Exam 3 Flashcards
3 ducts that close at the time of birth?
–Ductus arteriosus – connection between pulmonary artery and aorta, allows blood to bypass lungs to systemic circulation
–Foramen ovale – temporary flap between right and left atria, allows blood to bypass lungs
–Ductus venosus – connection between umbilical vein and inferior vena cava, bypasses fetal liver
Placenta > umbilicus via large umbilical vein > liver (divides) > Inferior Vena Cava (IVC) via ductus venosus
Happens @ time of birth
-Let child relax before taking a Apical Pulse
- Provide a relaxing environment
- Make sure stethoscope is not kinked
Ways to get an accurate Apical Pulse r/t to infant gets worked up and increases HR (Norm: 90-140 Toddler)
- Priority action after getting an EKG read on a child?
- If child is ^ 90lbs? if under 90lbs.?
- Take off/ don’t leave the leads on r/t they are a CHOKING HAZARD
- Adult 12 lead EKG (10 electrodes)/ Pediatric 15 lead EKG (13 electrodes)
2 MAIN groups that divide Cardiovascular disorders
- Acquired heart disorders
DZ processes or abnormalities that occur AFTER birth - Congenital heart disease (CHD)
Anatomic abnormalities present AT birth
- Bacterial (Infective) Endocarditis
- Acute Rheumatic Fever and Rheumatic Heart Disease
- Kawasaki Disease
Types of Acquired Heart Disorders
DX: Blood culture is the definitive dx tool for what acquired heart defect
Bacterial (infective) Endocarditis
Occurs: Early childhood; 6 months to 5 years
- Acute systemic vasculitis; self-limiting
Cardiac involvement (MI, aneurysm= most serious complication)
– Cause unknown; geographical and seasonal outbreaks (may be associated with unknown infection or toxin)
Kawasaki DZ (Acquired)
–Tachycardia w. Gallop (sounds like horse running)
–Strawberry Red tongue
–usually children under 5
–Fever for 5 DAYS
–must have 4 out of 5 (Changes in extremities, Rash, Bilateral conjunctival injection without exudate, Mucositis,
Cervical lymphadenopathy)
Kawasaki DZ (Aquired)
Nursing Care Management – Discharge teaching:
–S/S may continue
–Record daily temp., NOTIFY PHCP if 101° F or higher, despite medication use
–Monitor for S/S cardiac complications, aspirin toxicity, and bleeding
–NO ASPRIN-containing products if exposed to chicken pox or influenza
–AVOID contact sports if taking aspirin or anticoagulants
–AVOID MMR or varicella vaccine for 11 months after IVIG
–Long-term follow-up necessary
Kawasaki DZ (Aquired)
Acyanotic
Allows oxygenated, pulmonary venous blood to return directly to the lungs rather than being pumped to the body.
–HF is common/ may cause PULM. HTN
Left-to-Right Shunt
Cyanotic
Allows deoxygenated, systemic venous return to bypass the lungs and return to the body without becoming oxygenated.
–Polycythemia is common in cyanotic defects (secondary)
–sluggish blood flow and ez bruising
Right-to-Left Shunt
An abnormal connection allows blood to flow from the high-pressure LEFT side of the heart to the low-pressure RIGHT side of the heart (left-to-right shunt), which causes increased volume in the right side of the heart
Acyanotic/ Increase Pulmon. Blood Flow
- Atrial Septal Defect
- Ventricular Septal Defect
- Atrioventricular Canal Defect
- Patent Ductus Arteriosus
4 types of Defects w/ Increased Pulm. Blood Flow (Acyanotic)
Abnormal opening between atria
–Failure of foramen ovale to close
Oxygenated blood from LA shunted to RA and recirculated to the lungs
–RA and RV hypertrophy
Atrial Septal Defect (ASD)/ Acyanotic/ Increas. Pulm. Blood Flow
Abnormal opening between ventricles
Oxygenated blood from LV shunted to RV and recirculated to the lungs
–RV (possible RA) hypertrophy
–RISK for arrhythmias
–Development of pulmonary HTN
Ventricular Septal Defect (VSD)/ Increas. Pulm. Blood Flow/ Acyanontic
Incomplete fusion of endocardial cushions
–Low ASD with high VSD and clefts of M/T valves > large central atrioventricular valve
–Blood flows between all four chambers
–Generally, left-to-right shunting
Most common CHD in Down’s syndrome
Moderate to severe HF common; may be mild cyanosis that increases with crying=the more they CRY the BLUER they get
May need shunt replacement r/t MITRAL Regurgitation
Atrioventricular Canal Defect / Increased Pulmonary Blood Flow/ Acyanotic
Abnormal opening between aorta and pulmonary artery
–Failure of fetal ductus arteriosus to close
Oxygenated blood from aorta returns to pulmonary artery
–Increased blood flow to the lungs leads to pulmonary HTN and cardiomegaly
SX: machine-like MURMUR, Wide pulse pressure and bounding
Patent Ductus Arteriosus (PDA)/ Increased Pulm. Blood Flow/ Acyanotic
