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Peds - Spring 2016 > Care of the child with a cardiovascular disorder - Part 1 - Unit 4 > Flashcards

Care of the child with a cardiovascular disorder - Part 1 - Unit 4 Flashcards

1
Q

Left side is normally a lower pressure - T/F?

A

FALSE - it is normally higher pressure. It has to pump out to the rest of the body!

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2
Q

which part of the fetus requires the most oxygen?

A

head (brain!)

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3
Q

when the newborn infant takes his first breath, the result is (increased or decreased?) pulmonary blood flow and (increased or decreased?) pulmonary vascular resistance.

A

Increased.

Decreased.

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4
Q

O2 is the least potent vasodilator in the world. T/F?

A

FALSE - MOST potent.

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5
Q

before birth, which side of the heart has the higher pressures?

A

right

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6
Q

why is the systolic BP of the neonate low?

A

Decreased systemic vascular resistance!

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7
Q

increased pressure in the left atrium causes the foramen ovale to close. T/F/

A

TRUE

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8
Q

when does the ductus arteriosus (the one that connects the pulmonary trunk/aorta) close?

A

10-15 hours after birth.

PERMANENTLY by 10-21 days.

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9
Q

What causes the ductus arteriosus to constrict and close?

A

MORE O2! so, it can OPEN with hypoxia/stress/cold/etc.

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10
Q

kids - lower risk of heart failure than adults. T/F?

A

FALSE - higher risk, because kids are really sensitive to pressure changes.

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11
Q

cardiac cath - can be used for diagnosis and intervention. T/F/

A

True - a way to obtain pressure, open things/close things. etc.

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12
Q

Cardiac cath - thread through vein to get where? artery?

however, can you use a vein to get to the left side?

A 
Vein = right side of heart. 
Artery = left side of heart.

YES

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13
Q

are there risks to a cardiac cath?

A

YES - hemorrhage, infection, puncture problems, clotting issues, etc.

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14
Q

what should be monitored after a cardiac cath?

A

pulses (distal), temp/color, vitals, bleeding, may need to keep extremity straight, increased HR before BP falls (hemorrhage)

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15
Q

what is the cardiac output?

A

Measures heart’s efficiency - volume of blood pumped by the heart in one minute = = = = SV X HR = CO

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16
Q

In peds, the SV always changes - T/F?

A

FALSE - the SV does not change, the HR just rises and rises and rises - or falls falls falls.

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17
Q

A fast heart rate always increases the CO - T/F?

A

FALSE

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18
Q

Blood flows from areas of __ pressure to ___ pressure.

A

High to low..aka, the path of least resistance!

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19
Q

Normally, the resistance in the pulmonary circulation is ___ than the resistance in the systemic circulation.

A

LESS

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20
Q

The oxygen saturation of blood in the right atrium is normally ____ than the oxygen saturation in the left ventricle.

A

LOWER

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21
Q

What is CHF?

A

Congestive heart failure - a condition in which the heart cannot pump adequate amounts of oxygenated blood to meet the metabolic needs of the body. It’s a SYMPTOM that the heart is working too hard.

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22
Q

What are some changes caused by heart failure?

A

Volume overload, pressure overload, decreased contractility, high cardiac output demands, fluid overload, pneumonia, sepsis, defects, cardiomyopathy, etc.

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23
Q

What are the two types of heart failure?

A

right & left sided.

24
Q

What is right sided heart failure?

A

Right ventricle does not efficiently pump blood into the pulmonary artery, so RV pressure increases and the ride side of the heart becomes congested and backs up into the veins - leading to hepatomegaly and edema. RIGHT IS TIGHT!

25
Q

what is left sided heart failure?

A

LV does not efficiently pump blood into the circulation.
Increased pressure in the left atrium and pulmonary veins….leading to pulmonary edema!
Left is lungs!

26
Q

what are some causes of CHF in children?

A

Structural abnormalities, myocardial failure, excessive demands on the normal heart muscle

27
Q

What are some compensatory mechanisms of the heart?

A

Hypertrophy and dilation of cardiac muscle (more tension = more pressure), dilation increases stretch of the fibers, and then stimulation of sympathetic nervous system - catecholamines are released and they increase force and rate of contraction.

28
Q

stimulation of the sympathetic nervous system results in creased systemic vascular resistance - T/F?

A

FALSE - increase! So, BP goes up! Non vital organs don’t get blood flow!

29
Q

What are 3 major clinical assessment findings for CHF we will find?

A

Impaired myocardial function, pulmonary congestion, systemic vascular congestion.

30
Q

clinical manifestations for CHF - impaired myocardial function?

A

tachycardia, sweating, decreased urinary output, fatigue, anorexia, decreased interest in activities, cardiomegaly, pale cool extremities, decreased BP

31
Q

the nurse is listening to the heart sounds of a child with heart failure and hears a gallop rhythm (S3 & S4) - what is this due to?

A

Increased volume in heart, ventricular enlargement/dilation.

32
Q

clinical manifestations for CHF - pulmonary congestion?

A

tachycardia, dyspnea, cyanosis, exercise intolerance (eating issues for little kids?), orthopnea, persistent cough, wheezing/grunting.

33
Q

CHF kids - do we lay them flat?

A

NO - hold them, use a car seat…do NOT put them flat.

34
Q

clinical manifestations for CHF - systemic venous congestion?

A

weight gain (differentiate between fat & fluid!), hepatomegaly, edema, ascites, neck vein distention (hard to see on infant), slowed venous return.

35
Q

what are goals for treatment for CHF?

A

improve cardiac function (increase contractility - digoxin?), decrease afterload, remove accumulated fluid (less maintenance, diuretics), decrease cardiac demands, improve oxygenation (breathing more than 60 rpm? risk for aspiration!)

36
Q

CHF treatment - do all treatment at different hours. T/F?

A

FALSE - cluster care…let the kid rest.

37
Q

what are some meds to improve cardiac function?

A

digitalis glycosides, ACE inhibitors, Beta blockers

38
Q

what does a digitalis glycoside do?

A

Increases contraction force, decreases HR, increases renal perfusion (improves diuresis!)..

39
Q

Digoxin - very safe. T/F? When do we hold it?

A

FALSE - narrow margin of safety. So listen to HR for 1 full minute. Hold if HR

40
Q

what are signs of dig toxicity? What electrolyte imbalance increases risk for toxicity? What treats it?

A

Bradycardia, N/V, neurlogical/visual disturbances (yellow/green vision). Hypokalemia increases risk for toxicity…treated with digoxin immune fab.

41
Q

Decreased blood flow triggers the production of angiotensin 1 and 2 and causes vasoconstriction and increased secretion of aldosterone. T/F?

A

TRUE

42
Q

what do ace inhibitors do?

A

Prils - block conversion of angiotensin 1 to 2. Decreases pulmonary and systemic vascular resistance, decreases blood pressure as well as pressures in RA and LA. Decreases secretion of aldosterone.

43
Q

What do beta blockers do?

A

block alpha and beta adrenergic receptors. cause vasodilation, decrease HR/BP, antiarrhytmic effects. T/F?

44
Q

what is hypoxia? cyanosis?

A

Hypoxia - a reduction in tissue oxygenation.

Cyanosis - blue discoloration of mucus membranes, skin, and nail beds due to deoxygenated hgb.

45
Q

What are clinical manifestations of hypoxemia?

A

polycythemia (increased RBC), clubbing, possibly asymptomatic, severe = fatigue w/feeding, poor weight gain, tachypnea, dyspnea, squatting (kid squats down, trying to keep all O2 central)

46
Q

what are hypercyanotic spells?

A

Tet/blue spells. May occur in any child who’s heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. Decrease in pulmonary blood flow and increase in R to L shunting, as well.

47
Q

How do we manage hypoxemia?

A

Place infant in the knee/chest position, calm/comforting approach, 100% O2 by mask, morphine, IV fluid replacement.

48
Q

What do nurses do for the child with hypoxemia?

A

prevent dehydration, monitor fluid status, I/O, daily weight, assess respiratory status, protect from infection, O2

49
Q

Always give oral feedings to infants in respiratory distress. T/F?

A

FALSE - NEVER EVER!

50
Q

What is the most common heart anomaly?

A

VSD (ventricular septal defect)

51
Q

What are risk factors for congenital heart disease?

A

Rubella in early pregnancy, alcoholism, exposure to coxsackie virus (hand/food/mouth), diabetes, ingestion of lithium, advanced maternal age, downs (trisomy 21)

52
Q

What are the two major types of congenital heart disease?

A

Acyanotic (L to R Shunt) and Cyanotic (R to L Shunt)

53
Q

Acyanotic pulmonary blood flow - increase or decrease in pulmonary blood flow? What are the types?

A

Increase in pulmonary blood flow. ASD, VSD, PDA, Av Canal (ASD + VSD)

54
Q

Acyanotic - what is included with the ventricular flow obstruction?

A

Coarctation of aorta, aortic stenosis, pulmonary stenosis.

55
Q

Cyanotic - decrease or increase in pulmonary blood flow - what are the types, too?

A

Decrease - tetrology of fallot and tricuspid atresia.

56
Q

cyanotic - what is mixed blood flow?

A

transposition, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart.

57
Q

What are some general symptoms of CHD?

A

tachycardia, decreased peripheral perfusion, heart murmurs, possible cyanosis, dysrhythmia’s, pulmonary congestion, increased work of breathing, stridor/choking spells, recurrent respiratory infections, difficulty feeding, failure to gain weight, polycythemia, cerebral thrombosis, anoxic episodes (fainting)

Peds - Spring 2016 (29 decks)

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