Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Chapter 27: child w/ cardiovascular dysfxn > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Assessment

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indicators of cardiac dysfxn

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Compensatory mechanisms

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CHD and HF dx evaluation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

Obstructive defects: pulmonary stenosis

A

-Narrowing of pulmonary valve or artery
-Cyanosis varies (worsens w/ severe narrowing)
-No tx if mild
-Balloon valvuloplasty if severe

26
Q

Mixed defects: TGA

A

-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
Q

Mixed defects: TAPVC

A

-O2 blood leaking into wrong chamber
-Veins leading from lungs to heart
-Severe –> increased WOB, cyanotic
-Surgery

28
Q

Mixed defects: HRHS

A

-R sided structures undeveloped
-Heart can’t send enough blood to lungs
-Low O2 levels

29
Q

Mixed defects: HLHS

A

-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
Q

Murmurs and thrills

A

-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
Q

Pt teaching for cardiac surgery

A

-TPN or NG tube
-Meds for life (clotting, rejection, BP, infection)

32
Q

Preop assessments

A

-Temp (infection = can’t implant new heart) and weight
-Exam extremities (pulse, edema, rhythm, murmurs)
-Respiratory

33
Q

Postop assessments

A

-ICU monitoring
-Intubation
-Atraumatic care (chest tube removal)
-Monitor for fluid overload
-Progressive activity (may need rehab or PT)
-Rejection, infection, blood clots

34
Q

Chest tubes after surgery

A

-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
Q

Monitor fluid status

A

-Intake: IV, flushes
-Output: urine, chest tube, NG, drains, blood draws
-Urine output < 1 mL/kg/hr = possible renal failure (decreased CO)

36
Q

Postpericardiotomy syndrome

A

-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
Q

CVD meds

A

-IV IgG
-Digoxin (lanoxin) = improve contractility
-ACE inhibitors = reduce afterload
-ASA, NSAIDs
-Lasix = loop diuretic = monitor K
-Spironolactone (aldactone) = K sparing diuretic

38
Q

Acquired disorders: endocarditis

A

-Abx 1 hr before dental procedures
-BE (bacterial), IE (infectious), SBE (subacute BE)
-Streptococci, staphylococci
-Fungal infections

39
Q

Acquired disorders: IE

A

-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
Q

RF

A

-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
Q

Kawasaki disease

A

-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
Q

MIS-C

A

-New syndrome after COVID-19 exposure
-Fever and multisystem organ involvement
-Hypotension, LV dysfxn, arrhythmias, coronary enlargement, effusion
-Tx: IVG, abx, steroid therapy

43
Q

Hyperlipidemia

A

-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
Q

HTN

A

-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
Q

Dyslipidemia

A

-Abnormal lipid metabolism
-Dietary tx: restrict cholesterol and fat
-If no response to diet –> colestipol, cholestyramine
-Cultural food diet consideration

46
Q

Cardiac dysrhythmias

A

-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
Q

PH

A

-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
Q

Cardiomyopathy

A

-Contractility of myocardium is impaired
-Types: dilated, hypertrophic, restricted
-Tx: manage CHF, dysrhythmias
-Meds: digoxin, diuretics, BBs/CCs, dobutamine, nitroprusside, amiodarone

49
Q

Digoxin

A

-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
Q

Furosemide

A

-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
Q

Cardiomyopathy

A

-Restrictive: risk for sudden death esp. w/ competitive sports
-Dilated: most common
-Hypertrophy: common in adolescence

52
Q

Advanced HF

A

-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
Q

Heart transplant: piggyback

A

-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

54
Q
A

Pediatrics (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions