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Peds > Exam 2- Cardio > Flashcards

Exam 2- Cardio Flashcards

1
Q

Murmurs that come and go; account for 50% of murmurs in children

A

Functional (innocent) murmurs

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2
Q

Functional murmurs are always louder during _________states, like: (4)

A

high cardiac output
-fever
-exercise
-anxiety
-anemia

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3
Q

most common type of murmur; present in children grades 1-3

A

-Still’s Murmur

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4
Q

Stills Murmur:
-Type of murmur
-Best heard at:

A

-Functional (innocent) Murmur
-left lower sternal border (LLSB)

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5
Q

Murmurs that occur when your blood travels through a leaky or narrowed heart valve; caused by heart disease

A

Pathologic murmur

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6
Q

primarily anatomic abnormalities present at birth that result in abnormal cardiac function; most common form of cardiac disease in children

A

Congenital heart disease

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7
Q

Consequences of congenital heart defects fall into two broad categories; children can have both, although usually they occur independently

A

-heart failure
-hypoxia

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8
Q

Indications of congenital heart disease located in cardiac history: (5)

A

-poor weight gain
-poor feeding habits
-faitgue during feeding
-frequent respiratory tract infections and difficulties
-evidence of exercise intolerance

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9
Q

Common tests used in assessing cardiac function/diagnose heart disease: (4)

A

-electrocardiography
-echocardiography
-cardiac magnetic resonance imaging
-cardiac catheterization

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10
Q

cardiac catheterization procedures can be divided into three groups:

A

-diagnostic procedures
-interventional procedures
-electrophysiology studies

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11
Q

provides important information about oxygen saturation of blood within the chambers and great vessels, pressure changes, changes in cardiac output or stroke volume, and anatomic abnormalities

A

diagnostic cardiac catheterization

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12
Q

Nursing care post-cath: monitoring for:

A

-signs of bleeding
-impaired circulation of distal extremity
-dysrhythmias
-infection

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13
Q

prenatal factors that may predispose children to congenital heart disease (3)

A

-maternal chronic illnesses (diabetes)
-alcohol consumption
-exposure to environmental toxins and infections

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14
Q

Congenital cardiac disorders are divided into 4 groups:

A

-defects that result in increased pulmonary blood flow
-obstructive defects
-defects that result in decreased pulmonary blood flow
-mixed defects

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15
Q

Acyanotic heart condition either (2)

A

-increase pulmonary blood flow
-obstruction to blood flow from ventricles

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16
Q

Cyanotic heart conditions either (2)

A

-decrease pulmonary blood flow
-produce mixed blood flow

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17
Q

Types of defects that result in increased pulmonary blood flow (4)

A

-Atrial Septal Defect (ASD)
-Ventricular septal defect (VSD)
-Patent ductus arteriosus
-Atrioventricular canal

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18
Q

Types of defects that obstruct blood flow from ventricle (3)

A

-Coarctation of aorta
-Aortic stenosis
-Pulmonary stenosis

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19
Q

Types of defects that decrease pulmonary blood flow (2)

A

Tetralogy of Fallot
Tricuspid atresia

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20
Q

Type of defects that result in mixed blood flow (4)

A

-Transposition of great arteries
-Total anomalous pulmonary venous return
-Truncus arteriosus
-Hypoplastic left heart syndrome

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21
Q

hole in the septum between left and right atria; LA with higher pressure empties into RA

A

Atrial Septal Defect (ASD)

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22
Q

S/S of ASD & VSDp (4)

A

-heart murmur
-palipitations
-tachycardia
-decreased peripheral pulse

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23
Q

ASD & VSD management

A

Atrial septal defect may be closed using cardiac catheterization of Teflon repair

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24
Q

Foramen ovale usually closes:

A

few hours to 24 hours after birth

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25
Q

Hole in the septum between the left and right ventricle; LV with higher pressure empties into RV

A

Ventricular Septal Defect (VSD)

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26
Q

Double open heart (high opening between RV and LV, low between RA and LA) creates a large central AV valve that allows blood to flow between all four chambers of the heart

A

Atrioventricular canal defect (AVC)

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27
Q

AVC is common in kids with:

A

Down Syndrome

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28
Q

S/S of AVC (3)

A

-moderate to severe HF
-characteristic murmur
-mild cyanosis that increases with crying

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29
Q

occurs when the ductus arteriosus (between the aorta dn pulmonary artery_ fails to close after birth; causing left-to-right shunt

A

Patent Ductus Arteriosus (PDA)

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30
Q

S/S of PDA (4)

A

-Bounding pulse
-Wide pulse pressure
-Machine-like murmur
-HF

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31
Q

PDA treatment
Medication:
Surgical:

A

M: Indomethacin
S: Litigation (closed heart procedure)

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32
Q

Heart condition that includes 4 different effects; common win children with Trisomy 21

A

Tetralogy of Fallot

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33
Q

Defects included in Tetralogy of Fallot

A

-Ventricular septal defect (VSD)
-Pulmonary stenosis
-Overriding aorta
-Right ventricular hypertrophy (RVH)

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34
Q

S/S of Tetralogy of Fallot (6)

A

-Cyanosis
-Hyoxia
-Systolic murmur
-Anoxic spells
-Clubbing of fingers and toes
-Poor growth

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35
Q

Diagnosis of Tetralogy of Fallot (2)

A

Chest X-ray
ECG

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36
Q

Treatment of Tetralogy of Fallot

A

Surgical intervention:
-shunt placed until able to repair
-complete repair within first year of life
-Done in stages

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37
Q

hole in septum that separates the heart’s left and right ventricles

A

ventricular septal defect (VSD)

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38
Q

pulmonary valve is narrow

A

Pulmonary stenosis

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39
Q

defect in the aorta; aorta is shifted to the right and lies directly above the VSD (aorta grows out of both ventricles rather than just left ventricle)

A

Overriding aorta

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40
Q

right ventricle thickening

A

right ventricular hypertrophy

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41
Q

Tricuspid valve fails to develop and RV atrophy; consequently, no communication from RA to RV; blood flows through an ASD or patent foramen oval to the left side of the heart and through a VSD to the right ventricle and out to the lungs

A

Tricuspid atresia

42
Q

S/S of tricuspid atresia (5)

A

-cyanosis
-dyspnea
-tachycardia
-hypoxemia
-clubbed fingers

43
Q

Treatment of tricuspid atresia

A

Surgical shunt placement in 3 stages

44
Q

narrowing of pulmonic valve; leads to HF, RV hypertrophy, and arrhythmias

A

Pulmonary stenosis

45
Q

S/S of pulmonary stenosis (4)

A

-systolic ejection murmurs
-possibly asymptomatic
-some mild cyanosis
-cardiomegaly

46
Q

treatment of pulmonary stenosis

A

balloon angioplasty w/ cardiac catheterization

47
Q

narrowing of aortic valve

A

aortic stenosis

48
Q

s/s of aortic stenosis: infants (4)

A

-faint pulse
-hypotension
-poor feeling tolerance
-tachycardia

49
Q

s/s of aortic stenosis: children (4)

A

-exercise/ activity intolerance
-dizziness
-murmur
-chest pain

50
Q

aortic stenosis treatment (2)

A

balloon dilation w/ catheterization
valve replacement may be required later

51
Q

aortic and pulmonary stenosis both lead to _______ because:

A

-hypertrophy of the ventricular walls
-work hard to pump blood through the narrowed valves

52
Q

obstruction of blood flow due to narrowing of the descending aorta causing slow peripheral return

A

coarctation of the aorta

53
Q

S/S of coarctation of the aorta (7)

A

-High BP in upper extremities as compared to lower extremities
-Bounding pulse at upper extremities; cool skin at the lower extremities
-Weak femoral pulse
-HF in infants
-Dizziness
-Headache
-Fainting in older children

54
Q

Treatment of coarctation of the aorta (4)

A

-Balloon angioplasty for infants and children
-Replacement of stents for adolescents
-Complete anastomosis to repair
-Require lifelong monitoring

55
Q

Ballon angioplasty steps (3)

A

-balloon inserted in narrowed area
-balloon inflated, flattening plaque
-artery is widened, blood flow improvement

56
Q

Stent placement with balloon angioplasty steps (4)

A

-Build up of cholesterol partially blocking blood flow through artery
-Stent w/ balloon inserted into partially blocked artery
-Balloon inflated to expand stent

57
Q

Complex cardiac anomalies that all involve the mixing of O2 saturated systemic blood with the de-saturated pulmonary blood flow

A

Mixed blood flow defects

58
Q

Condition where the aorta is connected to RV instead of LV and pulmonary artery is connected to LV instead of RV

A

Transposition of great vessels

59
Q

In transposition of great vessels, _______ or defect must exist in order to oxygenate blood

A

PDA

60
Q

S/S of transposition of great vessels (4)

A

-cyanosis
-cardiomegaly
-HF
-O2 stats are always in the 80s, no matter how much oxygen is given

61
Q

Transposition of Great Vessels treatment

A

Corrective repair surgery in early infant (first 2 weeks of life)

62
Q

single vessel trunk coming from the ventricles due to failed separation between the left and right ventricles

A

Truncus arteriosus

63
Q

S/S of truncus arteriosus (6)

A

-HF
-Lethargy
-Heart murmurs
-Cyanosis
-Poor feeding
-Delayed growth

64
Q

treatment of truncus arteriosus

A

surgical repair within first month of life, another valve is inserted

65
Q

most fatal heart defect; complete underdevelopment of the left side of the heart; Right side must maintain BOTH systemic & pulmonary circulation

A

Hypoplastic left heart syndrome

66
Q

In Hypoplastic left heart syndrome, _______ & ______ act as a shunt to help initially; once they close, baby dies

A

forman ovale & ductus arteriosus

67
Q

S/S of hypo plastic left heart syndrome

A

-HF
-lethargy
-Cysonisis

68
Q

Hypoplastic left heart syndrome treatment

A

-Surgical procedure done in 3 stages
-heart transplant usually required

69
Q

3 procedures to help correct hypo plastic left heart syndrome

A

-Norwood procedure
-Glenn procedure
-Fontan procedure

70
Q

an extensive inflammation of small vessels and capillaries (acute systemic vasculitis); without treatment, progresses to involve the coronary arteries, causing aneurysm formation in about 20% of children

A

Kawasaki disease

71
Q

Kawasaki disease:
Occurs most frequently under age ____, with peak incidence in _____ age group

A

-5 years
-Toddler

72
Q

Kawasaki disease:
-Cause is _______, thought to be ________, but is not spread by person to person contact
-Most cases occur in ______ & _______
-Lasts ______ in 3 phases:

A

-unknown, infection
-late winter & early spring
-6-8 weeks; acute, sub-acute, & convalescence

73
Q

Kawasaki disease s/s: (8)

A

-Fever for 5 calendar days
-Bilateral conjunctivitis
-Strawberry tongue
-Abdominal pain
-Rash
-Cervical Lymphadenopathy
-Peeling hands
-Swollen joints

74
Q

Kawasaki phase:
high fever unresponsive to antipyretics

A

acute phase

75
Q

Kawasaki phase:
begins with resolution of fever, lasts until all clinical signs have resolved

A

Sub-Acute phase

76
Q

Kawasaki phase:
Child is MOST at risk for development of coronary artery disease

A

Sub-acute phase

77
Q

Kawasaki phase:
All clinical symptoms have resolved
Lab values indicating inflammatory response have not resolved
Completed when lab values are normal

A

Convalescent phase

78
Q

Kawasaki diagnosis

A

Based on lap tests and X-ray/ECG to show inflammations

79
Q

Kawasaki diagnostic labs (4)

A

CBC
CRP
ESR
Serum albumin

80
Q

Kawasaki treatment (3)

A

-administration of intravenous immunoglobulin (IVIG) & high dose (80-100mg/kg/day divided into 6 hours) of aspirin
-teach family that irritability can last for 2 months
-Encourage ROM exercises

81
Q

systemic inflammatory autoimmune disease that occurs after a throat infection from group A beta-hemolytic streptococcus (GABHS) bacteria; can change cardiac values; affects heart, blood vessels, CNS, Joints, and skin

A

Rheumatic fever

82
Q

Major S/S of rheumatic fever (4)

A

-polyarthritis
-carditis
-sydenham’s chorea
-erythema marginatum

83
Q

Minor S/S of rheumatic fever (2)

A

-fever
-subcutaneous nodules

84
Q

Lab diagnosis of Rheumatic fever: (4)

A

-Elevated anti-streptolysin-O titer
-Elevated C-reactive protein level (CPR)
-Positive throat swab
-Elevated erythrocyte sedimentation rate (ESR)

85
Q

Rheumatic fever treatment (4)

A

Antibiotics: Penicillin, penicillin G, sulfadiazine
anti-inflammtory agents

86
Q

Rheumatic fever interventions (4)

A

-encourage compliance of the medication regimen even when symptoms start to disappear
-assess for allergic reaction to medication
-assess and treat pain
-encourage bedrest

87
Q

medication improves myocardial contractility

A

Digoxin

88
Q

Digoxin consideration:

A

listen to apical pulse for full minute
hold if < 90 in infants, <70/min in children

89
Q

Digoxin is potentially dangerous drug because the margin of safety between ___, ____, and __ doses is very narrow

A

therapeutic, toxic, and lethal

90
Q

Checking for toxicity while on digoxin

A

-normal serum level 0.5-2 mcg/L
-abnormal can indicate toxicity

91
Q

T/F: if a child vomits while on digoxin, you should read minister dose

A

False; should not read minister because you don’t know how much was absorbed

92
Q

T/F: if child misses a dose of Digoxin, it is ok to give them the dose as long as its been past 4 hours

A

False, should only give missed dose if within 4 hour window of scheduled time; if outside window, hold dose

93
Q

If child misses 2 or more doses of digoxin:

A

call the provider

94
Q

Diet of child on heart meds should be: (2)

A

-high in potassium
-calorie dense

95
Q

BP med most common for children

A

-ACE inhibitors (captopril or enalapril)

96
Q

Clinical manifestations of heart failure (3)

A

-Impaired myocardial function
-Pulmonary congestion
-Systemic venous congestion

97
Q

S/S of distinctive of impaired myocardial function (4)

A

-Fatigue/Weakness
-Pale/cool extremities
-Weak peripheral pulse
-Decreased B/P

98
Q

S/S distinctive of pulmonary congestion

A

-Dyspnea
-Retractions
-Flaring nares
-Exercise intolerance
-Cyanosis
-Weezing

99
Q

S/S distinctive of systemic venous congestion (2)

A

-Peripheral edema, especially periorybital
-Neck bein distention

100
Q

S/S of heart failure (general) (4)

A

-Tachycardia
-Sweating
-Decreased urinary output
-Gallop rhythm

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