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NRS G240 Exam #3 > CHD > Flashcards

CHD Flashcards

1
Q

What is the most common pediatric anomaly?

A

VSD

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2
Q

Hx and physical exam: Risk factors (3)

A
  • Maternal health, environment and genetics
  • drug use or medication use
  • Rubella exposure
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3
Q

What to assess for in maternal, environmental and genetics hx? -3

A
  • CMV, toxoplasmosis

- IDMs

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4
Q

Drug use or medication use in history -2

A
  • FAS

- Dilantin

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5
Q

How to assess for cyanosis in an infant

A

Blanch nose or may notice it on lips

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6
Q

In children, where is edema first and last seen

A

-periorbital —> sacral

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7
Q

What to look for in the chest

A

Precordial chest wall

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8
Q

Which peripheral pulses to check in children

A

Brachial and femoral

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9
Q

For a right-sided cardiac cath where is the catheter threaded?

A

Threaded to the right atrium via the femoral vein

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10
Q

For a left-sided cardiac cath, where is the catheter threaded?

A

Threaded to the aorta via an artery

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11
Q

Nursing management before cardiac cath (3)

A
  • assess allergy to iodine or shellfish
  • pay attention to pulses
  • inform about possible complications
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12
Q

Complications of cardiac cath- 5

A
  • bleeding
  • arhthymias
  • hematoma
  • thrombus formation
  • infection
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13
Q

Nursing management after cardiac cath- 6

A
  • monitor complications
  • evaluate vital signs
  • neuro status
  • check pressure over cath site
  • assess pulses
  • encourage feeding
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14
Q

Checking vital signs after cardiac cath

A

Every 15 minutes for the first hour then every 30 min for the next hour then every hour then routine

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15
Q

WHere to check for bleeding in a post cardiac cath pt

A

Under pt —> check sheets, back, butt

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16
Q

What will the pulses be like after cardiac cath

A

-slightly less on the side that was catheterized

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17
Q

What does the child have to do with the affected extremity after cardiac cath

A

Keep it straight for 4-8 hours

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18
Q

Patho for increased pulmonary blood floe heart defects

A

Left side of the heart is at higher pressure than right which means defects that cause a connection between the two sides makes to blood flow from left to right causing more blood to the lungs and overwhelms the lungs ability to move blood to the left side of the heart

Wet lungs make gas exchange more difficult —> child compensates with tachycardia and tachypnea

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19
Q

Risks of increased pulmonary blood flow heart defects -3

A
  • risk of infections (PNA)
  • decreased blood to cellular level (thin, low weight, failure to thrive)
  • pulmonary HTN
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20
Q

S/s increased pulmonary pressure cardiac defect (7)

A
  • loud, mechanical murmur
  • tachypnea, tachycardia
  • poor feeding
  • diaphoresis with feeding
  • thin, small child
  • periorbital edema
  • frequent PNA
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21
Q

Can a child with increased pulmonary pressure heart defects receive O2? Why?

A

No it will cause more issues due to O2 causing pulmonary vasodilation = more pulmonary blood flow = more symptoms

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22
Q

Heart defects of increased pulmonary pressure (3)

A
  • ASD
  • VSD
  • patent ductus arteriosis (PDA)
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23
Q

What is ASD?

A

-opening between R and L atria —> blood flow from L to R —> R atria becomes distended —> blood backs up into pulmonary vessels causing R Ventricle to become distended

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24
Q

Hx and PE ASD (3)

A
  • poor feeding
  • hyper dynamic pericardium
  • fixed split heart sound and systolic ejection murmur
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25
Q

TX ASD

A

Closed in cardiac cath procedure —> surgical repair with patch before age 6

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26
Q

Complications ASD closure

A
  • atrial arrhythmias

- with Gore Helix decide strenuous activity should be avoided for 2 weeks post procedure

27
Q

Patho VSD

A

-opening between ventricles —> blood flows from L to R ventricle to pulmonary artery —> R ventricle hypertrophy

28
Q

SYmptoms VSD-5

Risk of - 2

A

-characteristic holosystolic harsh murmur along left eternal border (loud and harsh), CHF, frequent pulmonary infections, SOB, color change with feeding, risk of bacterial endocarditis, risk of pulmonary vascular obstructive disease

-

29
Q

What can happen in severe cases of VSD?

A

Eisenmenger syndrome —> resistance in pulmonary blood flow is greater than systemic circulation causing reversal of blood flow through the ventricle

30
Q

What disease increases risk of VSD

A

Down syndrome

31
Q

Medications that can be used for VSD

A
  • dopamine + inotropic

- Isuprel

32
Q

Complications of VSD repair

A

-ventricular arrhythmia or AV block

33
Q

What is the surgery for repairing VSD

A

Dacron patch

34
Q

What is PDA?

A

The ductus arteriosis does not close after birth (should close within 15 hours) —> shunting of blood from aorta to pulmonary artery

35
Q

Manifestations of a small PDA

A

ASymptomatic

36
Q

Manifestations of large PDA

A

-CHF with tachypnea, dyspnea, and hoarse cry

37
Q

Symptoms of PDA

A
  • bounding peripheral pulses
  • widened pulse pressure (> 25)
  • machinery murmur
  • murmur audible throughout cardiac cycle
38
Q

What drug can be used to close PDA

A

Indomethacin

39
Q

What is indomethacin and what does it do?

A

NSAID

Blocks prostaglandin synthesis closing the vessel

40
Q

How is PDA repaired?

A

Stitch closure

41
Q

Complications of PDA closure (2)

A
  • bleeding

- laryngeal nerve damage

42
Q

What happens in decreased pulmonary flow heart defects?

A

-less or no blood reaches lungs (failure to oxygenate)

43
Q

How does the body compensate for decreased pulmonary flow?

A

Kidneys stimulate bone marrow producing more RBCs causing polycythemia

44
Q

Issues of polycythemia

A

-diminished clotting ability, sluggish blood flow —> cerebral infarcts

45
Q

Decreased pulmonary blood flow cardiac issues (4)

A
  • tetralogy of fallout
  • tricuspid artesia
  • pulmonary stenosis
  • pulmonary atresia
46
Q

Clinical picture of decreased pulmonary blood flow (6)

A
  • significant cyanosis
  • murmur
  • need palliative surgery soon after birth
  • need PDA to survive —> keep open with prostaglandin
  • complete repair around 1st bday
  • O2 has no effect
47
Q

What is pulmonary stenosis?

A

Pulmonary valve is stenosis —> narrowed entrance to pulmonary artery —> R ventricular hypertrophy —> decreased pulmonary blood flow

48
Q

What is the extreme form of pulmonary stenosis?

A

Pulmonary atresia —> total fusion causing no blood flow to lungs

49
Q

Patho Pulmonary stenosis

A

PS —> R ventricular hypertrophy —> right ventricular failure —> R arterial pressure increases and may reopen foremen ovale —> unoxygenated blood to L atrium —> systemic cyanosis

50
Q

What will be seen on CXR for pt with pulmonary stenosis?

A

Cardiomegaly

51
Q

TX of pulmonary stenosis

A
  • balloon angioplasty

- Brock procedure

52
Q

4 defects of TOF

A
  • VSD
  • overriding aorta
  • pulmonary stenosis
  • R Ventricular hypertrophy
53
Q

Clinical manifestations of TOF

A
  • Tet spells
  • anoxic after feeding or crying
  • clubbing (after 1 year old)
  • squatting or knee chest position
54
Q

Risks of TOF

A
  • emboli
  • LOC
  • sudden death
  • seizures
55
Q

When are repairs of TOF indicated?

A

When tet spells and hypercyanotic spells increase

56
Q

STage one of TOF tx

A

Blalock or modified blalock shunt —> blood to pulmonary arteries from L or R subclavian artery

57
Q

patho TOF

A

Decreased blood flow to lungs as well as mixing of the blood from each side of the heart

58
Q

Reasoning behind knee-chest position in TOF

A

Comfort position to increase vascular resistance and flow back to the heart

59
Q

Drug used to keep PDA open in TOF

A

Alprostadil

60
Q

Obstructive defects of heart (2)

A
  • coarction of aorta

- aortic stenosis

61
Q

Coarctation of the aorta clinical picture 7

A
  • hypertension
  • murmur
  • decreased peripheral pulses
  • pallor
  • irritability
  • heavy sweating
  • difficulty breathing
62
Q

In coarctation of the aorta, where should pulses and BP be taken? Expectations?

A
  • all four extremities

- bounding pulses and increased BP in upper extremities

63
Q

Definitive DX PDA

A

Echo

NRS G240 Exam #3 (11 decks)

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