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ch 27 cardiovascular dysfunction Flashcards

1
Q

fetal circulation differences than child

A

-1 umbilical vein
-2 umbilical arteries
-ductus venosus and arteriorus
-foramen ovale

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2
Q

changes in CV system after birth

A

-lungs begin oxygenation
-shunts close
-rise systemic vascular resistance
-L heart pressure increase
-R heart pressure decrease

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3
Q

how long does transition from high pressure systemic circulation and low pressure pulmonary circulation take after birth

A

6-8 wks

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4
Q

located within the RA wall near the opening of the SVC, Pacemaker of the
heart

A

SA node

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5
Q

also located within the RA but near the lower end of the septum, major
pathway for impulses to get to the ventricles

A

AV node

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6
Q

which extends from the AV node along each side of the interventricular
septum and then divides into right and left bundle branches

A

AV bundle (bundle of His)

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7
Q

what can influence preload

A

hydration status

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8
Q

how to calculate cardiac output

A

heart rate x stroke volume

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9
Q

3 things that influence stroke volume

A

-preload
-afterload
-contractility

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10
Q

circulating blood volume, measured using CVP

A

preload

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11
Q

ventricular ejection - measured using arterial BP (resistance against ventricles)

A

afterload

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12
Q

ability of cardiac muscle to act as an efficient pump - peripheral tissue perfusion (pulses, warmth of extremities, cap refill)

A

contractility

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13
Q

what can influence afterload

A

high BP

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14
Q

what can influence contractility

A

electrolyte imbalances
MI

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15
Q

how to treat decreased cardiac output due to low preload

A

volume: IV fluids or blood product

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16
Q

how to treat decreased cardiac output due to high afterload

A

vasodilators
-pril

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17
Q

how to treat decreased cardiac output due to low contractility

A

inotropes (helps muscles contract)
-digoxin
-dopamine
-dalbutamine

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18
Q

tests of cardiac function

A

chest xray
ECG
echo
cardiac cath

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19
Q

*review vasodilators and inotrope meds

A
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20
Q

pediatric S+S cardiac dysfunction

A

-poor feeding
-tachycardia/tachypnea
-failure to thrive/poor weight gain/activity intolerance
-developmental delays

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21
Q

when might murmurs occur in a normal heart (periods of stress)

A

-anemia
-fever
-rapid growth

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22
Q

grading of murmurs

A

(above grade 3 = pathological)
grade 1: barely audible
grade 2: slightly louder
grade 3: moderately loud, no thrill
grade 4: loud and palpable thrill
grade 5: thrill, murmur heart with steth partially off chest
grade 6: audible w/o steth

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23
Q

postop cardiac cath nursing considerations

A

-monitor pulses
-vital signs q15mins
-dressing for bleeding
-I&O
-hypoglycemia
-keep extremity straight, sandbag on it

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24
Q

what do you need to document preop cardiac cath

A

-pulses (esp the one below the op site)
-HR
-BP

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25
maternal causes congenital heart disease
-maternal drug use (fetal alcohol syndrome) -rubella in first 7 wks of pregnancy -CMV, toxoplasmosis, other viral illnesses -infants of diabetic mothers -chromosomal/genetic
26
most common anomaly
VSD (ventricular septal defect)
27
consequences CHD
-congested heart failure -hypoxemia
28
S+S congested heart failure
-SOB -edema -crackles/rales, fluid in lungs
29
which sided heart failure is associated with: -systemic symptoms -lung symptoms
systemic: right lungs: left
30
S+S impaired myocardial function in CHF
-tachycardia -inappropriate sweating -fatigue -weakness -restlessness -pale -cool extremities -decreased BP -decreased urine output -weak peripheral pulses -cardiomegaly, gallop
31
S+S pulmonary congestion in CHF
-tachypnea -dyspnea -exercise intolerance -cyanosis -wheezing -grunting -resp distress
32
S+S systemic venous congestion in CHF
-peripheral and periorbital edema -weight gain -ascites -hepatomegaly -JVD
33
nursing considerations with digoxin admin
-check HR before (hold if HR <70 in children, HR<90 in infants) -max: 50 mcg/dose -fast onset, short half life -watch for potassium imbalance (hypoK = increases dig effects, hyperK = decreases dig effects)
34
S+S digoxin toxicity
vomiting blurred vision bradycardia
35
normal digoxin level
0.8-2.0
36
how to decrease preload
diuretic (lasix/furosemide)
37
classifications of CHD
acyanotic: -increased pulmonary blood flow -obstruction of blood flow out of heart cyanotic: -decreased pulmonary blood flow -mixed blood flow
38
increased pulmonary blood flow defects (3)
atrial septal defect (ASD) ventricular septal defect (VSD) -most common patent ductus arteriosus (PDA)
39
which side of heart has higher pressure
left
40
meds that can help close PDA
ibuprofen indomethacin (prostaglandin inhibitor)
41
3 severe obstructive defects
-coarction of aorta (COA) -aortic stenosis (AS) -pulmonic stenosis (PS)
42
S+S coarction of aorta (COA)
-poor perfusion of lower extremities -BP difference upper and lower extremities
43
S+S aortic stenosis (AS)
-faint pulses, poor perfusion -decreased cardiac output -tachycardia, hypoTN -poor feeding (infants) -exercise intolerance -chest pain -dizziness
44
risk with aortic stenosis
infective endocarditis *premedicated before dentist
45
Tx aortic stenosis
balloon replacement/repair valve
46
S+S pulmonic stenosis (PS)
-decreased oxygenation -R hypertrophy (cardiomegaly) -if patent PDA, may not see symptoms -mild cyanosis -CHF
47
Tx pulmonic stenosis
-balloon -replace/repair valve
48
S+S tetrology of fallot
-cyanosis "tet spells" -poor weight gain -irritable -heart murmur -tire easily -nail clubbing
49
Tx "tet spells"
infant: knee chest position older children: -100% O2 -morphine
50
decreased pulmonary blood flow defects (2)
-tetrology of fallot (tet) -tricuspid atresia
51
S+S tetrology of fallot
"boot shaped heart"
52
S+S transposition of great vessels Tx
S+S: -cyanotic at birth Tx: -give prostaglandins to keep PDA open -intubate (prostaglandins can stop breathing)
53
mixed defects (3)
-hypoplastic heart syndrome (L or R) -transposition of great vessels -total anomalous pulmonary venous connection (TAPVR)
54
Tx hypoplastic heart syndrome
-norwood shunt at birth -another procedure at 4 mo -fontan procedure (2-4 yo)
55
S+S hypoplastic heart syndrome
-developmental delay -low oxygen saturation
56
S+S TAPVR
-rapid breathing -grunting -emergency surgery needed
57
side effects calcium channel blockers (CCB)
-constipation -dizziness -palpations -fatigue -flushing -headache -nausea -lower extremity edema
58
CCB meds
verapamil nifedipine
59
what can't you eat with CCB meds
grapefruit
60
side effects ACE inhibitor meds
-persistent dry cough -dizziness -fatigue -weakness -loss of taste -headache -angioedema
61
who can't take ACE inhibitors
pregnant mothers anyone who has had anaphylactic reactions
62
ACE inhibitor meds
-pril
63
side effects digoxin
vomiting headaches dizziness hallucinations diarrhea blurred vision
64
side effects lasix/furosemide
dizziness headache blurred vision muscle cramping (hypoK)
65
chest tube considerations post heart surgery + when to notify surgeon
-monitor drainage color every hour (immediate postop bright red, changes to serous) -monitor drainage quantity (mark mL every hr) **(notify if drainage >3 mL/kg/hr for 3 consec hours, or 5-10 mL/kg in one hour) -be alert for cardiac tamponade -pain meds after
66
what urinary output indicates possible renal failure
<1 mL/kg/hr
67
postop heart surgery complications
-CHF -dysrhythmias -decreased cardiac output syndrome -decreased peripheral perfusion -pulmonary changes -neurologic changes
68
S+S postpericardiotomy syndrome
-fever -high WBC -pericardial friction rub -pericardial and pleural effusion -immediate postop or up to 21 days postop
69
causes endocarditis
-strep -staph (higher mortality rate) -fungal infections
70
S+S infectious endocarditis
-osler nodes (fingers) -janeway lesion (spots on hand) -malaise -low grade fever -sudden murmur -splenomegaly
71
Dx infectious endocarditis
duke criteria (major criteria: -blood cultures -echo findings)
72
Tx infectious endocarditis
-IV Abx 2-8 wks -serial echos -possible surgical valve repair/replacement -prophylactic Abx for high risk pts before procedures (including dental) -Abx: amoxicillin, ampicillin, clindamycin
73
high risk pts for developing infectious endocarditis
-artificial heart valve -h/o infective endocarditis -CHD -h/o heart transplant
74
complications infective endocarditis
CHF embolism
75
cause rheumatic fever possible consequence RF
group a b-hemolytic strep rheumatic heart disease
76
S+S rheumatic fever
-carditis -polyarthritis -erythema marginatum (red spots) -subq nodules
77
prevention rheumatic heart disease
treat strep tonsillitis/pharyngitis: -PenicillinG IM 1x -penicillin oral 10 days (sulfa if allergic to penicillin)
78
S+S kawasaki disease
-duration 6-8 wks -high fever -*strawberry tongue -edema in hands and feet -extreme irritability -arthritis -skin peeling bw fingers/toes -bilateral conjunctival injection (red eyes) -cardiac complications w/o Tx -peak incidence in toddlers
79
Tx kawasaki disease
-IV IG high dose within 7-10 days onset -aspirin (fever dose: 80 mg/kg/day, then antiplatelet dose: 3-5 mg/kg/day) -remicade and steroids (if IV IG fails, sign: breakthrough fever within 24 hrs after IV IG)
80
causes secondary HTN in peds
-renal disease -CV disease -endocrine/neurologic disorders
81
Tx systemic HTN
-ACE inhibitors -ARBs -DASH diet -lifestyle changes if obese
82
*BOX 27.13 -review of antiHTN meds
83
what kids would receive first line therapy of ACE inhibitor or ARB for HTN
-CKD -protienuria -diabetes
84
Tx hyperlipidemia
-diet: restrict intake cholesterol and fats meds if diet doesn't work: -colestipol -cholestyramine
85
brady dysrhythmias (2)
-sinus brady -AV block
86
tachy dysrhythmias (1)
SVT (superventricular tachy)
87
possible causes sinus tachy (not structural)
-fever -anxiety -pain -dehydration -anemia
88
what HR to start CPR on kid
<60 bpm
89
what bpm is SVT
200-300 bpm narrow complex
90
Tx SVT
-vagal maneuver (ice on face, unilateral carotid artery massage, valsalva) -adenosine rapid IV push -synchronized cardioversion
91
medical management tachycardia
-beta blocker (propranolol for infants, atenolol for children) -digoxin (not in kids with WPW syndrome) -radiofrequency ablation
92
Tx pulmonary artery HTN
-sildenafil (viagra) -CCB
93
3 types cardiomyopathy
-dilated (most common) -hypertrophic -restrictive
94
Tx cardiomyopathy
-treat underlying cause -digoxin -diuretics -b blocker,CCB -dobutamine -nitroprusside -amrinone
95
S+S cardiac tamponade
triad: -JVD -narrowing pulse pressure, low bp -muffled heart tones

peds (28 decks)

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