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.