Chapter 12: Cardiovascular Disorders Flashcards
The student nurse studying the anatomy of the heart learns that there are four chambers in the heart and that the one that is a reservoir for the peripheral venous return is the:
right atrium
An infant recieves a diagnosis of tricuspid atresia. The nurse is aware that balloon atrial septostomy is an emergent palliative procedure necessary for life for this patient because the heart has no means of blood flow to the pulmonary system or body. T/F
True
The nurse carrying out interventions postsurgery for a cardiac transplantation patient understands that the priority nursing intervention is to help the family understand the importance of ______.
medication compliance
What kind of interventions can be performed for a cardiac catheter?
Corrective and palliative inverventions
Hypoplastic Left Heart
R to L Shunting
Cyanotic
Assessment
- Tachypnea, chest retractions, dyspnea
- cyanosis
- decreased pulses, poor peripheral perfusion
- increased right ventricular impulse
- s/s of congestive heart failure
Nursing Diagnosis
- Altered cardiopulmonary tissue perfusion
- Hi risk for infection
- Risk of impaired gas exchange
- Risk for decreased cardiac output
Pulmonary Atresia
L to R shunting
Acyanotic
Assessment
- will be cyanotic and exercise intolerance
Nursing diagnosis
- Risk for impaired growth and development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
Interventions for high risk for infections
limit exposure to individuals w infections, promote pulmonary hygiene
Inverventions for Risk for infections
Limit exposure to individuals with infections, promote good pulmonary hygiene, and prophylactic exposure antibiotics when undergoing surgical or dental treatments to prevent subacute bacterial endocarditis
How do you auscultate peds?
Warm the stethoscope and BP of all four extremities
s/s of infective endocarditis?
unexplained fevers, anorexia, malaise, myalgia, arthralgia, head to abdomen weight loss, development of new murmur
what are the three types of shock?
hypovolemic, cardiogenic, and distributive shock
Nursing considerations for Kawasaki disease?
promote comfort, small frequent feedings, passive ROM, cool baths, gentle oral care, fluids, monitor, elevate joints, avoid soaps and lotions, take temps, IV monitor BP may drop
What percent of down’s have congenital heart disease?
50 percent
What are some medical managements of congestive heart failure?
decrease cardiac workload, inprove cardiac output, and improve nutritional intake
Aortic Valve Stenosis
L to R shunting
Acyanotic
Assessment
- Infants
- faint pulses
- hypotension
- tachycardia
- poor feeding
- Children
- heart murmur
- exercise intolerance
- chest pain
- dizziness when standing for long periods
Nursing diagnosis
- Risk for impaired growth and development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
A pediatrician orders a pacemaker for a 5 year old patient w sick sinus syndrome. The nurse should communicate to the parents that:
A pacemaker generator will be placed in the subcostal area and follow up requires routine pacemaker testing as per the manufacturer
Therapeutic management for infective endocarditis
High-dose antibiotics, removal of vegetations, value replacement, prophylaxis with antibiotics needed for dental work
What are s/s of digoxin toxicity?
poor feeding and dysrhythmia
How do you assess pediatric cardiac?
History from pregnancy through current time, respiratory system, pulses, blood pressure, and auscultation
what is cardiomyopathy, s/s, and how is it treated?
chronic disease within the heart muscle itself as a result of another disease. s/s: ventricles become thickened and enlarged, heart unable to pump effectively. Treatment: medications to improve heart monitoring
Transposition of the Great Vessels
R to L Shunting
Cyanotic
Assessment
- progressive cyanosis –>hypoxia–>acidosis
- s/s of congestive heart failure
- tachypnea
- poor feeder/failure to grow
Nursing Diagnosis
- Altered cardiopulmonary tissue perfusion
- Hi risk of infection
- Risk for impaired gas exchange
- Risk for decreased cardiac output
What should you monitor for post cardiac catheterization?
Monitor for bleeding, arrhythmias, and infections
Medical management of right to left shunting
prostaglandin E1-keeps structures open, may need immediate surgery, and monitor fluid status, growth and development, cardiac status and respiratory status
Hypertension
between 90th and 95th percentile (>120/80 for adolescent), two types: primary (related to obesity and stress) and secondary (caused by underlying disease)
The pediatric nurse knows that teaching the child and family information about cardiac conditions is essential and includes _____, vital signs, medications, the _____, and _______.
cardiopulmonary resuscitation, disease entity, and resources
A 10 year old patient in the cardiac unit undergoes a cardiac catheterization to determine the pressures within her heart. The findings include high pressure in the right ventricle. The nurse explains to the student nurse that this finding may indicate:
ventricular septal defect, pulmonary artery stenosis, pulmonary hypertension, or congestive heart failure
Interventions for altered nutrtion
offer small and frequent feedings, use soft nipple for ease of sucking, and organize care to allow for rest
The nurse is teaching the mother of an infant with a congential heart defect interventions to aid in the feeding process. The nurse tells her to:
Give the infant frequent, small feedings and feed the baby in a relaxed, quiet environment
What should you assess and medicate for post cardiac catheterization?
Assess the insertion site and fore diuresis r/t dye. Medicate for pain
The nurse can recognize a congenital heart defect by recognizing the _____ and recognizing ______ versus ______ congenital heart defects
shunting pattern, acyanotic, cyanotic
The student nurse learns that there are four valves in the heart and the valve that connects the right atrium to the right ventricle is the:
tricuspid valve
Name an ACE inhibitor and what does it do?
Captopril (Capoten) and Enalopril (Vasotec). They are antihypertensives
An electrophysiologic condition predisposing the child to death producing arrhythmias such as ventricular tachcardia, Torsade de Pointes, and ventricular fibrillation
Long Q-T syndrome
A multisystem disease affecting the cardiovascular system thought to be caused by a defective immune response to an infectious process
Kawasaki disease
A condition caused by an exaggerated response to a normal bodily function
Neurally mediated syncope
What is inective endocarditis?
Infection of the valves and inner lining of heart
Atrial Septal Defect
L to R shunting
Acyanosis
Assessment
- systolic murmur in pulmonic area
- splitting S2
- dyspnea
- fatigue and poor growth
Nursing Diagnosis
- Risk for impaired growth and development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
The nurse caring for patients in the pediatric intensive care unit knows that electrolyte measurements, particularly potassium, are perhaps the most critical lab test in the initial postoperative period. T/F
True
Coarctation of the Aorta
L to R Shunting
Acyanotic
Assessment
- may be asymptomatic
- BP difference of 20 mm Hg b/t upper and lower extremeties
- femoral pulses weak
- vertigo and epistaxis
- exercise intolerance
- dyspnea
Nursing Diagnosis
- Risk for impaired Growth and Development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
The nurse understands that the definitive diagnosis of cardiomyopathy is confirmed by a:
echocardiogram
What may be present in pediatric heart even when the cardiac output is normal?
Shock
What is toxic shock syndrome, s/s, and treatment?
toxin or bacteria in blood causing overstimulation of immune system. s/s: high fever, rash, hypotension, multisystem failure. Treatment: maintain I and O, Take child to hospital if confused
Nursing considerations for diuretics?
Check potassium levels (hypokalemia increases chance of digoxin toxicity), potassium sparing can cause hyperkalemia so still check levels
Interventions for Anxiety: Ineffective Family coping, disabling
Assess coping mechanisms of family, provide family information about condition, and refer family to the American Heart Association
Priority nursing diagnosis for shock
ineffective tissue perfusion, maintain tissue perfusion, increase cardiac output and oxygenation, prevent infection, family coping. correct the underlying cause: fluids, blood, antibiotics, oxygen, blood sugar, etc.
cyanosis
blue, O2 sats below 85%, polycythemia (Lots of blood cells), clubbing, frequent respiratory infections, developmental and academic lag, tachycardia, dyspneic during crying and feeding, need antibiotic prophylaxis to prevent endocarditis
Tricuspid Atresia
R to L shunting
Cyanotic
Assessment
- cyanosis
- tachycardia
- dyspnea
- older children have s/s of chronic hypoxemia w clubbing
Nursing diagnosis
- Altered cardiopulmonary tissue perfusion
- Hi risk for infection
- Risk for impaired gas exchange
- Risk for decreased cardiac output
Treatment for primary hypertension
reduce weight, increase physical activity, dietary modification, relaxation techniques, meds if others ineffective
When examining a newborn for cardiac defects, the pediatrician explains to the nurse that the baby’s tricuspid valve is displaced into the right ventricle. The nurse knows this condition is:
Epstein malformation
What nursing considerations with positive inotropes like Digoxin?
Hold if apical pulse below 100 in infants and check therapeutic levels (0.8-2ng/mL) VERY NARROW
The nurse is caring for a patient with neurally mediated syncope. The nurse performs the recommended nursing measures for this patient, including:
Increase water intake, administer beta blocker, giving an adrenocortico steriod
What does the cardiac catheter measure?
Oxygen levels
A pediatrician suspects that a patient has septal defect. The pediatric nurse knows that the patient will most likely be scheduled for the following:
Angiography and echocardiogram
Treatment for rheumatic fever?
penicillin, erythromycin ethylsuccinate for those allergic, asprin or corticosteroids for inflammations
A condition in which the cardiac muscle becomes dilated, hypertrophied, stiff, or inflamed and no longer functions well
Cardiomyopathy
what is rheumatic heart disease? what causes it?
systemic inflammatory disease that follows in response to a group A beta-hemolytic streptococcal infection. Familial, occurs in poor places, occurs in northeast during winter and spring
Pulmonary Stenosis
L to R Shunting
Acyanotic
Assessment
- may be asymptomatic
- may have mild cyanosis or congestive heart failure
- if severe, will be cyanotic and exercise intolerance
Nursing Diagnosis
- Risk for impaired growth and development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
Name a diuretic and what does it do?
Furosemide (Lasix). It increases urine output to lower fluids in circulation
Tricuspid Atresia
R to L Shunting
Cyanotic
Assessment
- cyanosis
- tachycardia
- dyspnea
- older children have s/s of chronic hypoxemia w clubbing
Nursing Diagnosis
- Altered cardiopulmonary tissue perfusion
- Hi risk for infection
- Risk for inpaired gas exchange
- Risk for decreased cardiac output
what is the purpose of the hyperoxygenation test?
It determines whethere there is a respiratory or a cardiac disorder. Cardiac shows no increase in oxygenation while respiratory will show an increase.
First step in most assessments?
History
What is a late indicator of clinical compensation of the heart?
Blood pressure
Interventions for Risk for impaired growth and development
Treat child as normally as possible, teach parents that children are more comfortable when they know what to expect, and promote age-appropriate activities as conditions allows
A pediatrician confirms a diagnosis of Kawasaki disease for a 2 year old patient. The pediatric nurse knows that diagnostic criteria for this disease include:
Cracking lips and strawberry tongue
The nurse is examining a patient admitted to the pediatric intensive care unit who is experiencing symptoms of heart failure. The nurse detects a “machine-like” murmur located under the left clavicle. The nurse suspects the patient has:
patent ductus arteriosus
Tetralogy of Fallot
Combines four defects
Right to Left Shunting
Cyanotic
Assessment
- Systolic murmur in pulmonic area
- polycythemia
- metabolic acidosis
- poor growth/poor feeders
- exercise intolerance
- clubbing
- TET spells characterized by hypoxia, pallor, and tachypnea
Nursing Diagnosis
- Altered cardiopulmonary tissue perfusion
- Hi risk for infection
- Risk of impaired gas exchange
- Risk for decreased cardiac output
What is Kawasaki disease?
Mucocutaneous lymph node syndrome, multisystem disorder involving vasculitis, has three phases: acute (red swollen feet hands), subacute (cracked skin, slaughing skin), and convalescents (lingering inflammation)
Nursing considerations for rheumatic fever
bed rest til erytrocyte sedimentation returns to normal, asprin and corticosteroids as ordered, monitor cardiac function, antibiotics (may need for years), heat or cold on joints, repositioning, and safety: mattress off floor
What is a heart transplant and its treatment?
replacement of heart w healthy one. surgical replacement, encourage nutrition, assess organ rejection, medications to prevent rejection and infection
Infection that occurs subsequent to a bacterial infection or introduction of an infective agent into the child’s blood stream
sub-acute bacterial endocarditis
How often should you straighten the affected leg of a cardiac catheter post procedure?
Every 4 to 6 hours
Therapeutic management of Kawasaki disease
administer aspirin and intravenous gamma globulin to reduce coronary artery lesions and aneurysms
Interventions for fluid retention
Administer meds safely, monitor I and O, maintain fluid restrictions if ordered, wieght (same time and scale), skin care and repositioning, Head over Body 30-45 degrees
The nurse caring for cardiac patients teaches the student nurse that a stent may be placed in a vessel as an initial treatment and narrow vessels or valves may be opened or dilated w a balloon angioplasty or valvuloplasty as a long-term treatment. T/F
False
What is cardiogenic shock and how to assess?
circulatory collapse due to impaired cardiac function or heart issues. assess: edema, respiratory distress, enlarged liver, skin color, temp, cap refill, poor response to fluid resuscitation
Factors of Congenital Heart Disease
Genetics, Fetal Alcohol, Family history, Gestational diabetes, Maternal Rubella, and Maternal age
Pediatric differences in heart and circulation?
Heart and great vessels develop during first three weeks to eight weeks of gestation, heart sounds high-pitched and greater intensity, pulse rate higher, chest wall thin.
What is an acquired heart defect?
A defect after birth
The nurse explains to the student nurse that congenital heart disease describes a defect in the _____, ______, or a noted disease pattern after birth
heart, great vessels
What is L to R shunting?
Oxygenated blood (left) mixing with unoxygenated blood (right). Usually acyanotic, only cyanotic if severe
What are some diagnostic testing for cardiac disorders?
Radiography, Echocardiography, Electrocardiogram, Holter moniter, Sress electrocardiogram, Magnetic resonance imaging, Cardiac catheterization
Least invasive step in assessment?
Inspection
What changes close fetal heart structures?
The first breath and clamping of the cord
Treatment for secondary hypertension
Treat the underlying disease
The nurse caring for children with cardiac disorders knows that cardiac tumors are rare in children, and the type found is almost exclusively:
rhabdomyomas
what is shock and the symptoms?
Inability of the body to maintain adequate blood flow and oxygen supply to meet metabolic needs of tissues. s/s: increased heart rate, decreased BP, can affect all body organs. death if not treated
Interventions for altered tissue perfusion
monitor hemoglobin and hematocrit levels, keep child calm, assist child in knee chest position (decreases venous return), administer oxygen or morphine as ordered for spells
Interventions for Impaired Gas Exchange?
Monitor I and O, Limit fluids as ordered, administered diuretics as ordered, position change every 2 hours as ordered, monitor vital signs, O2 sats, and lung sounds
Interventions for impaired gas exchange
Limit activity, maintain clear airway, and monitor electrolytes
What is hypovolemic shock, causes, and assessment?
overall decrease in circulating blood or fluid volumes. Causes: hemorrhage, burns, dehydration. Assess: vital signs, level of consciousness, skin color, temperature, mucous membranes, cap refill
Indicators of fluid retention
respiratory destress, poor urine output, inappropriate weight gain, inbalanced I and O, Edema, Poor feeding, mottling skin
What usually causes acquired heart defects?
Infection, autoimmune factors, and taratogens (chemicals that cause problems)
The nurse knows that the patient scheduled for cardiac transplantation is at risk for the following complications:
Rejection of the cardiac tissue, infection at the operative site, post transplant lympoproliferative disorder, and transplant coronary artery disease
What should you teach the family post cardiac catherization?
Avoid strenuous activity for 1 week, sponge bath 1-3 days afterwards, return to school 3 days after, cover w band-aid, report signs of infection: drainage, fever, bleeding, pallor, coolness or numbness at site, resume normal feeding
Elevated blood pressure
hypertension
What can cause CHF in children?
L to R shunts, Left obstructive lesions, arrhythmias, infections, tumors, drugs, and toxins
family teaching for kawasaki disease
family coping with irritibability and regression, anorexia-ice pops, high cal liquids not acidic, use straw and favorite bland foods
What are some s/s of congestive heart failure?
Rales, flaring, pallor, fatige, irritability, neck vein distention, decreased urine output, edema
Nursing considerations to decrease cardiac workload r/t CHF
Small frequent feedings (upright, large nipple hole, limit to 30 min, monitor feeding problems), plan for maximum rest, monitor electrolytes, oxygen as needed (use w care), protect from exposure to respiratory illnesses, hold digoxin if apical pulse below 100 in infants
Name a positive inotrope and what do they do?
Digoxin(Lanoxin). They increase contractility
What is a congenital heart defect?
A heart defect that a person is born with
family teaching for cyanosis
wash hands, avoid crowds, recognize triggers for hypercyanotic episodes, antibiotic prophylaxis, support parents in decision-making
Atrioventricular Septal Defect
L to R shunting
Acyanotic
Assessment
- heart murmur
- s/s of congestive heart failure
- mild cyanosis that increases w crying
Nursing Diagnosis
- Risk for impaired growth and development
- Altered nutrition: less than
- Risk for infection
- Impaired gas exchange
A 12 year old patient recieves a diagnosis for Long Q-T syndrome following a fainting spell at school. The pediatric nurse caring for the client tells his parents that the s/s of this disease include:
syncope, seizures, palpitations, and sudden death
Life-threatening defect in which the left ventricle is extremely small and unable to maintain an adequate cardiac output
Hypoplastic left heart syndrome
Where is a cardia catheter placed?
In the femoral artery or vein
What is distributive shock and how do you assess?
abnormality in the distribution of blood flow or inability of the body to maintain vascular tone through vasoconstriction. septic shock, drug intoxication, anaphylaxis, spinal injury. Assess: skin warm flushed. late: skin ashen, cool, vital signs, cap refill consciousness, output
What is decompensated shock? What represents it?
Fail to compensate for shock. Hypotension
How often do congenital heart diseases occur in infants?
8 to 12 per 1000 births.
Early s/s of congestive heart failure?
mild resting tachypnea, increasing difficulty feeding, failure to gain weight
What is congestive heart failure?
Inability to maintain sufficient cardiac output to meet metabolic demands of the body
The nurse planning nursing care for patients across care settings know that _____ requires complex multidisciplinary management and is used as a treatment for severe, life threatening cardiac conditions
cardiac transplant
What are examples of congenital heart defects?
Increased or decreased pulmonary blood flow, mixed disorders, and outflow disorders
Patent Ductus Arteriousus
L to R Shunting
Acyanotic
Assessment
- Depends on amount of shunting
- continuous murmur
- widening pulse pressure
- bounding pulses
- tachypnea
- poor feeding/weight gain
- frequent resp tract infections
- fatigue
- diaphoresis
Nursing Diagnosis
- Risk for impaired G and D
- Altered nutrition: Less than
- Risk for infection
- Impaired gas exchange
