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Pediatrics > Chapter 8: Cardiovascular > Flashcards

Chapter 8: Cardiovascular Flashcards

1
Q

Indications of adequate peripheral perfusion includes:

A

1) cap refill less than 2 sec
2) palpable pulses
3) skin warm to touch
4) able to feel sensations

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2
Q

What are the three types of murmurs and briefly explain each one

A

1) Innocent - no physiological or anatomical cause
2) Functional - physiological cause but not anatomical defect
3) Organic - anatomical defect w/ or w/o physiological abnormality

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3
Q

Murmur that is very loud, w/ a thurst and thrill

A

Grade V

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4
Q

Murmur that is loud w/ a thrill

A

Grade IV

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5
Q

Murmur that is moderately loud w/o a thrill or thrust

A

Grade III

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6
Q

Murmur that is loud enough to be heard w/o a stethocope

A

Grade VI

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7
Q

What type of test can produce images of your heart via pulsed, high-frequency sound waves?

A

Echocardiogram

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8
Q

What type of test provides information about the heart’s electrical activity?

A

ECG/EKG

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9
Q

A TEE can be used in conjunction w/ what test to view the posterior structures of the heart?

A

echocardiogram

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10
Q

Which of the following should be included in your teaching for child who is scheduled for an echocardiogram?

a) Child should NOT eat or drink 2 hours prior to procedure
b) Child should hold as still as possible during the test and refrain from talking
c) Child will have to be restrained to a chair to prevent movement
d) Child will have to perform mild exercise during the test on a treadmill

A

b

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11
Q

What can an ECG/EKG detect?

A
  • arrhythmias
  • ischemia
  • injury
  • necrosis
  • blocks
  • conduction delays
  • chamber enlargement
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12
Q

The nurse has admitted a child w/ a cyanotic heart defect. The nurse would expect the initial lab results to show which of the following?

a) a high Hgb
b) low Hct
c) high WBC count
d) low platelet count

A

b

Bone marrow produces more RBCs in response to hypoxia

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13
Q

What type of test can show cross-sections of the heart?

A

MRI

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14
Q

What questions would you ask the patient prior to having an MRI?

A
  • metal objects/jewelry
  • tattoos
  • allergies to shellfish and iodine
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15
Q

MRIs are helpful in detecting:

A

congenital (birth) defects

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16
Q

Valve replacements are indicated for:

A

heart valve narrowing (stenosis) and heart valve leaking (insufficiency)

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17
Q

Valvular problems are commonly caused by what?

A
  • Rheumatic Fever
  • Congenital Heart Defects
  • Heart Failure
  • Endocarditis
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18
Q

What are the most important things to monitor post-op valve replacement?

A

HAT

  • hypotension
  • arrhythmias
  • thrombus formation
  • VS
  • I/O
  • weight
  • labs
  • CXR
  • ABGs
  • Pulmonary catheter readings
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19
Q

S/S of bleeding include

A
  • black, tarry stools (GI)
  • bleeding gums
  • excessing bleeding from minor cuts and scrapes
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20
Q

Which of the following is true regarding a valve replacement

a) Valves will need to be replaced every 5 years
b) You will not be allowed to exercise at all
c) Lifetime anticoagulant therapy will be necessary
d) A valve replacement will shorten one’s life by 10-15 years

A

C

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21
Q

What should you include in your teaching regarding a valve replacement?

a) use a medium bristled brush when brushing your teeth
b) antibiotics should be taken prior to any dental work or invasive procedures to prevent endocarditis
c) Clicking sounds are abnormal and should be reported to the provider immediately
d) excessive bleeding is expected when having a minor cut and can be treated simply by applying a cold compress

A

b

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22
Q

What procedure requires an insertion of a radiopaque catheter via the femoral artery in order to visualize the heart and vessels?

A

Cardiac cath

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23
Q

It is normal for the patient to feel cool after the contrast is injected for a cardiac catherization.

True/False

A

False

“warm” not “cool”

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24
Q

What should you include in your assessment pre-op a cardiac catheterization

A
  • weight
  • I/O
  • Child’s color, temperature, and pedal pulses (mark distal pulses w/ indelible ink)
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25
Q

Nursing care post-op a cardiac catheterization includes:

A
  • keeping the affected area immobile for 4-6 hrs to prevent hemorrhage
  • restrict fluids to prevent hypervolemia (as orders)
  • instruct to rest to prevent cardiac overload
  • ensure adequate fluid intake (fluid or I.V.) to compensate for blood loss during procedure and diuretic action of contrast
  • monitor I/O, V/S, S/S of infection, rejection adverse rxns from immunosuppressive therapy, hemorrhage, hematoma formation
  • keep child warm to prevent heat loss
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26
Q

What would you instruct the child’s parents regarding the care of their child at home post-op cardiac catheterization?

1) How to clean the site
2) Activity
3) Diet
4) Pain management
5) What to monitor for

A

Cleaning site:

  • remove pressure dressing day after procedure
  • continue to cover site w/ adhesive bandage for several days
  • keep affected area clean and dry
  • give sponge baths only until site is healed

Activity:
-avoid strenuous exercise

Diet:
-regular

Pain:
-ibuprofen or tylenol

Monitor:

  • temperature; report fever asap (for infection)
  • redness, swelling, drainage, and bleeding at site
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27
Q

Chest tubes are generally removed how many days after cardiac surgery?

A

1st to 3rd day

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28
Q

It is normal for the child’s temperature to be elevated up to 100F in the first 48 hrs following a cardiac surgery.

True or False

A

True

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29
Q

What congenital heart defects increase pulmonary blood flow/

A
  • ASD
  • VSD
  • PDA
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30
Q

An opening between the left and right atrium is referred to as what congenital heart defect?

A

Atrial Septal Defect

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31
Q

An opening between the left and right ventricle is referred to as what congenital heart defect?

A

Ventrical Septal Defect

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32
Q

When the conduit between the pulmonary artery and aorta fails to close 24-48 after birth, it is referred to as what congenital heart defect?

A

Patent Ductus Arteriosus

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33
Q

ASD can result to:

A
  • Right atrial and ventricle volume overload
  • pulmonary artery HTN
  • Right ventricular hypertrophy
  • heart failure
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34
Q

Signs and symptoms of ASD includes:

A
  • fatigue after exercise
  • mid-systolic murmur at the 2nd-3rd left ICS
  • diastolic murmur at the left lower sternal border
  • clubbing, cyanosis
  • asymptomatic
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35
Q

Cyanosis that worsens with crying is most likely associated with cardiac/pulmonary causes because crying increases pulmonary resistance to blood flow, resulting in an increased right-to-left shunt.

A

cardiac

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36
Q

Cyanosis that improves with crying is most likely due to cardiac/pulmonary causes because deep breathing improves tidal volume

A

pulmonary

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37
Q

How is ASD treated?

A
  • antibiotics to prevent endocarditis

- surgery

38
Q

How is PDA treated?

A
  • indomethocin

- surgery

39
Q

In PDA, you can expect the following:

A
  • machine-hum murmur
  • bounding pulses
  • wide pulse pressure
  • HF
40
Q

The failure of the ventricular septum to close @ 8 weeks gestation is referred to which congenital heart defect?

A

Ventricular Septum Defect (VSD)

41
Q

The ventricle septum can close spontaneously. True/False

A

True

42
Q

VSD can result to

A
  • HF
  • liver, heart spleen enlargement
  • cyanosis, clubbing if R-to-L shunt occurs
  • tachycardia, diaphoresis
43
Q

Obstructive defects include

A
  • coarctation of the aorta
  • pulmonary stenosis
  • atrial stenosis
44
Q

The narrowing of the aorta is referred to as what obstructive defect?

A

coarctation of the aorta

45
Q

If the coarctation of the aorta is left untreated it can cause:

A

Left sided heart failure

46
Q

What would you expect to find in terms of blood pressure and pulse in a child with a coarctation of the aorta?

A
  • elevated BP + bounding pulses in upper extremities (head, neck, arms)
  • decreased BP + weak pulses in the lower extremities (legs, trunk, femoral)
47
Q

Coarctation of the heart can cause the following:

A
  • HA, dizziness, fainting
  • nosebleeds
  • difficulty walking**
48
Q

Heart Failure is usually treated with

A
  • digoxin
  • K+ wasting diuretics (encourage diet hight in potassium)
  • ACE inhibitors (monitor BP and K+ levels; causes vasodilation)
  • beta blockers (causes vasodilation)
  • oxygen
49
Q

Narrowing of the pulmonic valve or artery is referred to as

A

pulmonary stenosis

50
Q

Narrowing of the aortic valve is referred to as

A

aortic stenosis

51
Q

S/S of Pulmonary Stenosis includes:

A
  • systolic ejection murmur
  • cyanosis
  • cardiomegaly

(Right side would be obstructed because blood is coming from the right when is going through the pulmonary artery. This causes right ventricular hypertrophy and right sided heart failure)

52
Q

S/S of Aortic Stenosis includes:

A
  • pulmonary edema d/t to back flow of blood into lungs thus causing left sided heart failure and left ventricular hypertrophy
  • infant: faint pulses, hypotension, tachycardia, poor feeding
  • child: exercise intolerance, dizzy, CP, ejection murmur
53
Q

Teralogy of Fallot includes which defects:

A
  • pulmonary stenosis
  • overidding aorta (OA)
  • right ventricular hypertrophy (RVH)
  • ventricular septum defect (VSD)
54
Q

The hallmark sign of Teralogy of Fallot is

A

cyanosis

55
Q

Blood shunts from right to left with Teralogy of Fallot causing deoxygenated blood to mix w/ oxygenated blood thus causing child to appear cyanotic. True/False

A

True

56
Q

S/S of Teralogy of Fallot

A
  • Cyanosis (worsens in 1st year of life)

- systolic murmurs

57
Q

Babies/children w/ Tet/Blue spells would appear

A

cyanotic

58
Q

Babies with Pink tets would appear

A

non-cyanotic

59
Q

S/S of tet or pink tets include:

A
  • dyspnea
  • bradycardia
  • deep “sighing” respirations
  • syncope
  • occurs mainly in the AM preceded by crying, feeding, or BM
60
Q

Tet or Pink Tets can be managed by

A
  • knee-to-chest positioning
  • oxygen
  • morphine (aids in vasodilation)
  • beta blockers (prevents Tet spells)
  • ABX (prevents endocarditis)
  • surgical shunt repair
61
Q

Infective (Bacterial) Endocarditis affects which part of the heart

A

inner lining (heart, valves, prosthetics)

62
Q

Untreated endocarditis can lead to:

A
  • permanent valvular damage
  • HF
  • death
63
Q

Endocarditis can be treated with

A

ABXs (geramycin)

64
Q

S/S of endocarditis includes

A
  • malaise
  • fever (may recur for weeks)
  • myalgias/artralgias
  • HA
  • weight loss
  • splenomegaly
  • petechiae
  • splinter hemorrhages under nail*
65
Q

Osler’s nodes, Janeway lesions, and Roth’s spots are all signs of

A

endocarditis

66
Q

Purplish macule of palms and fingers?

A

Janeway lesions

67
Q

Tender, raised, subQ lesions on fingers, toes?

A

Osler’s nodes

68
Q

Hemorrhagic areas w/ white centers on retina?

A

Roth’s Spots

69
Q

Signs of Heart Failure includes

A
  • tachycardia (early); bradycardia (late)
  • diaphoresis
  • cool extremities (d/t poor peripheral perfusion)
  • peripheral edema*
  • respiratory distress
  • hepatomegaly
  • weight gain
70
Q

What to monitor for in patients w/ HF

A
  • weigh (daily)
  • HR, BP
  • BUN, creatinine, electrolytes
  • peripheral edema*
71
Q

Nursing interventions for HF

A
  • oxygenation (improves tissue perfusion)
  • positioning in semi-fowlers position (decreases resp. effort)
  • sedation/analgesics
  • restrict sodium (Na+)
  • conserving energy
  • provide quiet, restful environment
  • increase caloric intakes
72
Q

Signs of digoxin toxicity includes

A
  • N/V
  • anorexia
  • abdominal pain
  • arrhythmias
73
Q

When providing digoxin for heart failure, it is important to check the ________ pulse for ______________ and withhold if:

A
  • apical
  • 1 minute
  • infant: <90 - 110/min
    children: <70/min
74
Q

Which disease is characterized as the “strawberry tongue”?

A

Kawasaki disease

75
Q

In the acute phase of Kawasaki Disease, a child can expect the following

A
  • fever (>102.2) over 5 days
  • red eyes w/o discharge; conjunctivitis
  • strawberry tongue w/ white coating or red bumps on posterior
  • lymphadenopathy
  • intense oral, palmar, and plantar erythema and sweeping
  • dermatitis of trunk
  • maculopapular rash
76
Q

Treatment of Kawasaki Disease includes:

A
  • high doses of aspiring (80-100 mg/kg/day q 6h (anti-inflammatory dose)
  • IVIG - IV immune globulin (2g/kg over 8-12 hrs)

-

77
Q

When taking aspirin, you should advise client to take it with

A

milk or food

78
Q

Aspirin therapy for a child w/ Kawasaki Disease should be increase/decreased by ___________mg/kg/day if child has been afebrile for at least 6-8 weeks

A
  • decrease

- 3-5 mg/kg/day

79
Q

Children w/ Kawasaki Disease should avoid

A
  • immunization for 11 months

- second-hand smoke

80
Q

Signs of Aspirin toxicity includes:

A
  • tinnitus
  • bleeding
  • hyperventilation
  • drowsiness
81
Q

Nursing care for a child w/ Kawasaki Disease includes

A
  • applying cool cloths to skin
  • apply lotion
  • provide sponge baths w/ tepid (slightly warm) water
  • provide quite environment
  • perform passive ROM in bathtub
  • provide heart healthy diet
  • provide IV or PO foods, soft foods
82
Q

Rheumatic fever is usually acquired

A

genetically

83
Q

Rheumatic fever usually develops _________ weaks after

A

being infected with GABHS (group A beta-hemolytic streptococci)

84
Q

Rheumatic fever involves which parts of your body?

A
  • heart
  • joints
  • CNS
  • skin
  • SubQ tissues
85
Q

Treatment for Rheumatic fever includes

A

-ABXs (penicillin 200,000 units daily for 2 days or PCN G 1.2 million units IM monthly or Sulfadiazine 1 gm PO daily)

86
Q

Clients w/ Rheumatic fever should be advised to take

A

ABXS before, during, and after dental work or major surgeris

87
Q

Length of treatment for rheumatic fever can last up to

A

5 years or more depending on the type carditis

88
Q

What is used to diagnose Rheumatic Fever?

A

Jones Criteria

89
Q

Jone’s Major Criteria includes which of the following?

  • endocarditis
  • joint pain (arthralgia)
  • SubQ nodules
  • fever
  • joint pain (migratory polyarthritis)
  • erythema marginatum
  • prolonged PR intervals
  • elevated acute phase reactants
  • sydenhams’ chorea (rapid, jerky, movements)
A
  • endocarditis
  • SubQ nodules
  • joint pain (migratory polyarthritis)
  • erythema marginatum
  • sydenhams’ chorea (rapid, jerky, movements)
90
Q

Jone’s Minor Criteria includes which of the following?

A
  • fever
  • prolonged PR intervals
  • joint pain (arthralgia)
  • elevated acute phase reactants
91
Q

Jones Criteria requires the following in order for a client to be diagnosed w/ Rheumatic Fever

A

2 major criteria + 1 minor
1 major criteria + 2 minor

w/ evidence of a previous GABHS infection

92
Q

Lab findings would indicate the following for rheumatic fever

A
  • (+) ASO titer (most reliable)
  • (+) throat culture
  • elevated WBC
  • Elevated ESR, + CRP (C-reactive protein)
  • 1 degree AV block on ECG

Pediatrics (5 decks)

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