EXAM #2 Flashcards
Cardiovascular disease prevention
-No smoking or alcohol
-Prenatal care
-Folic acid
-Family hx of defects
What are indicators of cardiac dysfunction?
-Poor feeding
-Tachypnea/cardia
-Failure to thrive/poor weight gain/activity intolerance
-Developmental delays
-Family and prenatal history
Definition of a shunt:
Blood flow through an opening between two structures or vessels of the heart
Definition of Murmur:
A sound heard when listening to the heart; reflects flow of blood within the heart
-Normal during periods of rapid growth
What is CHF?
Inability of the heart to perform its function of pumping blood forward
What are the s/s of congestive heart failure?
-Poor feeding and growth
-Irritability
-SOB
-Excessive sweating
-Hepatomeagly
-Edema
-Exercise intolerance
-Acities (older kids)
-Puffy eyelids
-Buldging fontanelles
How to diagnose CHF:
-Hx & physical
-B-type natriuretic peptide
-Chest x-ray
-Exercise test
-Echocardiogram: looks at direction of blood flow
-MRI
-Cardiac cath
Nursing care for CHF:
-Comfort care
-Oxygenation
-Skin care
-Continious V/S monitoring
Medications for CHF management:
-Cardiac Glycoside (Digoxin)
-Loop Diuretic (Furosemide)
What HR should we hold Digoxin for a new born?
less than 100
What HR should we hold Digoxin for a child?
Less than 70
What HR should we hold Digoxin for an adolescent?
Less than 60
What foods should be consumed when on loop diuretics
Foods high in potassium (banana, broccoli, grapefruit)
What is cardiac catheterization used for?
Diagnosis and repair for CHF
Nursing management for Cardiac Cath:
-Pressure dressing
-Monitor V/S
-Check for pulse distally
-Immobilization of patient
-Bedrest for 6 hours afterwards
-Quiet play for 24 hours
What medications do we give for any congenital heart defect?
-Angiotensin Converting Enzymes (ACE) inhibitor (Captopril)
-Cardiac glycoside (Digoxin)
-Loop Diuretic (Furosemide)
Does pulmonary blood flow increase or decrease with acyanotic CHD?
Increase
Does pulmonary blood flow increase or decrease with cyanotic CHD?
Decrease
ANY CHD that starts with a T or H is considered an _______ defect
Cyanotic defect. If it doesn’t start with T or H, is is acyanotic.
5 Ts and H (hypoplastic Left sided heart defect)
What is the Increased pulmonary blood flow defect? What are the types?
An abnormal connection between two sides of the heart.
-Atrial Septal Defect
-Ventricular Septal Defect
-Patent Ductus Arteriosus
How is blood flow affected in the Increased pulmonary blood flow defects?
-Increased pulmonary blood flow
-Decreased systemic blood flow
What is an Atrial Septal Defect?
Simple defect of the atria
Clinical manifestations for Atrial Septal Defect:
-Possible Murmur or Thrill
-Possible right atrium enlargement
-Hepatomeagly (fluid overload)
-SOB
-Respiratory distress
-Periorbital edema
-Failure to thrive
-Increased risk for respiratory infection
-Increased risk for stroke
What is a Ventricular Septal Defect?
Defect in the ventricular septum.
Clinical Manifestations for Ventricular Septal Defect:
-Asymptomatic
-SOB
-Feeding difficulties
-Poor growth
-Easy fatiguability
-Recurrent respiratory infections
-Murmur
-Harsh murmur or thrill
Nursing care for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-Monitor V/S until stable
-CHF management: Digoxin & Lasix
Monitor for complications:
-Chest pain, palpitations, sudden hypotension, dehydration or anemia.
Medical management for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-May spontaneously close by itself.
-Surgical repair or closure device.
Postoperative mangement for Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD):
-Limit exposure & cluster care
-Prophylatic antibiotics
-Offer small, frequent meals
-Suction secretions
-Keep warm and relaxed
-Monitor I & Os (limit fluids as ordered)
-Monitor K level
-Change position Q2 hrs
-Give oxygen
What is Patent Ductus Arteriosus?
Blood flows from the Aorta to the pulmonary artery through abnormal connection (normal in fetus).
Clinical Manifestations of Patent Ductus Arteriosus:
-Harsh Murmur
-Frequent colds
-Susceptible to RSV
-Fatigue
-Poor feeding & growth pattern
-Wide pluse pressure
-Bounding pulse
Nursing care for Patent Ductus Arteriosus (PDA):
-Monitor V/S
-Wound-care (RITA)
-Allow time to close
-Ventilatory support
-Fluid restrictions and Diuretics
-Indomethacin (closes defect)
-Ibuprofen or NSAID
-Incubator or radiant warmer
Medical management for Patent Ductus Arteriosus (PDA):
-Thoracotomy
-VATS if medical mangement fails
-Coils and super glue
What is Coarctation of the aorta?
Narrowing or stricture of the descending aorta distal to the carotid arteries (2 links of sausage)
Clinical manifestations of Coarctation of the aorta:
-Murmur
-CHF signs
-Pain in the legs or cyanotic lower extremities due to lack of blood flow
-Increased pressure to head and upper extremities
Nursing care for Coarctation of the aorta:
-Monitor upper and lower blood pressures
-May have postsurgical rebound hypertension = HTN (give antihypertensive agents for 6-12mths)
Medical management for Coarctation of the aorta:
-Cardiac Cath-baloon angioplasty & vulvuloplasty
-Give Captopril (Capoten) or enalapril (Vasotec) as well as Digoxin and Lasix
What is Tetralogy of Fallot?
Four associated defects:
-Pulmonary stenosis
-Right Ventricular Hypertrophy
-Overriding Aorta
-Ventral Septal Defect
Clinical Manifestations for Tetralogy of Fallot:
-Tachypnea
-Dyspnea on Exertion
-Growth failure
-Cyanosis
-Harsh Murmur
-Rt ventricular hypertrophy.
What are TET spells? What helps prevent them?
-Cyanotic event that is exacerbated by excitement or crying.
-Pre-oxygenate, knee-chest position, and morphine.
What is transposition of great vessels?
Switching of the aorta and pulmonary artery
Clinical Manifestations of transposition of great vessels:
-Cyanosis
-SOB
-Poor feeding
-Clubbing of fingers and toes
-Murmur (sometimes)
Surgical interventions for transposition of great vessels:
Arterial switch operation
What is hypoplastic left heart syndrome?
-Ventricle is small or hypoplastic and unable to maintain CO. Right ventricle must work quickly as the main pumping mechanism.
-Poor outcomes.
Nursing & surgical mangement for hypoplatic left heart syndrome:
-Prostaglandin given to keep PDA open
-Norwood procedure
-BT Shunt
-Glenn procedure
-Fontan procedure
-Pallative or End-of-Life care in severe cases.
What labs should be monitored in cyanotic heart disease?
Hbg & Hct
Important things to remember when giving Digoxin:
-Assess Apical pulse for one min
-Give consistently
-DO NOT administer if child throws it up
How often should you palpate the liver for R sided HF?
Q 4-12 hours
Pathophysiology of Kawasaki’s Disease:
Acute systematic vaculitis of unknown cause with increased risk of coronary artery aneurysm.
-May progess to myocarditis or rhythm disturbances
-May form scars
Clinical Manifestations of Kawasaki’s Disease:
-Skin Rash
-Cervical lymphadenopathy unilateral
-Strawberry tongue and cracking lips
-Conjunctivitis without exxudate
-High fever
Nursing care/education for Kawasaki’s Disease:
-Support if they have aneurysm repair
-Medication
-Follow up appointments
-May be placed on anticoagulant therapy, blood testing and monitoring
-Activity restrictions
Pharmacological treatment/management for Kawasaki’s Disease
-IV immunoglobulin/ gammaglobulin
-NSAIDs-Salicylates (Aspirin)
-Digoxin
-Angiorensin enzyme inhibitiors-reduces the after load on the heart
-Lasix
What is Rheumatic Fever/Disease?
RF: self limiting (3mths)
-From Group A B-hemolytic streptococcal pharyngitis
Acute phase: Connective tissue inflammation (joints, brain, serous surfaces & heart)
Proliferative phase: Heart valves are damaged leading to stenosis & regurgitation
How to Dx Rheumatic disease:
JONES (major) PEACE (minor) Critera
*Joints polyarthritis (hot, swollen joints)
*Heart (carditis, valve damage)
*Nodules (subcutaneous)
*Erythema marginatum (painless rash)
*Syndenham chorea (flinching movement)
*Previous rheumatic fever
*ECG and PR prolongation
*Arthragias
*CRP and ESR elevated
*Elevated temperature
Presence of 2 major or 1 major & 2 minor criteria.
Clinical manifestations of Rheumatic Fever/Disease
-Carditis & valvulitis
-Polyarthritis
-Erythema marginatum
-Subcu nodules
-Arthragia
-Fever elevated ESR or C-reactive protein
-Prolonged PR interval