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Peds Exam (5900) #3 > Child w/ cardiovascular dysfunction > Flashcards

Child w/ cardiovascular dysfunction Flashcards

1
Q

Most common congenital heart anomaly?

A

Ventricular Septal Defect

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2
Q

causes of CHD in children?

A
  • Maternal or environmental
  • chromosomal/genetic
  • multifactorial
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3
Q

Ductus arteriosus closes?

A

functional 24-72 hours; permanent 2-3 weeks

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4
Q

Evaluation of Cardiovascular function - what to ask about?

A
  • Family history of CHD, sudden death
  • Mother’s pregnancy (any exposures, illnesses?)
  • Infant’s feeding pattern
    - Profuse sweating, fatigue, tachypnea, irritability,
    reflux, always hungry
  • Child’s feeding pattern (Picky or slow eater)
  • History of frequent URIs, respiratory difficulties
  • Exercise intolerance, fatigue
  • General appearance
    • Activity, Mood, Nutritional status, Edema
  • Poor weight gain
  • Skin (cyanosis, diaphoresis)
  • Fingernails (clubbing, cyanosis)
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5
Q

Classification of cardiac lesions in CHD?

A
  • Lesions with increased pulmonary blood flow (left to right shunts)
  • Lesions with decreased pulmonary blood flow (right to left shunts)
  • Obstructive lesions (Obstruction of blood flow out of the heart)
  • Lesions with mixed blood flow
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6
Q

Increased Pulmonary Blood Flow Defects and what happens?

A

have an abnormal connection between the two sides of heart - either the septum or the great vessels which leads to an Increased blood volume on the right side of the heart, increased pulmonary blood flow and decreased systemic blood flow

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7
Q

Increased Pulmonary Blood Flow Defect General characteristics?

A 
- Acyanotic
I- ncreased pulmonary vascularity
- Poor weight gain
- Heart failure frequent
- Late permanent pulmonary vascular changes can occur
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8
Q

Increased Pulmonary Blood Flow Defect examples

A
  • VSD (ventricular septal defect)
  • ASD (atrial septal defect)
  • PDA (patent ductus arteriosus)
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9
Q

Ventricular Septal Defect (VSD) Clinical signs?

A
  • May be asymptomatic initially
  • CHF
  • Failur To Thrive (FTT)
  • Frequent URIs
  • Fatigue, poor feeding
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10
Q

most common VSD location?

A

midseptal defect below aortic valve

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11
Q

Diagnostics for VSD?

A
  • Systolic murmur heard at left sternal border

- ECG, chest x-ray, echo, cardiac cath

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12
Q

Treatment for VSD?

A
  • Small VSDs may close spontaneously - 1st 2 years of life
  • Medical : tx of CHF, SBE prophylaxis
  • Surgical: palliative; corrective
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13
Q

Surgical Treatments for VSD - Palliative?

A
  • Pulmonary Artery (PA) Band
  • band Narrows the pulmonary artery, thereby decreases blood flow to the lungs & decreases CHF. Child will eventually outgrow PA Band & require corrective surgery
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14
Q

Surgical Treatments for VSD - Corrective?

A
  • Closure of VSD with patch
  • Complications of corrective surgery include: conduction problems (possibility of complete heart block), residual VSD, plus complications related to open heart surgery
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15
Q

Most common location for an Atrial Septal Defect?

A

midseptum near foramen ovale

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16
Q

Symptom of ASD?

A
  • often asymptomatic

- As child gets older, may see activity intolerance & dyspnea (shortness of breath)

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17
Q

Diagnostics of ASD?

A
  • If L to R shunt is large, will have a diastolic murmur

- ECG, chest-x-ray, echo

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18
Q

Treatment for ASD?

A
  • Medical: Bacterial endocarditis (BE) prophylaxis

- Repair (via cardiac cath or surgery)

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19
Q

Why repair an ASD?

A

to prevent activity intolerance & dyspnea (shortness of breath) as child gets older

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20
Q

Persistent patency of normal fetal structure, connection between the left pulmonary artery and the descending aorta?

A

Patent Ductus Arteriosus (PDA)

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21
Q

Patent Ductus Arteriosus (PDA) normally closes after birth due to _______?

A
  • increased arterial O2 sats & decreased prostaglandins when no placenta
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22
Q

What happens if the PDA stays open and why?

A
  • If stays open, direction of flow changes after birth
  • because of increased pressure & resistance in the aorta, causing increased blood to the pulmonary arterial and flow to the lungs
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23
Q

Clinical signs of PDA if small?

A
  • If small, may be asymptomatic
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24
Q

Clinical signs of PDA if large?

A
  • signs/sx of CHF.

- more apparent with anything that puts increased stress on heart.

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25
Q

Diagnostics of PDA?

A
  • Classic “machinery” type murmur

- ECG, chest x-ray, echo

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26
Q

Tx of PDA?

A
  • May close spontaneously
  • Medical: Indomethicin (prostaglandin inhibitor)
  • Via cardiac catheterization
    • Amplatzer duct occluder
  • Surgical: ligation or division
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27
Q

Indomethicin mechanism of action?

A

prostaglandin inhibitor, used to treat pain

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28
Q

General characteristics or S/S of Decreased Pulmonary Blood Flow Defects

A
  • cyanosis (varying degrees)
  • decreased pulmonary vascularity
  • heart failure rare
  • hypoxemia
  • polycythemia
  • clubbing
  • paroxysmal hypercyanotic spells (40%)
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29
Q

Examples of Decreased Pulmonary Blood Flow Defects?

A
  • Tetralogy of Fallot

- Tricuspid atresia

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30
Q

Four defects associated with the Tetralogy of Fallot (TOF)?

A
  • Ventricular septal defect (VSD)
  • Pulmonary stenosis (right ventricular outflow obstruction)
  • Right ventricular hypertrophy
  • Overriding aorta (dextroposition of the aorta)
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31
Q

Which defect associated with the Tetralogy of Fallot causes the other 3?

A

overriding aorta

32
Q

Clinical signs of TOF

A
  • Cyanosis, clubbing

- Paroxysmal hypercyanotic spells (a.k.a. TET spells)

33
Q

Tx of Paroxysmal hypercyanotic spells?

A

Morphine and O2

34
Q

Diagnostics for TOF?

A
  • Harsh systolic murmur at lower left sternal border
  • ECG, chest x-ray, echo
  • CBC - polycythemia
35
Q

TET position?

A

Squatting increases peripheral vascular resistance (PVR) and thus decreases the magnitude of the right-to-left shunt across the ventricular septal defect (VSD)

36
Q

Preoperative management of TOF?

A
  • prevent dehydrations

- NO AIR IN IV LINES

37
Q

Tx of TOF?

A
  • Blalock-Taussig shunt (palliative if child too small for repair, lots of TET spells)
  • Open heart surgery
    • VSD closure
    • Correct pulmonic stenosis
38
Q

Procedure where a small shunt is placed between the pulmonary artery and aorta which lets blood move from aorta to lungs?

A

Blalock - Taussig shunt

  • done for TOF if pt is to small for a full repair.
  • may have decreased or absent pulse in affected arm - - NO BP in that arm
39
Q

Examples of Obstructive Defects?

A
  • Coarctation of the aorta
  • Aortic stenosis
  • Pulmonic stenosis
40
Q

Anatomic narrowing/stenosis of aorta?

A

Coarctation of the aorta

41
Q

Coarctation of the aorta causes what to happens?

A

Increased pressure in left ventricle causing decreased cardiac output with significant decrease in blood flow to abdomen and legs

42
Q

Clinical signs of a Coarctation of the aorta?

A
  • Blood pressure higher in arms than in legs
  • High pulse pressure in carotid & radial pulses
  • Low pulse pressure in femoral & pedal pulses
  • Warm upper body, cool lower body
43
Q

Diagnostics of a Coarctation of the aorta?

A
  • usually no murmur
  • Upper Extremity BP at least 20mm mmHg > Lower - Extremity BP
  • Echo (confirmational test)
44
Q

Treatment of a Coarctation of the aorta?

A
  • Surgery - removal of stenotic area
  • Balloon angioplasty
  • BE prophylaxis
45
Q

Complications of a Coarctation of the aorta?

A
  • restenosis, residual hypertension, CV disease as adult
46
Q

Examples of Mixed Defects?

A
  • Transposition of the Great Vessels (TGV, TGA)
  • Total anomalous pulmonary venous connection (TAPVC)
  • Truncus arteriosus
  • Hypoplastic heart syndrome (Left or Right)
47
Q

Defect where the Aorta rises from right ventricle and Pulmonary artery rises from left ventricle?

A

Transposition of the Great Vessels (TVG)

48
Q

Transposition of the Great Vessels results in?

A

have two separate and parallel circulations

49
Q

Clinical signs of a Transposition of the Great Vessels?

A
  • Cyanosis always present

- Murmurs if other associated defects

50
Q

Treatment of TGV?

A
  • Continuous infusion of Prostaglandin E
  • Create or keep atrial septal defect open with balloon septostomy
  • Corrective surgery, usually as neonate
51
Q

Diagnostics for a TGV?

A

ECG, CXR, exho

52
Q

Defect where the left-sided cardiac structures are underdeveloped?

A

Hypoplastic Left Heart Syndrome (HLHS)

53
Q

Postoperative Complications of HLHS surgical tx?

A
  • CHF
  • Dysrhythmias
  • Decreased cardiac output syndrome
  • Decreased peripheral perfusion
  • Pulmonary changes
  • Neurologic changes
  • Postpericardiotomy syndrome
  • Endocarditis (BE, SBE, IE)
54
Q

Postpericardiotomy Syndrome Clinical manifestations?

A
  • Fever, increased WBCs, pericardial friction rub, pericardial & pleural effusion
55
Q

Postpericardiotomy Syndrome teaching?

A
  • complication of tx for HLHS
  • can occur immediately, or up to 7-21 days postop
  • may require pericardiocentesis or pleurocentesis
56
Q

CHF is usually seen in which children?

A
  • most < 12 months old

- primarily with left to right shunts and coarctation of the aorta

57
Q

S/S of Impaired myocardial function in a child with CHF?

A

Tachycardia, fatigue, weakness, restlessness, pallor, cool extremities, decreased BP, gallop rhythm (3rd heart sound), decreased urine output, cardiomegaly

58
Q

S/S of pulmonary congestion in a child with CHF?

A

Tachypnea, dyspnea, respiratory distress, exercise intolerance, poor feeding

59
Q

S/S of Systemic venous congestion in a child with CHF?

A

Peripheral and periorbital edema, weight gain, ascites, hepatomegaly

60
Q

Nursing Management of child with CHF?

A
  • Decrease energy expenditure
  • Provide adequate nutrition: high caloric formulas > 20 kcal./oz.
  • Avoid fluid overload
  • Administer meds to enhance cardiac function
    • Digoxin and diuretics
61
Q

Digoxin actions?

A

increases contractility and slows the HR

62
Q

S/S of Digoxin toxicity?

A

nausea/vomiting, anorexia, listlessness, bradycardia, dysrhythmias

63
Q

shunts oxygenated blood from the umbilical vein to inferior vena cava

A

Ductus venosus

64
Q

shunts oxygenated blood from R. atrium to L. atrium

A

Foramen ovale

65
Q

shunts blood from the pulmonary artery to the aorta

A

Ductus arteriosus

66
Q

Do no give Digoxin if infant’s HR is ?

A

< 100 BPM

67
Q

shunts oxygenated blood from umbilical vein to inferior vena cava in fetus

A

Ductus venosus

68
Q

shunts oxygenated blood from R. atrium to L. atrium in fetus

A

Foramen ovale

69
Q

shunts blood from pulmonary artery to aorta in fetus

A

Ductus arteriosus

70
Q

Ductus venosus

A

shunts oxygenated blood from umbilical vein to inferior vena cava in fetus

71
Q

Foramen ovale

A

shunts oxygenated blood from R. atrium to L. atrium in fetus

72
Q

Ductus arteriosus

A

shunts blood from pulmonary artery to aorta in fetus

73
Q

A mother states that her baby turns blue while feeding or crying, what do you suspect?

A

TET spells caused by TOF

74
Q

Patient has strong radial pulses, weak LE pulses and a BP > 20mmhg in UE when compare to LE, what do you suspect and what else would you look for?

A

Coarctation of the aorta, look for temp in upper body to be greater than lower body

75
Q

CHF is most often seen in?

A

children with a left to right shunt and coarctation of the aorta

Peds Exam (5900) #3 (10 decks)

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