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peds > ch 27 cardiovascular dysfunction > Flashcards

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
Q

maternal causes congenital heart disease

A

-maternal drug use (fetal alcohol syndrome)
-rubella in first 7 wks of pregnancy
-CMV, toxoplasmosis, other viral illnesses
-infants of diabetic mothers
-chromosomal/genetic

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26
Q

most common anomaly

A

VSD (ventricular septal defect)

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27
Q

consequences CHD

A

-congested heart failure
-hypoxemia

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28
Q

S+S congested heart failure

A

-SOB
-edema
-crackles/rales, fluid in lungs

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29
Q

which sided heart failure is associated with:
-systemic symptoms
-lung symptoms

A

systemic: right
lungs: left

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30
Q

S+S impaired myocardial function in CHF

A

-tachycardia
-inappropriate sweating
-fatigue
-weakness
-restlessness
-pale
-cool extremities
-decreased BP
-decreased urine output
-weak peripheral pulses
-cardiomegaly, gallop

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31
Q

S+S pulmonary congestion in CHF

A

-tachypnea
-dyspnea
-exercise intolerance
-cyanosis
-wheezing
-grunting
-resp distress

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32
Q

S+S systemic venous congestion in CHF

A

-peripheral and periorbital edema
-weight gain
-ascites
-hepatomegaly
-JVD

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33
Q

nursing considerations with digoxin admin

A

-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)

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34
Q

S+S digoxin toxicity

A

vomiting
blurred vision
bradycardia

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35
Q

normal digoxin level

A

0.8-2.0

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36
Q

how to decrease preload

A

diuretic (lasix/furosemide)

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37
Q

classifications of CHD

A

acyanotic:
-increased pulmonary blood flow
-obstruction of blood flow out of heart

cyanotic:
-decreased pulmonary blood flow
-mixed blood flow

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38
Q

increased pulmonary blood flow defects (3)

A

atrial septal defect (ASD)
ventricular septal defect (VSD) -most common
patent ductus arteriosus (PDA)

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39
Q

which side of heart has higher pressure

A

left

40
Q

meds that can help close PDA

A

ibuprofen
indomethacin (prostaglandin inhibitor)

41
Q

3 severe obstructive defects

A

-coarction of aorta (COA)
-aortic stenosis (AS)
-pulmonic stenosis (PS)

42
Q

S+S coarction of aorta (COA)

A

-poor perfusion of lower extremities
-BP difference upper and lower extremities

43
Q

S+S aortic stenosis (AS)

A

-faint pulses, poor perfusion
-decreased cardiac output
-tachycardia, hypoTN
-poor feeding (infants)
-exercise intolerance
-chest pain
-dizziness

44
Q

risk with aortic stenosis

A

infective endocarditis
*premedicated before dentist

45
Q

Tx aortic stenosis

A

balloon
replacement/repair valve

46
Q

S+S pulmonic stenosis (PS)

A

-decreased oxygenation
-R hypertrophy (cardiomegaly)
-if patent PDA, may not see symptoms
-mild cyanosis
-CHF

47
Q

Tx pulmonic stenosis

A

-balloon
-replace/repair valve

48
Q

S+S tetrology of fallot

A

-cyanosis “tet spells”
-poor weight gain
-irritable
-heart murmur
-tire easily
-nail clubbing

49
Q

Tx “tet spells”

A

infant: knee chest position
older children:
-100% O2
-morphine

50
Q

decreased pulmonary blood flow defects (2)

A

-tetrology of fallot (tet)
-tricuspid atresia

51
Q

S+S tetrology of fallot

A

“boot shaped heart”

52
Q

S+S transposition of great vessels
Tx

A

S+S:
-cyanotic at birth

Tx:
-give prostaglandins to keep PDA open
-intubate (prostaglandins can stop breathing)

53
Q

mixed defects (3)

A

-hypoplastic heart syndrome (L or R)
-transposition of great vessels
-total anomalous pulmonary venous connection (TAPVR)

54
Q

Tx hypoplastic heart syndrome

A

-norwood shunt at birth
-another procedure at 4 mo
-fontan procedure (2-4 yo)

55
Q

S+S hypoplastic heart syndrome

A

-developmental delay
-low oxygen saturation

56
Q

S+S TAPVR

A

-rapid breathing
-grunting
-emergency surgery needed

57
Q

side effects calcium channel blockers (CCB)

A

-constipation
-dizziness
-palpations
-fatigue
-flushing
-headache
-nausea
-lower extremity edema

58
Q

CCB meds

A

verapamil
nifedipine

59
Q

what can’t you eat with CCB meds

A

grapefruit

60
Q

side effects ACE inhibitor meds

A

-persistent dry cough
-dizziness
-fatigue
-weakness
-loss of taste
-headache
-angioedema

61
Q

who can’t take ACE inhibitors

A

pregnant mothers
anyone who has had anaphylactic reactions

62
Q

ACE inhibitor meds

A

-pril

63
Q

side effects digoxin

A

vomiting
headaches
dizziness
hallucinations
diarrhea
blurred vision

64
Q

side effects lasix/furosemide

A

dizziness
headache
blurred vision
muscle cramping (hypoK)

65
Q

chest tube considerations post heart surgery
+ when to notify surgeon

A

-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
Q

what urinary output indicates possible renal failure

A

<1 mL/kg/hr

67
Q

postop heart surgery complications

A

-CHF
-dysrhythmias
-decreased cardiac output syndrome
-decreased peripheral perfusion
-pulmonary changes
-neurologic changes

68
Q

S+S postpericardiotomy syndrome

A

-fever
-high WBC
-pericardial friction rub
-pericardial and pleural effusion
-immediate postop or up to 21 days postop

69
Q

causes endocarditis

A

-strep
-staph (higher mortality rate)
-fungal infections

70
Q

S+S infectious endocarditis

A

-osler nodes (fingers)
-janeway lesion (spots on hand)
-malaise
-low grade fever
-sudden murmur
-splenomegaly

71
Q

Dx infectious endocarditis

A

duke criteria
(major criteria:
-blood cultures
-echo findings)

72
Q

Tx infectious endocarditis

A

-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
Q

high risk pts for developing infectious endocarditis

A

-artificial heart valve
-h/o infective endocarditis
-CHD
-h/o heart transplant

74
Q

complications infective endocarditis

A

CHF
embolism

75
Q

cause rheumatic fever
possible consequence RF

A

group a b-hemolytic strep
rheumatic heart disease

76
Q

S+S rheumatic fever

A

-carditis
-polyarthritis
-erythema marginatum (red spots)
-subq nodules

77
Q

prevention rheumatic heart disease

A

treat strep tonsillitis/pharyngitis:
-PenicillinG IM 1x
-penicillin oral 10 days
(sulfa if allergic to penicillin)

78
Q

S+S kawasaki disease

A

-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
Q

Tx kawasaki disease

A

-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
Q

causes secondary HTN in peds

A

-renal disease
-CV disease
-endocrine/neurologic disorders

81
Q

Tx systemic HTN

A

-ACE inhibitors
-ARBs
-DASH diet
-lifestyle changes if obese

82
Q

*BOX 27.13 -review of antiHTN meds

A
83
Q

what kids would receive first line therapy of ACE inhibitor or ARB for HTN

A

-CKD
-protienuria
-diabetes

84
Q

Tx hyperlipidemia

A

-diet: restrict intake cholesterol and fats

meds if diet doesn’t work:
-colestipol
-cholestyramine

85
Q

brady dysrhythmias (2)

A

-sinus brady
-AV block

86
Q

tachy dysrhythmias (1)

A

SVT (superventricular tachy)

87
Q

possible causes sinus tachy (not structural)

A

-fever
-anxiety
-pain
-dehydration
-anemia

88
Q

what HR to start CPR on kid

A

<60 bpm

89
Q

what bpm is SVT

A

200-300 bpm
narrow complex

90
Q

Tx SVT

A

-vagal maneuver (ice on face, unilateral carotid artery massage, valsalva)
-adenosine rapid IV push
-synchronized cardioversion

91
Q

medical management tachycardia

A

-beta blocker (propranolol for infants, atenolol for children)
-digoxin (not in kids with WPW syndrome)
-radiofrequency ablation

92
Q

Tx pulmonary artery HTN

A

-sildenafil (viagra)
-CCB

93
Q

3 types cardiomyopathy

A

-dilated (most common)
-hypertrophic
-restrictive

94
Q

Tx cardiomyopathy

A

-treat underlying cause
-digoxin
-diuretics
-b blocker,CCB
-dobutamine
-nitroprusside
-amrinone

95
Q

S+S cardiac tamponade

A

triad:
-JVD
-narrowing pulse pressure, low bp
-muffled heart tones

peds (28 decks)

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