescent phase

76
Q

S/S during the acute phase of Kawasaki disease

A

High fever (over 102 F) lasting for 1-2 weeks and will be unresponsive to antipyretics, various areas of erythema on body (eyes, chapped and cracked lips, oral mucosal membrane, palms and soles), arthritis, enlarged cervical or neck lymph nodes, cardiac symptoms such as dysrhythmias and myocarditis

77
Q

S/S of subacute phase of Kawasaki disease

A

Fever resolves but patient has arthritis, peeling skin around nails, palms, or soles.

78
Q

S/S during convalescent phase of Kawasaki disease

A

No clinical manifestations, but abnormal labs may be present

79
Q

Abnormal labs associated with Kawasaki disease

A

Elevated CPR and ESR, decreased albumin levels

80
Q

Criteria for diagnosis of Kawasaki disease

A

Fever for over five days and four of the five symptoms including: conjunctivitis, rash, extremity changes (redness of hands and feet, peeling skin), adenopathy (enlarged lymph nodes), mucosal changes (red cracked lips, red mucus membranes, strawberry tongue) — hint: remember CREAM

81
Q

Kawasaki disease treatment

A

IV immunoglobulin, high dose aspirin

82
Q

Kawasaki disease nursing care

A

Monitor cardiac function (d/t carditis), monitor daily weights and I&Os, educate family that live immunizations should NOT be administered to child for 11 months (varicella, MMR)

83
Q

Disorder characterized by decreased hemoglobin due to insufficient intake of iron or some kind of malabsorption syndrome that results in decreased absorption of iron

A

Iron deficiency anemia

84
Q

Key risk factor for iron deficiency anemia in children

A

Excess intake of cows milk

85
Q

S/S of iron deficiency anemia

A

Fatigue, pallor, SOB, tachycardia

86
Q

Labs associated with iron deficiency anemia

A

Decreased Hgb, Hct, RBCs, MCH, MCV, and ferritin

87
Q

Iron deficiency anemia treatment

A

Iron supplementation: iron sulfate (PO), iron dextran (IV or IM; use z-track method for IM administration to prevent leakage of med into subq tissue)

88
Q

Iron deficiency anemia family teaching

A

Increase child’s intake of iron-rich foods (green veggies, meat, raisins, iron fortified foods), vitamin C INCREASES absorption of iron while calcium DECREASES absorption of iron (take with iron supplements with OJ, but avoid taking them with milk)

89
Q

Family teaching for child who takes liquid iron

A

Use straw and brush teeth after to prevent staining of teeth; green or tarry-like stools are expected

90
Q

An autosomal recessive genetic disorder that results in chronic anemia, pain, infection, and organ damage

A

Sickle cell anemia

91
Q

Sickle cell anemia risk factors

A

Family hx, African American, middle eastern or Mediterranean descent

92
Q

S/S of sickle cell anemia

A

Pain, fatigue, swollen hands and feet, jaundice

93
Q

Sickle cell crises can be brought on by

A

Infection, stress, or dehydration

94
Q

Sickle cell crisis characterized by severe pain

A

Vaso-occlusive

95
Q

Treatment of vaso-occlusive sickle cell crisis

A

Around-the-clock opioid administration

96
Q

Sickle cell crisis that occurs when sickle cell blood vessels become trapped in the spleen which lead to enlargement of spleen and severe anemia

A

Splenic sequestration crisis

97
Q

Sickle cell crisis usually caused by a viral infection (fifth disease) in which bone marrow stops producing RBCs leading to severe anemia

A

Aplastic crisis

98
Q

Labs associated with sickle cell anemia

A

Decreased Hct
Increased reticulocytes, WBCs, and bilirubin

99
Q

T or F: all newborns are screened for sickle cell anemia

A

True

100
Q

Blood test that measures Hgb levels and assesses for abnormal types of Hgb

A

Hemoglobin electrophoresis

101
Q

Sickle cell anemia treatment

A

Pain management (opioids), antibiotics (infection), IV fluids, blood products, oxygen therapy, hydroxyurea (can reduce sickling of blood cells and prevent vaso-occlusive crisis)

102
Q

Sickle cell anemia family teaching

A

Encourage adequate fluid intake, prevent infection (hand hygiene, avoid crowds, stay up to date with vaccines), seek immediate medical attention if child has fever or S/S of infection

103
Q

Group of genetic disorders characterized by defective hemoglobin formation and anemia

A

Thalassemia

104
Q

S/S of thalassemia

A

Pallor, jaundice, decreased appetite and growth rates, enlarged liver and spleen, deformed facial bones

105
Q

Thalassemia treatment

A

Frequent blood transfusions, chelation therapy to decrease build-up of iron from blood transfusions

106
Q

X-linked recessive disorder that causes deficiency in clotting factors

A

Hemophilia

107
Q

Hemophilia ___ results in a deficiency of clotting factor 8 and hemophilia ___ results in a deficiency of clotting factor 9

A

A; B

108
Q

S/S of hemophilia

A

Excess bleeding and bruising, joint pain and swelling, decreased ROM

109
Q

Labs associated with hemophilia

A

Elevated aPTT, decreased factor 8 or 9; NOTE: platelet count and PT will NOT be affected

110
Q

Hemophilia treatment

A

Factor replacement

111
Q

Hemophilia family education

A

Prevent bleeding (no NSAIDs or aspirin, avoid IM injections), engage in PT to maintain ROM, NO contact sports, RICE acute bleeding (rest, ice, compression, elevation)

112
Q

Interventions for epistaxis (nose bleed)

A

Lean head forward, maintain pressure with thumb and finger on soft spot of nose for 10 minutes, apply ice pack to bridge of nose; packing with epinephrine or cauterization may be indicated for persistent bleeding

113
Q

Epistaxis family teaching

A

Keep nose lubricated and use cool mist humidifier in room, avoid blowing nose forcefully

NCLEX: Pediatric (11 decks)

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