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Chapter 27: child w/ cardiovascular dysfxn Flashcards

1
Q

Birth changes

A

-Foramen ovale: closes w/ exposure fo O2
-Ductus arteriosus: starts to close w/ increased O2

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2
Q

Assessment

A

-Murmur: normal, will be outgrown
-Tachy, brady, BP
-Dx: EKG, TEE, MRI, CT

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3
Q

Cardiac catheterization

A

-Severe cases
-Very invasive
-Anesthesia
-Post op bleeding
-Keep legs straight for 4-6 hrs
-Sedation may be needed to keep the child still

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4
Q

Cardiac catheterization: Nursing mgmt

A

Preprocedural
-NPO (risk of hypoglycemia)
-Sedation (risk of respiratory arrest)

Postprocedural
-Monitor pulses, temp, colors of extremity
-Respiratory
-VS q15m
-Prevent immobility
-I&Os

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5
Q

s/s of cardiac disorder

A

-Cyanosis (bluish tints of lips)
-Tachypnea
-Edema
-Clubbing (not common in child unless w/ CF)
-Fever
-Retractions (hard to eat, risk of being underweight)
-Prominence of precordial chest wall (seen in cardiomegaly)
-Engorged or abnormal pulsations
-Abdominal distention (usually liver)

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6
Q

Hypoxemia

A

-Hypoxemia: low arterial O2 tension (give prostaglandin E1)
-Hypoxia: low O2 in tissue
-Cyanosis: low O2 in blood
-s/s: polycythemia, clubbing, hypercyanotic (TET) spells (sudden episode of profound cyanosis and hypoxia)

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7
Q

Indicators of cardiac dysfxn

A

-Poor feeding
-Development delays
-FTT
-Diaphoresis (babies don’t sweat, child shouldn’t be dripping sweat)

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8
Q

Types of cardiac defects

A

Congenital
-Anatomic, abnormal fxn, majority of birth defects

Acquired
-After birth, disease process, can be complication of CHD

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9
Q

Hx indicators of cardiac dysfxn

A

-s/s occur 4-12 weeks after birth (FTT, diaphoresis, cyanosis)
-Developmental delays: not meeting milestones
-Prenatal hx: exposure, autoimmune disorders, med use
-Family hx: 1st degree genetic link

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10
Q

CHD

A

-Chronic illness –> DM or PKU, alc consumption, teratogen exposure
-Genetic –> family hx
-Chromosomal abnormalities
-Altered hemodynamics
-Most sympotamic in 1st yr of life
-Major cause of death in 1st year of life (failure to identify issue)
-Most common anomaly is VSD (ventricular septal defect)

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11
Q

Causes of CHD

A

-Maternal drug use (FAS)
-Maternal illness: rubella in 1st 7 weeks –> PDA, pulmonary branch stenosis; CMV, toxoplasmosis, virus –> cardiac defect; diabetic mothers –> cardiomyopathy, TGA
-Chromosomal/geneitc
-Multifactorial

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12
Q

CHF and CF

A

-Volume overload
-Pressure overload
-Decreased contractility
-High output demands
-Right side failure: hepatomegaly and edema in extremities
-Left side failure: pulmonary edema

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13
Q

Compensatory mechanisms

A

-Cardiac reserve: hypertrophy of cardiac muscle
-CO: stimulation of SNS to maintain
-Renal response: decreased output

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14
Q

CHD and HF in children s/s

A

-Impaired myocardial fxn: tachy, fatigue, pale, cool extremities, decrease output., decreased BP, gallop rhythm (S3 and S4)
-Pulmonary congestion: tachypnea, dyspnea, exercise intolerance, cyanosis
-Systemic venous congestion: peripheral and periorbital edema, weight gain, scite, neck vein distention, hepatomegaly

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15
Q

CHD and HF nursing mgmt

A

-Big adjustment
-Education and emotional support
-Encourage bonding
-Cardiac glycosides and ACE inhibitors
-Diuretics (fluid/Na restriction)
-Neutral thermal environment, treat infections, position for comfort, med for sedation, decrease environmental stimuli, supplemental O22

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16
Q

CHD and HF dx evaluation

A

-Tachypnea and tachy, activity intolerance, weight gain
-Chest x-ray: cardiomegaly
-EKG: ventricular hypertrophy

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17
Q

CHD classifications

A

1) defects w/ increased pulmonary blood flow: PDA, ASD, VSD
2) defects w/ decreased pulmonary blood flow: TOF, tricuspid atresia
3) obstructive defects: coarctation of aorta, aortic stenosis, pulmonary stenosis
4) mixed defects: mixing of O2 blood w/ unO2 blood: transdisposition of great arteries, TAPVR, truncus arteriosus, hypoplastic L heart syndrome

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18
Q

Defects w/ increased pulmonary blood flow: PDA

A

-Connection btwn aorta and pulmonary artery is open d/t failure of ductus arteriosus to close
-If mild, can close on own
-Surgical closure

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19
Q

Defects w/ increased pulmonary blood flow: ASD

A

-Hole in septum btwn R and L atria
-L to R shunt
-If mild, closes on own
-Surgical closure

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20
Q

Defects w/ increased pulmonary blood flow: VSD

A

-Hole in septum btwn R and L ventricle
-L to R shunt
-May cause fluid buildup in lungs
-Surgical closure

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21
Q

Defects w/ decreased pulmonary blood flow: TOF

A

-Pulmonary stenosis or atresia (pink vs blue), VSD, overriding aorta, RV hypertrophy
-Pink TET spells: mild, normal O2 levels, loud cardiac murmur
-Blue TET spells: cyanotic very quickly during feeding or crying (rapid drop in O2), pass out, characteristic of TOF
-Child squats during TET spells
-TET spell mgmt: immediately put in knee to chest position

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22
Q

Defects w/ decreased pulmonary blood flow: tricuspid atresia

A

-Valve btwn R atrium and R ventricle fails to develop
-Complete closure of tricuspid valve
-Atresia means narrow
-Most often SIDS
-Hoping for atrial septal defect (keeps them alive)

23
Q

Obstructive defects: coarctation of aorta

A

-Narrowing or pinching of aorta (decreased blood flow)
-BP elevated in arms, decreased in legs (will be cool, weak pulses)
-Surgery after birth

24
Q

Obstructive defects: aortic stenosis

A

-Narrowing of aortic valves
-Infants: faint pulses, hypotension, tachy, poor feeding
-Child: exercise intolerance, dizziness, chest pain

25
Obstructive defects: pulmonary stenosis
-Narrowing of pulmonary valve or artery -Cyanosis varies (worsens w/ severe narrowing) -No tx if mild -Balloon valvuloplasty if severe
26
Mixed defects: TGA
-Complete transposition of great arteries (D-TGA): reduces O2 rich blood in body, w/o tx = death -Congenitally corrected transposition (L-TGA): less common, tx depends -Surgery is usually done
27
Mixed defects: TAPVC
-O2 blood leaking into wrong chamber -Veins leading from lungs to heart -Severe --> increased WOB, cyanotic -Surgery
28
Mixed defects: HRHS
-R sided structures undeveloped -Heart can't send enough blood to lungs -Low O2 levels
29
Mixed defects: HLHS
-L sides structures underdeveloped -Skinny aorta, absent mitral valve -Must have PDA or ASD -If PDA closes = death -Immediately after birth --> continuous prostaglandin E: AKA alprostadil, prostin, PgE, temporary maintenance of ductus arteriosus, via IV, may cause apnea, fever and irritability, risk for NEC -Palliative surgical repair: norwood (new larger aorta), bidirectional glenn (SVC attached to RPA and divided blalock-taussig shunt), fontan (conduit to connect IVC to RPA, fenestration btwn conduit and RA) -Eventual heart transplant
30
Murmurs and thrills
-Murmur: heart sounds that reflect blood flow, can occur in periods of stress -Innocent murmurs: normal -Thrills: soft vibration over heart that reflects transmitted sound of heart murmur
31
Pt teaching for cardiac surgery
-TPN or NG tube -Meds for life (clotting, rejection, BP, infection)
32
Preop assessments
-Temp (infection = can't implant new heart) and weight -Exam extremities (pulse, edema, rhythm, murmurs) -Respiratory
33
Postop assessments
-ICU monitoring -Intubation -Atraumatic care (chest tube removal) -Monitor for fluid overload -Progressive activity (may need rehab or PT) -Rejection, infection, blood clots
34
Chest tubes after surgery
-Drainage hourly for color and amt -3 days after, shouldn't be red (serosanguinous) -Purulent = infection -Notify surgeon if drainage > 3 mL/kg/hr x 3 consecutive hrs or 5-10 mL/kg in any 1 hr (possible hemorrhage) -Alert for cardiac tamponade (rapid onset, emergency, fluid build up in sac around heart = pressure)
35
Monitor fluid status
-Intake: IV, flushes -Output: urine, chest tube, NG, drains, blood draws -Urine output < 1 mL/kg/hr = possible renal failure (decreased CO)
36
Postpericardiotomy syndrome
-s/s: fever, WBCs, pericardial friction rub, pleural effusion, -1-3 weeks to show -Cause unknown -After surgery is done -May need pericardiocentesis or pleurocentesis
37
CVD meds
-IV IgG -Digoxin (lanoxin) = improve contractility -ACE inhibitors = reduce afterload -ASA, NSAIDs -Lasix = loop diuretic = monitor K -Spironolactone (aldactone) = K sparing diuretic
38
Acquired disorders: endocarditis
-Abx 1 hr before dental procedures -BE (bacterial), IE (infectious), SBE (subacute BE) -Streptococci, staphylococci -Fungal infections
39
Acquired disorders: IE
-Heart murmur -Insidious, malaise, low fever -Splenomegaly -Osler nodes = red, painful nodes on pads of fingers -Janeway spots: painless hemorrhagic spots on palms and soles -Major criteria: blood cultures, echo findings -Minor criteria: fever, predisposing risk factors -Tx: abx PICC line 2-8 weeks, repeat cultures, if no response to abx = prosthetic valves, dental hygiene
40
RF
-Rheumatic fever -Group A beta-hemolytic streptococcal -Seen in developing countries -Affects joints (polyarthritis), skin, brain, serous surfaces, and heart (carditis), erythema marginatum (rash on trunk and proximal extremities, nonpruritic), subcutaneous nodules (over bony prominences) -RHD: most common complication, damage to valves -Tx: penicillin oral x 10 days, penicillin G IM x 1 dose, sulfa oral x 10 days, erythromycin (if allergic to above) oral x 10 days
41
Kawasaki disease
-Acute systemic vasculitis (inflammation of blood vessels) -6-8 weeks -May be autoimmune, cause unknown -w/o tx = cardiac complication (ectasia, giant aneurysms > 8 mm) -s/s: soles of feet peeling, extremely irritable, high fever, strawberry tongue, arthritis, in late winter or early spring, similar to strep A (misdiagnosed) -Antipyretics don't relieve fevers = risk for seizures -Dx: prolonged fever w/ 4/5: conjunctivitis, inflammation of oropharynx, rash, extremity changes, cervical lymphadenopathy -Mgmt: high dose of aspirin for couples months, IV Ig, follow up w/ cardio for 6 m - 1 yr, reduce stimulation, keep them calm
42
MIS-C
-New syndrome after COVID-19 exposure -Fever and multisystem organ involvement -Hypotension, LV dysfxn, arrhythmias, coronary enlargement, effusion -Tx: IVG, abx, steroid therapy
43
Hyperlipidemia
-High fat in blood -Screening is key for high risk children (family hx or parent w/ high cholesterol) -Cholesterol > 210 is concerning -Diet 1st step
44
HTN
-BP persistently > 95th for age, gender, height -PreHTN: > 90-95th percentile for age, gender, height -Normal: < 90th percentile for age, gender, height -Primary: no underlying cause -Secondary: d/t underlying medical condition
45
Dyslipidemia
-Abnormal lipid metabolism -Dietary tx: restrict cholesterol and fat -If no response to diet --> colestipol, cholestyramine -Cultural food diet consideration
46
Cardiac dysrhythmias
-Dx: ECG, holter, cardiac catheter, TE -SVT is most common tachydysrhythmia (extremely tachy, reversed w/o meds, have them blow hard into straw or blow bubbles)
47
PH
-Pulmonary HTN -Progressive, eventually fatal, no cure -CHD w/ L to R shunt at high risk -Eisenmenger syndrome: R sided HF bc pump is ineffective against increased pulmonary resistance
48
Cardiomyopathy
-Contractility of myocardium is impaired -Types: dilated, hypertrophic, restricted -Tx: manage CHF, dysrhythmias -Meds: digoxin, diuretics, BBs/CCs, dobutamine, nitroprusside, amiodarone
49
Digoxin
-Count apical pulse for 1 min before amin -Withhold if pulse < 70 BPM in child of < 90 BPM in infant -Don't give w/ meals -Give q12h and at same times every day -If vomiting = don't give med -Monitor K level -s/s of toxicity: N/V/D, lethargy, brady (get a dig level)
50
Furosemide
-Lasix -Inhibits reabsorption of NaCl -Drug fo choice for severe HF -Diet high in K or supplements -Monitor BP and weight daily -Adverse effects: N/V, dizziness
51
Cardiomyopathy
-Restrictive: risk for sudden death esp. w/ competitive sports -Dilated: most common -Hypertrophy: common in adolescence
52
Advanced HF
-Ross HF classification -CRT -Mechanical ventilation -s/s: tachypnea, exercise intolerance, decrease in # of wet diapers, sucking then tiring quickly -Mgmt: improve tissue O2, decrease O2 consumption -Tx: heart transplant (severe cases)
53
Heart transplant: piggyback
-Recipient's own heart is left in place and new heart is implanted as additional pump -Rarely done -Noncompliance w/ intense med regimen can lead to death or rejection -1st 6 m - 1 y after surgery = most complications
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Pediatrics (24 decks)

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