Care Of A Child With Cardiovascular Alterations Flashcards
1
Q
Infant CPR
Single Rescuer….
2 Rescuers…
Limit interruptions to….
Rate…
A
Single
Depth: 1.5”
Two fingers trust in center just below nipples, encircled thumbs, or heel of hand.
Ratio: 30 : 2 breaths
2 rescuers
Depth 1.5”
2 encircled thumbs
Ratio 15:2
Limit interruptions to <10 sec
100 - 120 min
2
Q
Child CPR
Single Rescuer…
Double Rescuer…
A
Single:
Depth 2”
Heel of 1 or 2 hands
30:2
Double (Same except)
15:2 ratio
3
Q
Adult for CPR sakes is condsider3d….
A
Puberty or 8 yrs which ever is greater
4
Q
<7 yrs heart lies more horizontal
1 - 6 yrs heart is ____ x birth size
6 - 12 yrs heart is _____ x birth size
Infants depend on serum calcium
A
1 - 6 = 4x
6 - 12 = 10x
5
Q
HR is faster in infancy…. BPM
BP is lower…. BP
A
HR 90 - 160 BMP
BP 80 - 55 mmHg
6
Q
Innocent murmurs & Splitting of S2 heart sound level of concner…
A
None. Normal finding
7
Q
List normal physical assessment in order…
A
Inspection
Auscultation
Palpation
Percussion
8
Q
Normal Po2 in children…
A
80 - 100
9
Q
Name diagnostic procedure
Contrast solution
Radiography
Visualize blood flow
A
Arteriogram
10
Q
Name diagnostic procedure
Non-invasive US
Visualize heart structures
A
Echocardiogram
11
Q
Name diagnostic procedure
Definitive study
Highly invasive
Usually outpatient
Diagnosis, interventional, or electrophysiologic
A
Cardiac Catheterization
12
Q
Name diagnostic procedure
Can determine size & structure changes
Serves as baseline
A
Chest Radiograph & Cardiac MRI
13
Q
Name diagnostic procedure
Cardiac electrical activity
Can determine post-op complications
A
Electrocardiogram
14
Q
Name diagnostic procedure
Monitor changes to VS
Rest & exercise
A
Exercise stress test
15
Q
Cardiac Catheterization
A ______ inserted into blood vessel and guided to the heart with aid of Fluoroscopy.
Procedure time ______
Right sided threaded to this structure_____ via this vein ______
Left sided threaded to this structure _____ via _______
A
A Radiopaque Catheter inserted into blood vessel and guided to the heart with aid of Fluoroscopy.
Usually last 1- 3 hrs
Right sided threaded to this structure Right Atrium via this vein femoral
Left sided threaded to Aorta via Artery
16
Q
Pre/Post cardiac Catheterization
Pre
NPO…
Consent
Involve this specialist….
Post
This posistion…
No baths for how long…
A
Pre
NPO 4 - 6 Hrs
Child life specialist
Post
Lay straight 4 - 8 hrs
3 days no baths
17
Q
Congenital heart defects
Defects with increased pulmonary flow…(3)
A
Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus
18
Q
Congenital heart defects
Defects with decreased pulmonary flow and mixed Defect….(2)
A
Tetralogy of Fallot
Transposition of the great vessels
19
Q
Congenital heart defects
Defects obstructing systemic blood flow…(1)
A
Coarctation of the aorta
20
Q
Opening between the 2 ventricles
Left to right shunting
Risk for infective endocarditis
Size & Symptoms vary
A
Ventricular Septal Defects
21
Q
Ventricular Septal Defect
Small hole may not have any symptoms
Mod/large hole
Poor growth
Pulmonary HTN
Decreased exercise tolerance
Name 3 more….
Very large hole:
Eisenmenger Syndrome:
Increased Pulmonary vascular resistance, severe Pulmonary HTN & Right Ventricular hypertrophy
This type of shunting…
A
Heart failure
Pulmonary infection
Murmur
Right to left: Shunting leads to Cyanosis & Chronic Hypoxia
22
Q
Ventricular Septal Defect
Treatment
Most small holes close by 2 yrs
Surgical closure
Prognosis (2)….
A
Arrhythmias
Some require pacemakers
23
Q
Opening between the 2 atrium
Most are asymptomatic with spontaneous closure by 18 months
Corrective surgery if not closed by age 3
Increased blood volume to right atrium & lungs
A
Atrial septal defect
24
Q
Atrial Septal Defects
Clinical Manifestions
Small / Mod: Asymptomatic
Large Defect:
Easy tiring
Murmur
2 more findings….
A
Heart failure
Poor growth: Failure to thrive
25
Atrial Septal Defect
Small defects usually close Spontaneously
Mod large / large require Surgical Repair
Cardiac Catheterization
_____ therapy 6 months post procedure
Open heart surgery
What Lifelong problem may develop post opp...
Aspirin therapy 6 months postop
Atrial arrhythmias may develop post opp from open heart surgery
26
Persistent opening between the aorta and the pulmonary artery.
Normal in fetal circulation but should close shortly after birth.
Causes left-to-right shunting of blood.
Continuous "machinery-like" murmur (best heard at left upper sternal border)
Bounding pulses and wide pulse pressure
Tachypnea or difficulty breathing
Poor feeding or failure to thrive
In severe cases: heart failure or pulmonary hypertension
Patent Ductus Arteriosus
27
2nd common most cardiac defect
Connection present between Aorta & Pulmonary Artery
Risk: Preterm & Born at high altitude
Increased workload on leftside of heart & increase Pulmonary Pressure --> Right Ventricular hypertrophy
Findings: Bounding peripheral pulses, Diastolic BP low, harsh continuous murmur
Patent Ductus Arteriosus
28
Which medication stimulates closure in Patent Ductus Arteriosus ....
Indomethacin
29
Pulmonary Stenosis
Ventricular Septal Defect
Overriding aorta
Right ventricle hypertrophy
Decrease blood flow to the lungs resulting in Cyanosis
Name problem...
Tetralogy of Fallot
30
Tetralogy of Fallot
Causes decreased blood flow to the lungs resulting in Cyanosis
Name the 4 defects that cause this problem...
Pulmonary Stenosis
Ventricular Septal Defect
Overriding aorta
Right ventricle hypertrophy
31
A Tet Spell (Tetralogy of Fallot) may be brought on by feeding, crying, stooling, and resulting in severe hypoxia / Cyanosis.
Nursing interventions... (6)
KNEE TO CHEST POSISTION
O2
IV FLUIDS
CALM
Morphine Sulfate 0.1mg/kg
Propranolol 0.1mg/kg
32
Blow by oxygen uses 100% oxygen that is held 2 -3 cm from infants nose/mouth.
What is the oxygen flow rate...
10 - 15L/min
33
Aorta arises from right ventricle
Pulmonary artery rises from left ventricle
Corrective surgery needed within days of life
Cyanosis, Tachypnea, fatigue, growth failure
Describes....
Transposition of great vessels
34
Transportation of great vessels
Describe posistion of Aorta & Pulmonary Artery....
Aorta arises from Right Ventricle
Pulmonary Artery from Left Ventricle
35
TGV
Aorta from right ventricle
Pulmonary artery from left ventricle
Why is Prostaglandins E1 given....
2 meds given to reduce work load on the heart...
2 surgeries...
Keep Ductus Arteriosus open. Allowing Unoxygenated & Oxygenated blood to mix.
Diuretics & Digoxin
2 surgeries
Palliative-balloon atrial septostomy
(Temporary)
Corrective arterial switch
(Permanent)
36
Performed in a cardiac catheterization lab.
A catheter with a balloon on the tip is inserted via a vein (usually femoral).
Guided into the right atrium → through the foramen ovale → left atrium.
The balloon is inflated and pulled back forcefully into the right atrium to tear/enlarge the septum.
Describes which surgery...
Treats...
Palliative-balloon atrial Sepostomy
37
Narrowed area of the aorta
"Obstructive defect"
Severity depends on degree of narrowing
Upper extremities: Bounding Pulse / Higher BP
Lower extremities: Weak / absent pulse/ lower BP
Risk for CVA, Aortic rupture, aneurysms
New borns Cyanosis lower extremities, HF, Shock
Older children: C/O leg pain with activity, dizziness, fainting, HA
Coarctation of the Aorta
38
Coarctation means...
Narrowing
39
Coarctation of the Aorta
In symptomatic new borns
_____ is given to reopen Ductus Arteriosus and promote blood flow to kidneys and lower extremities.
Balloon dilation with/without stent placement via Cardiac Catheterization
Surgical resection of narrowed portion followed by end-to-end reanastomosis.... describe
Prostaglandins E1
end-to-end reanastomosis
Cutting out disease part and reattaching "good ends"
40
Infective endocarditis is associated with these 2 problems....
Acute rheumatic fever
Kawasaki disease
41
Infections: Rheumatic fever, Kawasaki Disease, endocarditis
Obesity
Drug / alcohol exposure
HTN
Chemo
Connective tissue disorder, autoimmune, endocrine disease
Organ transplant
Hyperlipidemia
Are all risk factors for...
Acquired Cardiac Disorder
42
Increased right sided pressure of heart.
Hepatic congestion
Venous return congestion
Type of dysfunction....
Diastolic dysfunction
43
Increased left sided pressure
Pulmonary congestion
SS
Respiratory distress
Cough
Rales
Trouble feeding
Dyspnea with activity
Wheeze
Cough
This type of Dysfunction....
Systolic dysfunction
44
Activation of the RAAS system...
Sympathetic stimulation
SS
Palor
Tachycardia
Sweating
Edema
Weight Gain
HTN
This type of heart failure...
Neurohormonal
45
________ Congestion
Location: Lungs
Cause: Typically due to left-sided heart failure
Mechanism: The left ventricle fails to pump blood effectively → blood backs up into the pulmonary veins → increases pressure in the lungs → fluid leaks into alveoli
Pulmonary
46
Signs/Symptoms:
Shortness of breath (dyspnea)
Crackles (rales) on lung auscultation
Orthopnea (difficulty breathing lying flat)
Paroxysmal nocturnal dyspnea (waking up gasping for air)
Cough with frothy sputum
______ sided congestion....
Left
47
Feeding guidelines for infants with HF
Smaller volumes of Specialty concentrated formula..... (cal / oz)...
Feeding how often....
Limit Feeding time to.....
If not able to finish Feeding Gavage remaining
Cluster care allow for periods of rest
Gavage Feeding if RR >.....
24-27 cal/oz
Q3H feeding
30 minute feeding time
RR >60 Gavage feeding
48
Alprostadil (Prostaglandin)
Which affect does it have...
Maintains open (patent) Ductus Arteriosus
Vasodilates ductus Arteriosus smooth muscle
49
Increases contractility
Used with heart failure & arrhythmias
This med...
Digoxin
50
When to give Digoxin...
Empty stomach
51
Hold Digoxin
Adult apical HR....
Infant HR....
SS of toxicity....
Adult <60
Infant <90
N/V/D & Bradycardia
52
Inhibits resorption of Na & Cl
Manage edema in HF
Give with food
PHOTOSENSITIVITY
Monitor BP, Kidney Function, & electrolyte
Furosemide
53
When to give Indomethacin....
Monitor for.
For closure of patent Ductus Arteriosus.
- inhibits prostaglandin synthesis-
Monitor for
EDEMA
INFECTION
54
Penicillin VK this route...
Penicillin G this route...
Penicillin VK - PO empty stomach
Penicillin G - IM
55
Penicillin V potassium &
Penicillin G benzathine
Both have this indication....
How do they work...
Prophylaxis for Endocarditis & Rheumatic Fever
Inhibits cell wall synthesis
56
Hydralazine
Vasodilator
Used for:
HF
Moderate/severe HTN
Nursing implications:
Monitor HR & BP
Contraindicated in....
Rheumatic valve disease
57
Risk for endocarditis
Infection of inner lining of heart, often involves heart valves
Prosthetic heart valves
Congenital Heart defects
History of endocarditis
Damaged Valves - Rheumatic fever
Dental procedures
IV drugs / Central Lines
58
Diagnostic of Endocarditis:
Blood Culture/ Echocardiogram
Physical findings:
Roth spots....
Janeway lesions...
Osler nodes....
Splinter hemorrhage...
Non-painful Erythematous macules on palms of hands and soles of feet
Retinal hemorrhage with pale center
Linear red/brown streaks in nail beds that are associated with tiny blood clots that damage the capillaries
Painful, Erythematous nodules on tips of fingers and toes.
Roth spots:
Retinal hemorrhage with pale center
Janeway lesions:
Non-painful Erythematous macules on palms of hands and soles of feet
Osler nodes:
Painful, Erythematous nodules on tips of fingers and toes.
Splinter hemorrhage:
Linear red/brown streaks in nail beds that are associated with tiny blood clots that damage the capillaries
59
Name 4 physical findings associated with Infective endocarditis...
Roth spots:
Retinal hemorrhage with pale center
Janeway lesions:
Non-painful Erythematous macules on palms of hands and soles of feet
Osler nodes:
Painful, Erythematous nodules on tips of fingers and toes.
Splinter hemorrhage:
Linear red/brown streaks in nail beds that are associated with tiny blood clots that damage the capillaries
60
Can a pt with IV antibiotics/antifungal go home with their IV....
Yes, it can take 4 - 6 weeks of treatment
61
Most common in 5 - 15 yrs old
Happens after a Group A strp throat infection.
Antibody reaction to antigens in Cardiac, Neuronal, and Synovial
Presents:
High fever
Malaise
Fatigue
Erythema marginatum
Subcutaneous nodules
Migratory polyarthritis
1-8 months after infection:
Sydenham chorea
Jerking/flinching
Valvulitis - inflammation of valves
Pancarditis - Inflammation of 3 layers of the heart
All associated with...
Acute Rheumatic Fever
62
Acute Rheumatic Fever
SS
Constitutional....
Skin....
Joints....
CNS....
Heart...
High fever
Malaise
Fatigue
Erythema marginatum
Subcutaneous nodules
Migratory polyarthritis
1-8 months after infection:
Sydenham chorea
Jerking/flinching
Valvulitis - inflammation of valves
Pancarditis - Inflammation of 3 layers of the heart
63
Diagnosis of Rheumatic Fever (2)
Throat culture / Group A Beta-Hemolytic Streptococcus
Or
Elevated anti-streptolysin O titers
Modified Jones Criteria
2 major or 1 major / 1 minor
64
Modified Jones Criteria is used to diagnose....
Explain...
Rheumatic fever
2 major or 1 major / 1 minor
J– Joints: Migratory polyarthritis (large joints – knees, ankles, elbows)
O – (Heart): Carditis (can be pancarditis: endo-, myo-, and pericarditis)
N – Nodules: Subcutaneous nodules (painless, firm, over bony prominences)
E – Erythema marginatum: Rash with pink rings, often on the trunk and limbs
S – Sydenham chorea: Involuntary, jerky movements, emotional instability
65
J– Joints: Migratory polyarthritis (large joints – knees, ankles, elbows)
O – (Heart): Carditis (can be pancarditis: endo-, myo-, and pericarditis)
N – Nodules: Subcutaneous nodules (painless, firm, over bony prominences)
E – Erythema marginatum: Rash with pink rings, often on the trunk and limbs
S – Sydenham chorea: Involuntary, jerky movements, emotional instability
Is used to diagnose...
Rheumatic Fever
66
Pharmaceutical for Rheumatic Fever
Antibiotics: Which type...
Anti-inflammatory (2)...
Prophylactic therapy to prevent reoccurrence...(Length of time)
ARF w/o carditis....
ARF with carditis...
RHD (Rheumatic Heart Disease)....
Eradicate Group A Strep Infection
Even if throat cultures are negative, treat presumptively.
First-line:
Penicillin V (oral): 250 mg 2–3 times/day for 10 days
Benzathine penicillin G (IM): Single dose
Children: 600,000 units (<27 kg)
Adolescents/adults: 1.2 million units
Penicillin allergy:
Azithromycin, Clarithromycin, or Clindamycin
Anti-inflammatory Therapy
For arthritis and carditis symptoms:
Mild to moderate symptoms:
Aspirin: 60–100 mg/kg/day (in divided doses)
Watch for signs of salicylate toxicity
Taper once symptoms improve and CRP/ESR normalize
Severe carditis or heart failure:
Prednisone: 1–2 mg/kg/day
Gradually tapered over 2–3 weeks
Follow with aspirin during the taper
Prophylactic therapy to prevent reoccurrence:
No carditis: 5 years or until age 21 (whichever is longer)
Carditis, no valve disease: 10 years or until age 21
Carditis + valve disease: 10 years or until age 40 (or lifelong)
67
Acute Rheumatic Fever Meds:
Penicillin G (im or IV)
Penicillin V (Oral)
Therapeutic effect: bacterialcidal
Monitor for signs of C diff..
Monitor IV site for...
Erythromycin ethylsuccinate:
Therapeutic effect: bacteriostatic
Monitor bowels & SS of C diff
C diff: diarrhea, bloody, ab pain, fever
Phlebitis
68
Generalized systemic vasculitis
Diffuse red rash
Edema hands & feet
Peeling of skin grion,hands,feet
Strawberry tongue
Cervical lymphadenopathy
Which disease...
Which labs are elevated...
Kawasaki
Elevated labs
C-reactive protein (CRP):
Significantly elevated (often >3 mg/dL)
A marker of systemic inflammation
Erythrocyte sedimentation rate (ESR):
Elevated (usually >40 mm/hr)
Another marker of inflammation
White blood cell count (WBC):
Leukocytosis (elevated WBC count) typically in the range of 15,000–30,000 cells/mm³
Often includes an elevated neutrophil count
Platelet count:
Thrombocytosis (increased platelets) is common in the second week of the illness, often >450,000/μL
Can be a sign of ongoing inflammation
Liver enzymes (AST, ALT):
Mild elevations in liver enzymes (AST, ALT) can be seen due to inflammation.
Albumin:
Low albumin levels (hypoalbuminemia) can occur due to inflammation.
Urine analysis:
Mild proteinuria or sterile pyuria (presence of white blood cells without infection) may be seen.
Other markers:
BNP (B-type natriuretic peptide): May be elevated in cases with cardiac involvement.
Immunoglobulins (IgA, IgG): Elevated levels may be seen during the acute phase.
69
Acute
Fever
Conjuctival hyperemia (red eyes)
Red throat
Swollen hands
Rash
Enlarged cervical lymph nodes
Subacute
Cracked lips
Fissures
Desquamation of fingers & toes
Joint pain
Thrombocytosis
Cardiac Manifestions
Disease and treatment....
Kawasaki
High doses aspirin 80 - 100 mg / kg / day until fever gone
Low-dose aspirin after fever gone: 3 - 5 mg/kg/day
IVIG administration
NO ANTIBIOTICS
Monitor cardiac status
70
What will usually preced a heart emergency in peds.. .
Respiratory issue.
PEWS
71
Check this pulse for a max of 10 secs
Infant 0 - 12 months.....
Child 1 - 8 yrs....
Infant brachial
Child/ adult Carotid
72
Rescue breaths
Infant 0 - 12 months...
Child/adult....
Infant 1 breath / 3 secs
Child/adult 1 breath / 6 secs
73
Activate emergency services first, then start CPR.
Start CPR first (if necessary), then activate emergency services after 2 minutes of CPR.
Which is witnessed/ unwittnessed unresponsive child....
Witnessed Collapse: Activate emergency services first, then start CPR.
Unwitnessed Collapse: Start CPR first (if necessary), then activate emergency services after 2 minutes of CPR.
74
Supplemental oxygen can worsen the hypoxia in conditions with right-to-left shunting because it may increase the flow of poorly oxygenated blood through the shunt, decreasing overall oxygen delivery to tissues.
Name 2 heart issues that have R - L Shunting...
Tetralogy of Fallot
Transposition of the great vessels
75
Order for Right Chest Tube to 20cm suction.
Which gauge do you use for measure 20 cm...
On the Chest Tube / Wall suction
Small gauge on Chest tube will display suction
Set the wall to like 80...
76
Arteriogram uses contrast solution to visualize blood flow.
What else can it do?
Remove plaques
77
Pressure dressings are used post op for this procedure...
Cardiac Catheterization
78
Hallow systolic murmur is heard in...
VSD
The most common CHD
Risk for infective endocarditis
79
ASD
If large hole doesn't close on its own may need surgery.
Post op medication...
Possible lifelong complication...
Aspirin 6 months post op
Life long arrhythmias possible
80
Bounding peripheral pulses
Diastolic BP low
Harsh continuous murmur
Found in...
PDA
81
1st signs of TOF...
Cyanosis & Murmur
82
Polycythemia
Hypercyanosis
Metabolic acidosis
Poor growth
Clubbing
Are associated with...
TOF
83
Respiratory Acidosis
Oxygen won't help
Goal: OX >75%
At birth: Cyanosis & No Murmur
Problem...
TGV
84
Give which life saving medications to new born with TGV...
Prostaglandins: Keep Ductus Arteriosus open
Diuretics & Digoxin
85
Palliative-balloon atrial septostomy involves putting a cather tiped balloon from one side of the atrium to the other - Goal is to enlarge hole in Septal wall.
Used woth this problem...
TGV
86
Coarctation of the Aorta may require Prostaglandins to keep Ductus Arteriosus open...
True
87
Nursing implications for Alprostadil....
10 - 20% become apneic
88
Indomethacin
Nursing Considerations...
Monitor for edema
May mask infection
89
Give penicillin V with a meal...
False
Empty stomach
90
Generalized systemic vasculitis
Diffuse erythematous rash
Edema hands / feet
Peeling of skin perineal, hands, feet
Strawberry tongue
Cervical lymphadenopathy
Problem...
Kawasaki
Caused by possible previous viral illness
91
Kawasaki disease phases
Fever
Conjuntival redness
Red throat
Swollen hands
Rash
Enlarge cervical lymph nodes
Acute
92
Kawasaki disease phases
Cracked lips
Fissures
Desquamation of hands / feet
Joint pain
Thrombocytosis
Cardiac manifestions
Subacute 2 - 4th weeks
93
Sweeling of hands & feet
Abrupt high grade fever
Hyperemic conjunctive
Changes in Oral Muscoa
Extremities changes
Polymorphous rash
Cervical lymphadenopathy
5 out of 6 is diagnos for...
Kawasaki disease
94
Treatment for kawasaki disease...(2)
High doses aspirin 80 - 100mg /kg/ day until fever is gone
Low dose flows: 3 - 5 mg/kg/day
IVIG administration
NO ANTIBIOTICS
95
