Exam 2 Cardiac Disorders Flashcards
Physical Assessment
1) Assess HR where, how long, up to at least ___ yrs or _____, _____
2) Normal HR infants =
3) Normal HR Adolescents =
4) How to listen (3)
1) 4th intercostal, 1 full minute, 2 yrs or known cardiac abnormality, sickness
2) 80-140
3) 60-100
4) Ask where’s your heart? Let touch stethescope, distractions/games for auscultation
Normal Findings (4)
- Regular Rate and Rhythm, No murmur
- cap refill < 3 seconds
- no clubbing
- femoral pulses strong, equal
Abnormal Findings (4)
- systolic murmur 3/6
- cap refill > 3 seconds
- clubbing
- femoral pulses decreased, unequal
Acyanotic Cardiac Anomalies (3)
What happens to O2 sat?
ASD
VSD
Coarctation of Aorta
O2 sat not effected!
Atrial Septal Defect =
= abnormality (hole) between R and L atria, wall defect which allows left to right shunting
Causes of ASD (4)
- Atrial opening
- Foramen ovale does not close
- Incrased pulmonary blood flow
- Missing septum
Test for ASD =
What do you see?
Echocardiogram
Right Ventricular Hypertrophy (right side works harder by it is pumping more blood)
S/S of ASD
1) D_____
2) Easily _____
3) S____ M____ bc?
1) Dyspnea
2) Easily Fatigued
3) Systolic Murmur at pulmonic region bc of high flow of blood through pulmonary artery
Cycle of ASD =
Low pressure right atrium -> left to right shunting -> oxygenated blood in left atrium moves to right atrium -> goes to lungs to be reoxygenated -> less oxygenated blood going to body, more blood in pulmonary circulation
Ventricular Septal Defect =
= Abnormality (hole) between L and R ventricle, wall defect which allows left to right shunting
S/S of VSD
1) T______
2) D______
3) Easily ______
4) Systolic _____ at ______
5) _ _ _
1) Tachypnea
2) Dyspnea
3) Easily fatigued
4) Murmur at lower left sternal border*
5) CHF (dt cor pulmonale)
Test for VSD =
What will you see?
Echocardiogram
- Right ventricular hypertrophy
Coarctation of Aorta =
= narrowing of the descending aorta, decreased blood flow to lower periphery
Coarctation of Aorta
1) Blockage occurs after ____, ___ body is still perfused
2) Often occurs near?
3) Leads to ___ sided CHF -> _____
1) Subclavian artery, upper body still perfused
2) Ductus Ateriosus (PDA)
3) Left sided CHF -> death
S/S of Coarctation of Aorta
1) ____ feet
2) _____ of lower extremities
3) BP =
4) Pulses =
5) Exercise _____
6) D_____
1) Cold
2) Cramping
3) Upper > Lower
4) Upper > lower
Test for Coarctation of Aorta
What will you see?
Echocardiogram
Coarc is visible
Nursing Interventions for Acyanotic Cardiac Defects
Surgery (3)
Teaching (4)
Continued Monitoring
Surgery = show family equipment, safety measures, IV placement
Teaching = Nutritional suggestion (increase cals to gain weight before surgery), Promote rest, ANTIBIOTIC PROPHYLAXIS* , Post op teaching (wound care infection, rest, incentive spirometry)
Continued Monitoring = Growth Charts, Pulse Ox, decreased cardiac workload
ND’s for Acyanotic Defects
1) Risk for A____
2) Risk for ____ family ____
3) Risk for impaired ____ and ______
4) Risk for ______**
5) Risk for imbalance _____ : ____ than body req.
6) Risk for impaired ____ _____
1) Anxiety
2) Ineffective family coping
3) Growth and Development
4) INFECTION**
5) nutrition, less
6) Gas exchange
Cyanotic Cardiac Anomalies (3)
Tetralogy of Fallot
Transposition of Great Vessels
Hypoplastic Left Heart Syndrome
Tetralogy of Fallot =
4 defects =
= 4 defects which create right to left shunting of blood -> deoxygenated blood gets pushed out to body instead of lungs
- Overriding Aorta
- VSD
- Right Ventricular Hypertrophy
- Pulmonic Stenosis
Tetralogy of Fallot Cycle of Blood Flow =
= Blood takes path of least resistance
- pulmonic stenosis -> blood shifts from R to L due to resistance of pulmonary artery -> deoxygenated blood pushed to body
S/S of Tetralogy of Fallot
1) ____ spells
- caused by (3)
- can lead to H___, P____, T____
2) ______ caused by?
3) ____ murmur at ____ region caused by?
1) TET spells*
- Crying, Stooling, Feeding
- Hypoxia, Pallor, Tachypnea
2) Clubbing caused by tissue hypoxia
3) Systolic murmur at pulmonic region caused by harsh blood flow through defects
Solution for Tetralogy of Fallot *
Keep PDA open using Prostaglandins
Teaching for Tet Spells
1) __/___ of TET spell
2) _____ a TET spell (2)
3) Post-surgical teaching
4) Prevent ___/___ as much as possible
1) S/S
2) Relieving - Knees to chest, Squatting -> decreases blood return from lower extremities to calm heart
4) crying/tantrums
Transposition of Great Vessels =
_____ circulatory pathways
Child needs what to survive?
= Aorta arises from right ventricle, Pulmonary artery arises from left ventricle
Closed
Another anomaly = ASD, VSD, PDA (can be created surgically)
S/S of Transposition of Great Vessels
1) C______
2) H_______
3) ___ feeding -> easily _____
4) ____ to ____
5) S_____
1) Cyanosis
2) Hypoxia
3) Poor feeding -> easily fatigued
4) Failure to thrive*
5) Stroke
Solution for Transposition of Great Vessels * (2)
1) Keep PDA Open using Prostaglandins
2) Surgery to switch arteries and correct anomaly
Hypoplastic Left Heart Syndrome =
Almost no blood can enter ventricle ->
Leads to hypertrophy of ____ ventricle and heart _____
Needs what eventually?
= small, thick left ventricle, inability to adequately pump blood to aorta
Blood backs up to left atrium
Right ventricle, heart failure
Heart Transplant
Multiple Anomalies of Hypoplastic Left Heart Syndrome
- Stenotic (2)
- Hypoplastic (2)
- _____ of aorta
- _____ septal defect
- Stenotic mitral valve (L), Stenotic aortic valve (L)
- Hypoplastic Left ventricle, Hypoplastic ascending aorta (narrow)
- Coarctation of Aorta
- Atrial septal defect (ASD)
S/S of Hypoplastic Left Heart Syndrome
1) T______
2) ______ work of breathing
3) C_____
4) ______ peripheral perfusion
5) _ _ _
1) Tachypnea
2) Increased
3) Cyanosis
4) Poor
5) CHF
Solution for Hypoplastic Left Heart Syndrome *
- ____ surgical teaching
- signs of ____
- Monitor ___ charts
- Monitor lifelong ____ medications
Keep PDA open using prostaglandins*
- Post
- CHF
- Growth carts
- transplant
Nursing Interventions for All Cyanotic Defects
1) Procedural _____
2) S/S of _____
Monitoring (3)
Continued Monitoring (1)
1) Antibiotics
2) worsening
- Pulse osx, Respiratory status, Cardiovascular status
- Growth charts
Acquired Cardiac Illnesses (3)
Rheumatic Fever
Kawasaki’s Disease
CHF
Rheumatic Fever =
= Systemic inflammatory disease that involved heart, joints, connective tissue
Cause of Rheumatic Fever =
Occurs 1-3 weeks after Group A- beta hemolytic streptococcus infection (strep throat)
Tests to Diagnose Rheumatic Fever
1) ____ ___ or _____
2) + _____ (blood test for strep)
3) + _____
1) rapid strep, culture
2) + ASLO (anti-streptolysin O titer)
3) + Anti-Dnase-B titer
Phases of Rheumatic Fever
Acute Phase (- wks) =
Proliferative Phase =
= (2-3 wks) inflammation of connective tissue in heart, joints, skin
= cardiac valves scan and stenosis occurs
Rheumatic Fever is Diagnosed using ____ Criteria *
Needs how many of each criteria?
Jones
2 major criteria or 1 major criteria and 2 minor criteria
Major Jones Criteria for Rheumatic Fever (5)
1) Multiple Joint involvement (usually large joints
2) Carditis (new murmur, tachy, pericardial friction rub, ekg changes)
3) Chorea (involuntary movement of limbs, slurred speech)
4) Erythema Marginatum (erythematous, macular rash)
5) Subcutaneous Nodules (non tender nodules on flexor surfaces)
Minor Jones Criteria for Rheumatic Fever (4)
1) Fever
2) Arthalgia
3) Elevated ESR, CRP/ Decreased RBC
4) Prolonged P-R and/or QT intervals
Medications for Rheumatic Fever (2)*
- Aspirin* (benefits outweigh risks of reyes)
- Prednisone (decreases inflammation)
Rheumatic Fever Interventions
- ___ rest until ____ normalizes
- explain why?
- ______ stimulation
ND’s for Rheumatic Fever (3)
- Bed, ESR
- we promote bed rest
- mental stimulation
- Risk for cardiac injury
- Pain
- Risk for knowledge deficit r/t illness
Kawasaki’s Disease =
= Vasculitis affecting many systems (inflammatory process of arteries)
Kawasaki’s Disease most common _____ and occurs most often in what age?
Most common acquired heart disease
Most common children < 5
S/S of Kawasaki’s Disease
- Increased _____ count*
- Signs of _ _ _
- PLATELET*
- CHF
Stage 1 of Kawasaki’s Disease (5)
- Fever > 5 days
- Conjuctivitis
- Dried lips/mucous membranes
- Swelling to hands and feet
- Lymphadenopathy
Stage 2 of Kawasaki’s Disease (6)
- Fever resolves
- Irritable
- Anorexia
- Desquamation of hands/feet
- Arthritis/Arthalgia
- Cardiovascular issues
Stage 3 of Kawasaki’s Disease (2)
- ESR Decreases
- Illness appears to resolve
Medication for Kawasaki’s Disease (2)**
- IVIG (thins platelets)
- Aspirin (thins platelets)
Teaching for Kawasaki’s Disease
- _____ ROM exercises
- Gentle ___ -____*
- Monitor for complications (3)
- Passive
- tooth-brushing*
- Aneurysm, Bleeding, Signs of myocarditis
Right Sided CHF ->
Left Sided CHF ->
Systemic back up (edema, ascites)
Pulmonary back up (cough, rales, wheezing)
S/S of CHF
1) T____, ___ pulses, cardio____, C_____, ___Tension
2) D____, T_____, R_____
3) P____, Fluid _____, Weight _____
1) Tachycardia, Abnormal pulses, cardiomegaly, clubbing, hypertension
2) Dyspnea, Tachypnea, Retractions
3) Posturing, Fluid retention, weight gain
CHF Solution =
Fix the problem!
CHF Medications
1) _____ ->
- Monitor
2) ____ ->
- Monitor
3) ____ inhibitors ->
1) Digoxin (Lanoxin) -> increases contractility of heart, slows HR
- Monitor for bradycardia HR < 60
2) Furosemide (Lasix) -> stops reabsorption of sodium and chloride, promotes fluid excretion /decreases edema
- Monitor I/O’s
3) ACE inhibitors -> relaxes smooth muscle by reducing vasoconstriction and sodium retention
