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

Question 1

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

Answer 1

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

Question 2

which part of the fetus requires the most oxygen?

Answer 2

head (brain!)

Question 3

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

Answer 3

Increased.

Decreased.

Question 4

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

Answer 4

FALSE - MOST potent.

Question 5

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

Answer 5

right

Question 6

why is the systolic BP of the neonate low?

Answer 6

Decreased systemic vascular resistance!

Question 7

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

Answer 7

TRUE

Question 8

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

Answer 8

10-15 hours after birth.

PERMANENTLY by 10-21 days.

Question 9

What causes the ductus arteriosus to constrict and close?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

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

Answer 12

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

YES

Question 13

are there risks to a cardiac cath?

Answer 13

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

Question 14

what should be monitored after a cardiac cath?

Answer 14

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

Question 15

what is the cardiac output?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

FALSE

Question 18

Blood flows from areas of __ pressure to ___ pressure.

Answer 18

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

Question 19

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

Answer 19

LESS

Question 20

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

Answer 20

LOWER

Question 21

What is CHF?

Answer 21

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.

Question 22

What are some changes caused by heart failure?

Answer 22

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

Question 23

What are the two types of heart failure?

Answer 23

right & left sided.

Question 24

What is right sided heart failure?

Answer 24

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!

Question 25

what is left sided heart failure?

Answer 25

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!

Question 26

what are some causes of CHF in children?

Answer 26

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

Question 27

What are some compensatory mechanisms of the heart?

Answer 27

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.

Question 28

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

Answer 28

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

Question 29

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

Answer 29

Impaired myocardial function, pulmonary congestion, systemic vascular congestion.

Question 30

clinical manifestations for CHF - impaired myocardial function?

Answer 30

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

Question 31

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?

Answer 31

Increased volume in heart, ventricular enlargement/dilation.

Question 32

clinical manifestations for CHF - pulmonary congestion?

Answer 32

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

Question 33

CHF kids - do we lay them flat?

Answer 33

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

Question 34

clinical manifestations for CHF - systemic venous congestion?

Answer 34

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

Question 35

what are goals for treatment for CHF?

Answer 35

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!)

Question 36

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

Answer 36

FALSE - cluster care...let the kid rest.

Question 37

what are some meds to improve cardiac function?

Answer 37

digitalis glycosides, ACE inhibitors, Beta blockers

Question 38

what does a digitalis glycoside do?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

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

Answer 41

TRUE

Question 42

what do ace inhibitors do?

Answer 42

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.

Question 43

What do beta blockers do?

Answer 43

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

Question 44

what is hypoxia? cyanosis?

Answer 44

Hypoxia - a reduction in tissue oxygenation. | Cyanosis - blue discoloration of mucus membranes, skin, and nail beds due to deoxygenated hgb.

Question 45

What are clinical manifestations of hypoxemia?

Answer 45

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)

Question 46

what are hypercyanotic spells?

Answer 46

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.

Question 47

How do we manage hypoxemia?

Answer 47

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

Question 48

What do nurses do for the child with hypoxemia?

Answer 48

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

Question 49

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

Answer 49

FALSE - NEVER EVER!

Question 50

What is the most common heart anomaly?

Answer 50

VSD (ventricular septal defect)

Question 51

What are risk factors for congenital heart disease?

Answer 51

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

Question 52

What are the two major types of congenital heart disease?

Answer 52

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

Question 53

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

Answer 53

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

Question 54

Acyanotic - what is included with the ventricular flow obstruction?

Answer 54

Coarctation of aorta, aortic stenosis, pulmonary stenosis.

Question 55

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

Answer 55

Decrease - tetrology of fallot and tricuspid atresia.

Question 56

cyanotic - what is mixed blood flow?

Answer 56

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

Question 57

What are some general symptoms of CHD?

Answer 57

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)