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Pediatrics > CHapter 41 > Flashcards

CHapter 41 Flashcards

1
Q

what are types of cardiac defects?

A
  1. congenital
  2. acquired - infection, autoimmune response
  3. Vascular dysfunction - kawasaki disease
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2
Q

what are some risk factors for cardiac conditions

A
  1. maternal factors - infection (rubella), alcohol and substance abuse during pregnancy, DM
  2. genetic factors - congenital conditions, down syndrome, and other chromosomal diseases
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3
Q

what are indicators of cardiac dysfunction?

A
  1. poor feeding
  2. tachycardia and tachypnea
  3. failure to thrive/ poor weight gain/ activity intolerance
  4. developmental delays
  5. prenatal and/ or family history of cardiac disease
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4
Q

manifestations of heart failure

A
  1. impaired cardiac function
    • sweating, tachycardia, fatigue, pallor, cool extremities with weak pulse, hypotension, cardiomegaly
  2. pulmonary congestion
    • tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, exercise intolerance
  3. systemic venous congestion
    • hepatomegaly, peripheral edema, ascites, neck vein distention, periorbital edema, weight gain
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5
Q

hypoxemia manifestation

A
  • Cyanosis
  • Poor weight
  • Tachypnea
  • Dyspnea
  • Clubbing
  • Polycythemia
  • Weight gain
  • Hypercyanotic spells (blue or Tet spells)
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6
Q

diagnostic tests for cardiac dysfunction

A
  1. chest xray
  2. ecg
  3. echocardiogram
  4. cardiac catheterzation
  5. lab test (Hgb, Hct, electrolytes)
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7
Q

pre-pocedure nursing considerations for cardiac catheterization

A

• Perform a nursing history and physical exam
• Check for allergies (iodine)
• Age appropriate teaching
• NPO 4-6 hours prior
• Obtain baseline vitals, including oxygen saturation
• Mark the location and quality dorsalis pedis and posterior tibial
pulses on both extremities.
• Administer pre-sedation

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8
Q

post procedure considerations for cardiac catheterization

A

• Provide continuous cardiac monitoring and oxygen saturation to
assess for bradycardia, dysrhythmias, hypotension, hypoxemia.
• Assess heart rate and respiratory rate for 1 full minute.
• Assess pulses for equality and symmetry
• Assess the temperature and color of the affected extremity:
• Assess insertion site for bleeding or hematoma.
• Maintain a clean dressing
• Prevent bleeding:
• Monitor I & O for hypovolemia or dehydration
• Monitor for hypoglycemia.

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9
Q
  1. what can cause an increase in pulmonary blood flow?

2. what are examples of defects that increase pulmonary blood flow?

A
  1. -abnormal connection between both sides of the heart
    • increased blood volume in right side of heart
    • decreased systemic blood flow
  2. Atrial septal defects, ventricular septal defects, patent ductus arteriosus
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10
Q

what can cause a decrease in pulmonary blood flow

A

decreased blood volume on right side of heart

increase systemic blood flow

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11
Q

What are some obstruction defects?

A
  1. coarctation of the aorta

2. aortic stenosis and pulmonary stenosis

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12
Q

Decreased Pulmonary Blood

Flow Defects

A
  • Tetralogy of Fallot

* Tricuspid atresia - abnormal narrowing

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13
Q

patient centered care

  1. VSD
  2. ASD
  3. PDA
A
  1. -Cardiac Catheterization
    -diuretics
  2. Cardiac Catheterization (careful observation)
    • Diuretics
    • Low dose aspirin 6 months after procedure
  3. Administration of indomethacin
    • Administration of diuretics
    • Protective extra clothes for infants
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14
Q

patient centered care:

  1. pulmonary stenosis
  2. aortic stenosis
  3. coarctation f the aorta
A
  1. balloon angioplasty with cardiac catheterization
  2. balloon dilation, beta blockers and calcium channel blockers
  3. surgical repair on children less than6 years of age, balloon angioplasty and stent placement for adolescents
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15
Q

patient centered care

  1. tricuspid
  2. tetralogy of fallout
  3. transposition of great arteries
  4. truncus areteriosis
  5. hypoplastic left heart syndrome
A
  1. surgical repair
  2. surgical repair in first year of life, with shunt placement until undergo surgery
  3. surgery switching arteries in first 2 weeks of life, IV prostaglandin E, stent placement in adolescents
  4. surgical repair in first month of life
  5. repair shortly after birth
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16
Q

Infective endocarditis

  1. what causes this?
  2. what are risk factors
  3. Expected findings?
  4. how is it diagnosed
  5. complications
A
  1. Bacterial : Strep. virdians, Candida albicans, and Staph aureus
  2. indwelling catheters
  3. fever, malaise, new murmurs
    • diaphoresis
    • feeding problems
    • tachycardia
    • septicemia
  4. CBC ESR, Blood cultures, ECG
  5. Myocardial Infarction, heart failure, embolism
17
Q

what are nursing responsibilities for Infective endocarditis?

A

• Administer antibiotics parenterally for up to 8 weeks via
peripherally inserted central catheter (PICC)
• Oral care - Preventative oral care for children with existing cardiac problems
• Education: Advise dentist of need for prophylactic antibiotics prior to
dental and surgical procedures, observe for signs of infection.

18
Q

Rheumatic fever

  1. Pathophysiology
  2. where is it common
  3. what does it affect
A
  1. • Inflammatory disease occurs after group A β-hemolytic streptococcal
    pharyngitis
  2. • Infrequently seen in U.S.; big problem in Third World
  3. • Self-limiting
    • Affects joints, skin, brain, serous surfaces, and heart
19
Q

talk about rheumatic heart disease and what it affects

  1. what are some clinical manifestations
  2. what are some diagnostic procedures
A
  1. most common complication of rheumatic fever
  2. damage to valves
    3.• Carditis
    • Polyarthritis
    • Erythema marginatum (Rash)
    • Subcutaneous nodules
    • Chorea
    • Fever
  3. Chest xray, ECG, echocardiogram
20
Q
  1. treatment of RHD

2. this is the same as

A
  1. • Penicillin G—IM x 1
    • Penicillin V—oral BID x 10 days
    • Sulfa—oral QD x 10 days
    • Erythromycin (if allergic to above)—oral x 10 days
  2. Treatment of streptococcal tonsillitis/pharyngitis
21
Q

how is Kawasaki disease treated

A
  1. IV igG and ASA
22
Q

systemic hypertension

  1. what is the difference between primary and secondary
  2. what are some causes in pediatrics
A
  1. primary is no known cause, and secondary is a known cause

2. renal disease, CV disease, endocrine or neurologic disorder

23
Q

pulmonary artery hypertension

  1. Risk
  2. Expected findings
  3. How is this diagnosed
  4. Nursing actions
A
  1. Genetic
  2. Dyspnea, chest pain syncope
  3. Xray, ECG, echocardiogram, Cardiac catheterization
  4. Family support, Oxygen, prostacyclin, and educate about avoiding high altitudes, adhere to medication
24
Q

dyslipidemia

  1. patho
  2. nursing consideration
  3. treatment
A
  1. Abnormally elevated cholesterol or fats (lipids) in the blood.
  2. dietary (restrict intake of cholesterol and fat). If no response to diet, use drugs (colestipol, cholestyramine)
25
Q

Cardiomyopathy

  1. risk factors
  2. expected findings
  3. Patient centered care
  4. how is this diagnosed
A
  1. genetics, infections, metabolic conditions, drug toxicity, dysrhythmias
  2. tachycardia, dysrhythmia, dyspnea, hepatosplenomegaly, fatigue, poor growth and feeding, chest pain, and syncope.
  3. beta blockers, Calcium channel blockers
    ace inhibitors, anticoagulants and heart transplant
  4. chest xray, ecg echo, cardiac catheterization
26
Q

cardiogenic shock

  1. Patho
  2. risk
  3. expected findings
  4. diagnosed through?
A
  1. impaired cardiac function that leads to decrease in cardiac output
  2. recent cardiovascular surgery, dysrhythmias, anaphylaxis
  3. Dyspnea, crackles, grunting, hypotension,
    tachycardia, weak peripheral pulses
  4. similar to others
27
Q

care for cardiogenic shock

A

• Remain calm
• Increase tissue oxygenation:
• Decrease workload of heart:
• Keep the child well-hydrated/Maintain fluid and electrolyte imbalance:
• Conserve the child’s energy
• Provide adequate nutrition:
• Perform daily weight and I & O to minor fluid status and nutritional status
• Monitor heart rate, blood pressure, serum electrolytes, renal function to assess for
complications
• Administer prescribed medications

28
Q

what are some drugs used for CV disorders

A
  • IV IgG
  • Digoxin (Lanoxin)
  • ACE inhibitors (Captopril Enalapril)
  • ASA, NSAIDs
  • Beta-Blockers (Metoprolol Carvedilol)
  • Potassium wasting diuretics (Furosemide, Chlorothiazide)
  • Spironolactone (Aldactone)
29
Q

Cardiac dysrhythmias and how it is diagnosed

A
  • ECG
  • Holter Monitoring
  • Electrophysiologic cardiac catheter
  • Transesophageal recording
30
Q
  1. how is bradydysrhythmias treated
A
  1. AV block, and may use pace maker
31
Q

Postoperative Care for the Child

A
  • Monitor vital signs and A/V pressures
  • Intra-arterial monitoring of BP
  • Intra-cardiac monitoring
  • Respiratory needs
  • Rest, comfort, and pain management
  • Fluid management
  • Progression of activity

Pediatrics (15 decks)

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