Ch 39 Peds Cardiovascular Flashcards

Question

ventricular septal defect (VSD)

Answer 1

abnormal opening bet right & left ventricles many close spontaneously during 1st yr of life in children w small/mod defects characteristic murmur s/sx of CHF common s/sx of dec. cardiac output possible tx: closure during cardiac cath OR open repair w cardiopulmonary bypass

Answer 2

``` blood exiting a portion of the hart meets an area of stenosis. location of narrowing is usually near the valve of obstructive defect infants & children = s/sx of CHF mild obstruction may be asymptomatic *aortic stenosis *coarctation of the aorta *pulmonary stenosis ```

Answer 3

resistance to blood flow from left ventricle into aorta results in dec. cardiac output, left ventricular hypertrophy, pulmonary vascular congestion *valvular stenosis is most common type (usually d/t malformed cusps --> bicuspid instead of tricuspid valve OR fusion of cusp) ch. murmur severe defect infants = signs of dec. car out children = exercise intol, CP, dizzy

Answer 4

dilation of narrowed valve by cardiac cath | surgical aortic valvotomy (palliative), valve replacement at second procedure

Answer 5

localized narrowing near the insertion of the ductus arteriosus BP higher in upper extremeties (bounding pulses in arms, weak femoral pulses) sx: headaches, dizziness, fainting, epistaxis from HTN

Answer 6

balloon angioplasy in children (restenosis can occur) surgical: mechanical ventilation and meds to improve cardiac output pre op resection of coarcted portion, enlargement of constricted section using graft. defect outside heart --> cardiopulmonary bypass not required / thoracotomy incision used

Answer 7

BP higher in upper ext than lower ext arms = bounding pulses femoral = weak or absent lower ext: cool temps

Answer 8

narrowing at entrance to pulmonary artery blood flow resistance --> R ventricular hypertrophy (hypoplastic) & dec. pulmonary blood flow severe --> CHF occurs

Answer 9

extreme form of pulmonary stenosis | total fusion of the commissures and NO blood flows to the lungs

Answer 10

dilation of narrowed valve via cardiac cath surgical: infants - transventricular (closed) valvotomy children: pulmonary valvotomy w cardiopulmonary bypass

Answer 11

obstructed pulm blood flow AND anatomical defect (ASD or VSD) bet R and L sides of heart pressure on R side of heart inc., exceeds pressure on L side, allos desaturated blood to shunt R to L --> causes desat in systemic circulation - hypoxemia and cyanosis *tetralogy of fallot *tricuspid atresia

Answer 12

``` four defects: 1. VSD 2. pulmonary stenosis 3. overriding aorta 4. R ventricular hypertrophy pulm vasc resis > system resis --> RtoL system resis > pulm vasc resis --> LtoR ```

Answer 13

may be acutely cyanotic at birth or may have mild cyanosis - progresses over time as pulm stenosis worsens acute episodes of cyanosis and hypoxia = "blue spells" or "tet spells" occur when infants's o2 req exceed blood supply

Answer 14

inc. cyanosis, squatting, clubbing of fingers, poor growth (d/t inc. cyanosis) squatting = compensatory mech to return blood flow to heart for oxygenation

Answer 15

palliative shunt: inc. pulmonary blood flow and inc. o2 sat in infants who cannot undergo primary repair. shunt provides blood flow to pulm arteries from L or R subclavian artery complete repair: usually performed w/in 1st yr of life. req. median sternotomy and cardiopulm bypass

Answer 16

failure of the tricuspid valve to develop no communication bet R atrium and R ventricle blood floow through an ASD or patent foramen ovale to L side of heart and through a VSD to the R ventricle and out to the lungs *often associated w pulmonic stenosis & transposition of the great arteries --> complete mixing of unoxyg & oxyg blood in the L side of the heart

Answer 17

if ASD is small, defect may be closed during cardiac cath | otherwise, surgery

Answer 18

full saturated system blood flow mixees w desat blood flow, causing desat of the system blood flow - -> pulm congestion and cardiac output dec * hypoplastic left heart syndrome * total anomalous pulmonary venous connection * transposition of the great arteries or transposition of the great vessels * truncus arteriosus

Answer 19

underdevelopment of the L side --> hypoplastic left ventricle and aortic atresia *defect is fatal in the first few months of life w/o intervention

Answer 20

surgical tx: necessary --> transplantation may be considered preop period: newborn req mech ventilation and a cont. infusion of prostaglandin E1 to maintain ductal patency, ensuring adequate systemic blood flow

Answer 21

pulm artery leave the L ventricle, aorta exits from the R ventricle no communication exists bet the systemic and pulm circulation cardiomegaly is evident a few wks after birth

Answer 22

nonsurgical: prostaglandin E1 may start to inc. blood mixing temporarily if systemic and pulm mixing are inadequate baloon atrial septostomy during cardiac cath may be done to inc. mixing and maintain cardiac output surgical: arterial switch procedure (L ventricle acts as systemic pump, new aorta created)

Answer 23

failure of the pulmonary veins to join the left atrium mixed blood returns to the R atrium and shunts from the R to the L through an ASD R side: hypertrophies L side: remains small

Answer 24

surgical: corrective repair performed in early infancy | pulmonary vein is anastomosed to the L atrium, ASD closed, anomalous pulm venous connection is ligated.

Answer 25

failure of normal septation and division of the embryonic bulbar trunk into the pulm artery and the aorta --> single vessel that overrides both ventricles blood from both ventricles mixes in the common great artery mod - severe CHF

Answer 26

surgical tx: corrective surgical repair performed in 1st few mo of life

Answer 27

1. place infant in knee-chest position 2. admin 100% o2 3. admin morphine sulfate 4. admin fluids IV 5. document occurrence, actions taken, infant's response

Answer 28

auscultate for crackles, rhonchi, or wheezes if resp effort inc. --> place child in reverse trendelenburg position, elevating the head and upper body to dec. work of breathing assess for signs of CHF (periorbital edema or dependent edema in hands/feet)

Answer 29

invasive dx procedure to determine cardiac defects provides info about o2 sat of blood in great vessels and heart chambers dx/ interventional/ electrophysiological reasons general anesthesia usually unnecessary may be outpatient

Answer 30

hemorrhage from entry site clot formation and subsequent blockage distally transient dysrhythmias

Answer 31

assess accurate height / weight --> determines selection of catheter allergic rxns to iodine assess and mark bilateral pulses assess baseline o2 sat

Answer 32

monitor finding on cardiac monitor and o2 sat for 4 hrs after procedure assess affected extremity (coolness may = arterial obstruction) vital signs q15min x 4, q30min x 4, q1h x 4 immobilize affected extremity in a flat position for at least 4 -6 hrs for venous entry site and 6-8 hrs for arterial entry site acetaminophen / ibuprofen for pain / discomfort

Answer 33

remove dressing day after procedure --> bandaid for 2-3 days | no tub baths for 2 -3 dys

Answer 34

inflammatory autoimmune disease that affects connective tissues, and blood vessels of the CNS most serious complication = rheumatic heart disease (affects cardiac valves, esp mitral valve) manifests 2-6 wks after an untx group A betahemolytic streptococcal infection of the upper resp tract

Answer 35

``` Major Criteria: carditis arthralgia chorea erythema marginatum subcutaneous nodules Minor Criteria: fever arthralgia Elevated erythrocyte sedimentation rate or positive C reactive protein level prolonged PR interval on ECG ** to dx: 2 major OR 1 major + 2 minor must be accompanied by evidence of preceding strep infection ```

Answer 36

``` fever elevated antistreptolysin O titer elevated erythrocyte sedimentation rate elevated C reactive protein level Aschoff bodies (lesions): found in heart, blood vessels, brain, and serous surfaces of the joints / pleura ```

Answer 37

involuntary mvmts of extremities and face --> affects speech

Answer 38

inflammation of all parts of the heart, primarily the mitral valves

Answer 39

red skin lesions starting on the trunk and spreading peripherally

Answer 40

small, nontender swellings, often over the joints

Answer 41

tender, painful joints (elbows, knees, ankles, wrists)

Answer 42

control joint pain and inflammation w massage and hot / cold tx bed rest during acute febrile phase abx (penicillin) as rx admin salicylates and anti inflammatory agents as rx (mask polyarthritis --> do not give before dx confirmed) sz precautions if experiencing chorea

Answer 43

aka mucocutaneous lymph node syndrome acute systemic inflammatory illness *cardiac involvement is most serious complication --> aneurysms can develop

Answer 44

acute stage: fever, conjunctival hyperemia, red throat, swollen hands, rash, enlargement of cerical lymph nodes Subacute stage: cracking lips and fissures, desquamation of the skin on the tips of the fingers/ toes, joint pain, cardiac manifestations, thrombocytosis convalescent stage: child appears normal but signs of inflamm may be present

Answer 45

monitor temp frequently assess: heart sounds, heart RR, extremities (for edema, redness, and desquamation), eyes (for conjunctivitis), mucous membranes (for inflamm). admin soft foods / liquids that are not too hot / cold passive ROM exercises to facilitate joint mvmt admin acetylsalicylic acid (aspirin) as rx admin immunoglobulin IV as rx to reduce duration of the fever and incidence of coronary artery lesions and aneurysms (blood precautions)

Answer 46

tinnitus, HA, vertigo, bruising

Answer 47

coughing up blood

Answer 48

vomiting up blpod

Answer 49

blood in stool

Answer 50

avoid admin of MMR or varicella vaccine to the child for 11 mo after IV immunoglobulin therapy

Answer 51

irritability that may last for 2 mo after onset of sx peeling of hands / feet pain in joints persisting for several wks stiffness in morning, after naps, and in cold