[Exam 3] Chapter 41- Alteration in Perfusion/Cardiovascular Disorder Flashcards
What is CHD?
Structural anomalies present at birth, but may not be diagnosed until later in life
What are acquired heart disease?
Disorders that occur after birth. Wide range of causes or can occur as complications
Many congenital heart defects result in what?
HF and Chronic Cyanosis, leading to failure to thrive
What side of the heart is most dominant?
Right at birth, and then moves to left within first few months of life
Common Medical Tx: How often is Digoxin given?
Every 12 hours, 1 hour before or 2 hour after feeding
Common Medical Tx: What to do if Digoxin dose missed?
Give within 4 hours. If longer, withold and give the dose at regular time.
Common Medical Tx: What happens if child vomits with Digoxin?
Do n ot give an additional dose
Common Medical Tx: What to monitor with Digoxin?
Monitor potassium levels, as decrease enhances effects of digitalis, causing toxicity
Common Medical Tx: Why would chest tube be inserted?
To facilitate removal of air or fluid and allow lung expansion,. Used after open heart surgery or pneumothorax
Common Medical Tx: What does Digoxin do?
Increases contractility of the heart by decreasing conduction and increasing force
Common Medical Tx: When would Digoxin be witheld?
Count pulse one minute. Withold is < 60 for adult, < 90 for infant
Common Medical Tx: Serum Digoxin range?
0.8-2
Common Medical Tx, Health Hx: Parents should be asked if children experience what symptoms?
Orthopnea, Dyspnea, Easy fatigability, growth delays, squatting, or edema.
Common Medical Tx, Health Hx: History of preseent illness may reveal what in child?
poor feeding including fatigue, lethargy, or vomiting. or diaphoresis.
Common Medical Tx, Health Hx: Assess past medical history for what?
Problems at birth, frequenct infections, prematurity and autoimmune disorders
Common Medical Tx, Physical Exam: Physical exam for this child consists of what?
Inspectio, palpation and auscultation
Common Medical Tx, Physical Exam, Inspection: In infants, edema occurs where first
In the face, then the presacral region, then the extremities
Common Medical Tx, Physical Exam, Inspection: Edema of lower extremities if characteristic of what
right ventriucar heart failure
Common Medical Tx, Physical Exam, Inspection: Why should you inspect the chest configuration?
Note any prominence of precordial chest wall, seen in those with cardiomegaly (abnormal heart enlargement)
Common Medical Tx, Physical Exam, Palpation: Femoral pulse that is weak or absent when compared to brachial indicates?
Coarctation of the aorta
Common Medical Tx, Physical Exam, Auscultation: All murmurs have to be evaluated based on what?
Location, Relation, Intensity, Quality, and Variation
Common Medical Tx, Physical Exam, Auscultation: Abnormal splitting or intensifying of S2 occurs with who
children with major heart problems
Common Medical Tx, Physical Exam, Auscultation: What are ejection clicks?
High pitched, and are related to the problems with dilted vessels or valve abnormalities
Common Medical Tx, Physical Exam, Auscultation: Mild to late ejection click associated with?
Mitral valve prolapse
Common Medical Tx, Physical Exam, Auscultation: S3 heart sound associated with?
Cardiac abnormalities
Common Medical Tx, Physical Exam, Auscultation: S4 hearrt sound associated with?
Cardiac abnormalities
Common Medical Tx, Physical Exam, Auscultation: A widened pulse pressure between systolic and diastolic indicates what?
Greater than 50 accompanied by bounding pulse, and associated with aortic insufficiency, fever, anemia, or complete heart block
Common Medical Tx, Physical Exam, Labs: What is an Arteriogram?
Radiopaque contrast injected through catheter into circulation. X-Rays taken to visualize structure of heart and blood vessels
Common Medical Tx, Physical Exam, Labs: What is Ambulatory ECG Monitoring?
Monitoring hearts electrical patterns for 24 hours uning a portrable compact unit
Common Medical Tx, Physical Exam, Labs: Why is a Chest X-Ray done?
Serves as baseline for comparsion with films taken after surgery
Common Medical Tx, Physical Exam, Labs: What is an Echocardiogram?
Noninvasive ultrasound procedure used to assess heart wall thickness, size of ehart chambers , and motion of valves
Common Medical Tx, Physical Exam, Labs: What does ECG evaluate?
HR, rhythm, conduction, and musculature
Common Medical Tx, Physical Exam, Labs: What is the exercise stress test?
Monitoring HR, BP, ECG and Oxygen consumption
Common Medical Tx, Physical Exam, Labs: Why would Hgb and Hct be drawn?
To detect anemia
Common Medical Tx, Cardiac Catheterization: What may be some reasons for doing this?
Cardiovascular disease causing cyanosis.
Severe HF
Planned Cardiac Surgery
Assessment after repair of cardiac defect
Common Medical Tx, Cardiac Catheterization: Diagnostic cardiac catheterization used to do what?
Identify structural defects.
Common Medical Tx, Cardiac Catheterization: Interventional cardiac catheterization done why?
As treatment measure to dilate occluded or stenotic structures or close some defects
Common Medical Tx, Cardiac Catheterization: What does electrophysiologic cardiac catheterization involve?
Use of electrodes to identify abnormal rhythms and destroy sites of abnormal electrical conduction
Common Medical Tx, Performing Cardiac Catheterization: How is this done?
Radiopaque catheter inserted into bleed vessels and then guided through vessel to heart. Contrast material injected once destination reached and radiographic images taken
Common Medical Tx, Performing Cardiac Catheterization: How is right-sided catheterization done?
Threaded to right atrium via femoral vein
Common Medical Tx, Performing Cardiac Catheterization: How is left sided done?
Catheter is threaded to airta and heart via an artery.
Common Medical Tx, Performing Cardiac Catheterization: What procedures can be performed if catheter in heart?
BP, Changes in cardiac output or SV, O2 of each heart chambere and major blodo vessels
Common Medical Tx, Performing Cardiac Catheterization: Why would samples of tissue betaken?
TO evluate for infection, muscular dysfunction, or rejection after transplant
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: What information should be gathered here?
If fever present (reschedule), height/wt for medication dosage. Allergies. And medications like anticoagulants.
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: What feeling will children feel when catheter inserted?
Sensation of heart racing. Feeling of wamrth or stinging when contrast material injected.
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: WHen is food/fluid withheld?
4-6 hours before procedure.
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: What possible complications may occur after?
bleeding, low grade fever, loss of pulse, and development of arrhythmia (abnormal heart rhythm).
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: Leg position after procedure?
Straight for 4-8 hours after procedure
Common Medical Tx, Nursing Mx of Cardiac Catheterization, Before Procedure: What may decreased the risk for catheterization-induced arrhythmia?
Digitalis can be held the night ebfore and morning of catheterization
Common Medical Tx, Nursing Mx of Cardiac Catheterization, After Procedure: After, monitor for complications of what?
Bleeding, arrhythmia, hematoma, and thrombus formation.
Common Medical Tx, Nursing Mx of Cardiac Catheterization, After Procedure: How often will you evaluate VS and dressing?
Every 15 for first hour, and every 30 mins for next hour
Common Medical Tx, Nursing Mx of Cardiac Catheterization, After Procedure: Hypotension may show what?
Hemorrhage due to performation of heart muscle.
Common Medical Tx, Nursing Mx of Cardiac Catheterization, After Procedure: What to do if bleeding occurs over site?
Apply pressure 1 in above the site to create pressure over vessel, thereby reducing blood flow to area
Common Medical Tx, Nursing Mx of Cardiac Catheterization, After Procedure: Contrast has diuretic effect, so what should you watch for
Dehydration and hypovolemia
Congenital Heart Disease: Complications of CHD include?
HF, Hypoxemia, Growth Retardation, Developmental DElay and Pulmonary Vascular Disease
Congenital Heart Disease - Patho: What may happen to wall during development?
Septal walls or valves may fail to develop, or vessels may be stenotic.
Congenital Heart Disease - Patho: What will hapen if ductus arteriosus fails to close?
Blood will move from the aorta to the pulmonary artery, ultimately increasing right aterial pressure.
Congenital Heart Disease - Patho: With less oxygenated blood reaching the tissues, what issues may arise?
CLubbing, polycythemia, exercise intolerance, hypercyanotic spells and brain abscess
Congenital Heart Disease - Therapeutic Mx: This may include what?
Palliative care or a surgival corrective approach
Congenital Heart Disease - Therapeutic Mx: What can be done in newborns and infants with severe cyanosis?
Prostaglandin infusion will maintian patency of ductus arteriosus and improve pulmonary blood flow.
Disorders with Decreased Pulmonary Blood Flow: This occurs when?
When there is some obstruction of blood flow to the lungs, causing pressure on right side of heart to increase. Then shunts through structural defect. Results in tissues recieiving less oxygenated blood
Disorders with Decreased Pulmonary Blood Flow: Defects with this are characteized by what
mild to severe oxygen desaturation. O2 will range from 50-90%
Disorders with Decreased Pulmonary Blood Flow: How will kidneys respond to low blood oxygen levels?
Produce erythropoietin, stimulated bone marrow to produced more RBC , polychthemia)
Disorders with Decreased Pulmonary Blood Flow: Problem with poplycythemia?
Can lead to an increase in blood volume and possibly blood viscosity.
Disorders with Decreased Pulmonary Blood Flow: Disorders with this include what?
Tatralogy of Fallot and Tricupsid Atresia
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot: What is this?
COngenital heart defect composed of four heart defects
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot: Four heart defects here?
Pulmonary stenosis (narrowing of pulmonary valve, creating obstruction from right ventricle to pulmonary artery)
VSD
Overriding Aorta (Enlargement of aortic valve)
Right ventriclar hypertrophy (due to increase in use)
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot: Surgical internvetion required when
During first year of lfie
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Patho: What happens with pulmonary stenosis?
Blodo flow from right ventricle obstructed and slowed, decreasing blood flow to lungs for oxygenation. Pressure also increases in right ventricle.
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Patho: With Pulmonary stenosis blocking blood flow, where does ti go?
Through VSD into left atrium.
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Patho: Degree of cyanosis depends on what?
Extent of pulmonary stenosis, size of VSD, and vasclar resistance of pulmonary / systemic circulations
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Patho: When is this diagnosed
First week of life due to murmur or cyanosis
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Health Hx: Note color that may change when?
With feedings, activity, or crying
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Health Hx: May experience hypercyanosis, which is what
develops suddenly and is manifested as increased cyanosis, hypoxemia, dyspnea and agitation
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Health Hx: How will infants or toddlers relieve hypercynatic spells?
May bend at knees or fetal position for infant
Toddlers may squat
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Health Hx: Auscultate chest for adventitious breath sounds, which may indicate what?
DEvelopment of heart failure.
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Labs: What will be increased due to polycythemia?
Hct, Hgb, and RBC count
Disorders with Decreased Pulmonary Blood Flow - Tetralogy of Fallot, Labs: What labs will be conducted?
Echocardiogram (Ultrasound study of structure), revelaing right ventricular hypertrophy
ECG indicating right ventricular hypertrophy
Cardiac Catheterization
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia: What is this?
Valve between right atrium and right ventricle fails to develop. No opening to allow blood flow from right atrium to the right ventricle.
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia, Patho: Where will deoxygenated blood go?
Pass through opening in atrial septum (foramen ovale) into the left atrium, never entering pulmonary vasculature
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia, Patho: What happens to blood in left ventricle
Recieves mixed blood, with some going through the VSD into the right ventricle and into the lungs
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia, Health Hx: Note cyanosis that occurs when?
Either at birth or a few days later when the ductus arteriosus closed.
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia, Labs: CBC drawn why?
To assess compensatory increases in Hct, Hgb, and RBC count, indicating polycythemia.
Disorders with Decreased Pulmonary Blood Flow - Tricuspid Atresia, Labs: What labs are done?
Echocardiography, revealing absence of tricuspid valve
ECG, indicating HF
Cardiac Catheterization and Angiography, revealing structural defects
Disorders with Increased Pulmonary Flow: Defects with connecting involving left/right side will cause what to happen to blood?
Shunt blood from the higher pressure left side to the lower-pressure right side.
Disorders with Increased Pulmonary Flow: Since there is a lot of blood flow going through right side of heart, what does this do to lungs?
Amount of blood flowing here will be large, and may lead to heart failure early in life
Disorders with Increased Pulmonary Flow: What happens if ventricular hypertrophy occur
Right-to-left shunting may occur, allowing deoxygenated blood to mix with oxygenated blood.
Disorders with Increased Pulmonary Flow: Excessive blood flow in lung can produce what response
Tachypnea and tachycardia
Disorders with Increased Pulmonary Flow: Increased pulmonary blood flow results in what?
Decreases systemic blood flow, leading to sodium and fluid retention
Disorders with Increased Pulmonary Flow: Why may pulmonary hypetension occur?
Due to increased pressure of pulmonary blood flow.
Disorders with Increased Pulmonary Flow: Why is oxygen not helpful?
Is a vasodilator, and pulmonary blood flow will be greater, causing tachypnea, increasing fluid volume retention.
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD): What is this?
Passageway or hole in the wall that deives the right from left atrium
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD): What are the tree times?
Ostium Primum (ASD1) - Opening on lower portion
Ostium Secundum (ASD2) - Opening near Center
Sinus Venosus Defect - Opening near junction of superior vena cava and right atrium
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD): If its small, what will happen?
Can happen spontaneous closure within first 18 months. If not by age 3, need surgery
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Patho: How does blood flow?
Flows through opening from left atrium to right atrium due to pressure differences, due to shunting. Leads to increased blood flow into lungs.
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Patho: If untreated, can cause what problems?
Pulmonary hypetension, HF, Artiral Arrhythmias, or Stroke
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Nurse Assess: An increase in blood flow to lungs can cause what symptoms?
HF, which leads to SOB, Easy Fatigability or Poor Growth
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Health Hx: What problems will you note?
Poor feeding, decreasing ability to keep upw ith peers, or hx of difficulty growing.
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Health Hx: Auscultate the heart, noting what?
Split second heart sound and a systolic ejection murmur
Disorders with Increased Pulmonary Flow, Atrial Septal Defect (ASD) - Lab: What is done ?
Echocardiography to confirm diagnosis.
ECG may show normal sinus rhythm or prolonged PR
X-Ray may show enlargement of heart
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect (VSD): What is this?
Opening between right and left ventricular chambers of heart.
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect: Spontaneous closure may occur by what age?
By age 2
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect: When is repair recommended?
Larger defect repair by 2 years of age recommended
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Patho: What determines the direction of the blood flow?
Pulmonary vascular resistance and systemic vascular resistance.
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Patho: Left-to-right shunt occurs when
pulmonary vascular resistance is low, leading to icnreased amount of blood into right ventricle and lungs leading to increase in pulmonary vascular resistance
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Patho: Increased pulmonary vascular resistance leads to what?
Increased pulmonary artery pressure (pulmonary hypertension) and right ventricular hypertrophy
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Patho: What happens when right-to-left shunting occurs?
Pulmonary resistance higher, resulting in Eisenmenger Syndrome (pulmonary hypertension and cyanosis).
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Patho: HF occurs with who?
Moderate to severe unrepaired VSDs
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Nurse Assess: Why may infant not show signs at birth
left-to-right shunting minimal because high pulmonary resistance at birth
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Health Hx: Signs of HF at what age
4-8 weeks , showing tiring easily, especially with feeding
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Health Hx: Ausculate heart for what?
Holosystolic harsh murmur along left sternal border.
Disorders with Increased Pulmonary Flow, Ventricular Septal Defect - Labs: What may reveal opening?
MRI or Echocardiogram with color flow Doppler.
Cardiac Catheterization may reveal extend of blood flow
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): What is this?
Failure of endocardial cushions to tuse. Needed to separate central parts of heart near tricuspid or mitral valves.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): Complete AV canal defect involves what?
ASD and VSDs as well as common AV orifice and common AV valve.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): What does this do for blood flow?
Permits oxygenated blood from lugs to eter left atrium/ventricle, and then crossing ASD and VSD and reeturning to lungs.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): What shunt does this invovle
Left-to-right shunt
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): Why is this a problem?
Because blood is already oxygenated, and body still needs to meet demand for oxygenated blood.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): What happens to left ventricle
Must pump 2-3x more blodo than in normal heart.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): What complication does this lead do?
Pulmonary Edema
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD): Infants with complete AV canal defect exhibits what signs?
Moderate-to-severe signs of HF
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD) - Health Hx: What will you notice during physical exam?
Inspect skin for cyanosis. Observe for retractions, tachypnea or nasal flaring.
Loud murmur is noted within first 2 weeks of life.
Disorders with Increased Pulmonary Flow, Atrioventricular Canal Defect (AVSD) - Labs: What lab is done?
Echocardiography will reveal extend of defect, as well as shunting
ECG may indicate right ventricular hypertrophy.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus: What is thus?
Failure of ductus arteriosus to close within first few weeks of life. Connection between aorta and pulmonary artery.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA): Occurs most frequently in which population?
Premature than in term infants.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA): With this, how is blood flow in systemic system?
Oxygenated, and is able to reach systemic circulation
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Patho: What happens to blood flow?
Failure to close leads to blood to flow from aorta to pulmonary artery. Leads to increase in workload of left side of heart.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Patho: What complications may occur?
Pulmonary vascular congestion occurs, causing an increase in pressure, leading to right ventricular hypertrophy
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Patho: What signs may be displayed?
If small, none. If large, signs of HF
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Health Hx: Health hx may reveal what?
Respiratory ifections, fatigue, and poor growth.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Health Hx: What to note from physical exam?
Tachycardia, tachypnea, bounding peripehral pulse and widened pulse pressure.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Health Hx: BP here?
Diastolic low to due to shunting.
Disorders with Increased Pulmonary Flow, Patent Ductus Arteriosus (PDA), Labs: What lab performed?
Echocardiogram determiens defective opening.
ECG may show ventricular hypertrophy
Chest radiography demonstrates cardiomegaly
Obstructive Disorders, Coarctation of the Aorta: What is this?
Narrowing of the aorta
Obstructive Disorders, Coarctation of the Aorta - Patho: Where does this occur?
Area nnear the ductus arteriosus. Can occur preductal or postductal.
Obstructive Disorders, Coarctation of the Aorta - Patho: What happens to BP?
Increased in the heart, and decreased in the lower portions of the body
Obstructive Disorders, Coarctation of the Aorta - Patho: What happens to left ventricle?
Afterload is increased, and this can lead to heart failure
Obstructive Disorders, Coarctation of the Aorta - Patho: Due to elevation in BP, child at risk for what
aortic rupture, aortic aneurysm, and CVa
Obstructive Disorders, Coarctation of the Aorta - Health Hx: What problems may they show?
Irritability and frequent epistaxis. Leg pain with activity, fainting and dizziness with older children.
Obstructive Disorders, Coarctation of the Aorta - Health Hx: How much will BP differ in upper and lower body?
By about 20
Obstructive Disorders, Coarctation of the Aorta - Labs: What can be done?
Echocardiogram .
chest radiography may reveal left-sided enlargement
Obstructive Disorders, Aortic Stenosis, Patho:What is this?
Obstruction of blood flow between left ventricle and arota. Cause dby muscle osbtruction below aortic valve.
Obstructive Disorders, Aortic Stenosis, Patho:Most common kind?
Aortic valve stenosis. The valve has narrowed, causing obstruction .CO decreases Left Ventricle then works harder.
Obstructive Disorders, Aortic Stenosis, Patho: Wht happens to left ventricle?
Left ventricular hypertrophy. Failure can occur leading tp packup of pressure inpulmonary circulation and edema.
Obstructive Disorders, Aortic Stenosis, Health Hx:What signs may child have
Fatigability or complaints in chest. Dizziness with prolonges standing. Infant may have issue with ffeeding
Obstructive Disorders, Aortic Stenosis, Health Hx:How will pulse feel
Pulse may be faint if severe
Obstructive Disorders, Aortic Stenosis, Lab: Most common lab?
Echocardiogram.
ECG may determine left ventricular hypertrophy if severe.
Obstructive Disorders, Pulmonary Stenosis: What is this?
Condition that causes obstruction of blood flow between right ventricle and pulmonary arteries.
Obstructive Disorders, Pulmonary Stenosis: Children with severe stenosis may exhibit what?
Dyspnea and Fatigue with Exertion
Obstructive Disorders, Pulmonary Stenosis, Patho: Most common form?
Valve obstruction. Leaflets are thickened and fused together along separation lines.
Obstructive Disorders, Pulmonary Stenosis, Patho: What happens to right ventricle?
Has to do more work causing muscle to thicken. Leads to decreased pulmonary blood flow.
Obstructive Disorders, Pulmonary Stenosis, Patho: What happens if pressure in right atrium increases?
Foramen Ovale may reopen
Obstructive Disorders, Pulmonary Stenosis, Health Hx: What may child report?
Dyspnea or cyanosis with exertion. Document growth.
Obstructive Disorders, Pulmonary Stenosis, Health Hx: Auscultate heart for what?
High-pitched clicking following the second heart sound and a systolic ejection murmur
Obstructive Disorders, Pulmonary Stenosis, Lab: What lab may be done?
Echocardiogram to detect obstruction
Mixed Defects: What are these?
Defects that involve mixing of well-oxygenated blood with poorly oxygened blood.
Mixed Defects, Transposition of Great Vessels (Arteries): What is this?
Pulmonary artery and arota are transposed from their normal positions. Aorta and Pulmonary Artery switch spots.
Mixed Defects, Transposition of Great Vessels (Arteries): When is this diagnosed?
Within first few days of life, when infant manifests cyanosis . Worsens when ductus arteriosus closes.
Mixed Defects, Transposition of Great Vessels (Arteries): When is surgery performed?
By 4-7 days
Mixed Defects, Transposition of Great Vessels (Arteries), Patho: Blood FLow here?
Oxygenated blood returning from lungs to left atrium and ventricle is sent back to the lungs through pulmonary artery.
Mixed Defects, Transposition of Great Vessels (Arteries), Health Hx: What is a significant sign of this?
Significant cyanosis without a murmur.
Mixed Defects, Transposition of Great Vessels (Arteries), Health Hx: What signs will ifnant observe?
Cyanosis while at rest or crying.
Mixed Defects, Transposition of Great Vessels (Arteries), Health Hx: Auscultation of ehart will reveal what?
Loud second heart sound.
Mixed Defects, Transposition of Great Vessels (Arteries), Lab: Which lab performed?
Echocardiography reveals evidence of transposition.
Catheterization may determine whether O2 levels due to mixing of blood
Mixed Defects, Total Anomalous Pulmonary Venous Connection: What is this?
Pulmonary Veins do not connect to left atrium, and connect to right atrium by superior vena cava
Mixed Defects, Total Anomalous Pulmonary Venous Connection (TAPVC) - Patho: What happens to blood flow?
Oxgenated blood that would normally enter left atrium now enters right atrium. Pressure on right side increased.
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Patho: What is usually present to support life?
Patent foramen ovale or an ASD
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Patho: Where does left atrium get blood?
Only sorce is from blood that is shunted from the right atrium across defect.
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Patho: What happens to lungs?
Pulmonary hypertension and pulmonary edema
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Health Hx: What happens if foramen ovale or ASD is small?
Significant cyanosis will be present.
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Health Hx: Note history of what
Cyanosis, tiring easily and difficulty feedings.
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Health Hx: Heart sounds?
Fixed splitting of the second heart sound and murmur.
Mixed Defects, Total Anomalous Pulmonary Venous Connection - Labs: What is done
Echocardiogram will reveal abnormal connection of pulmonary veins and enlargement of right side.
Mixed Defects, Truncus Artereiosus: What is this?
Only one major artery leaves the and supplies blood to all pulmonary adn systemic circuits.
Mixed Defects, Truncus Artereiosus, Patho: Blood flow here?
Blood from the left ventricle mixes with right due to there only being one valve.
Mixed Defects, Truncus Artereiosus, Patho: Pressure here?
Pulmonary circulation typically less than systemic, leading to increased blood flow to lungs.
Mixed Defects, Truncus Artereiosus, Patho: How does infant appear?
Demostrates cyanosis
Mixed Defects, Truncus Artereiosus, Health Hx: What to note for cyanosis?
Will increase during activites of feeding. Also note tiring easily.
Mixed Defects, Truncus Artereiosus, Health Hx: What to check for with respirations?
RR, which may be elevated and show nasal flaring, grunting, or noisy breathing
Mixed Defects, Truncus Artereiosus, Labs: What is done
Echocardiogram will confirm presence
Mixed Defects, Hypoplastic Left heart Syndrome (HLHS): What is this?
Structure on left side of heart are severly underdeveloped. Unable to supply blood to systemic circulation
Mixed Defects, Hypoplastic Left heart Syndrome (HLHS): Treatment options?
Palliative care, cadiac transplant within first few weeks, or palliative reconstructive surgery beginning days to weeks of birth
Mixed Defects, Hypoplastic Left heart Syndrome (HLHS), Patho: Blood work here?
Right side of the main working part. Passses through ASD. Onc PDA closes, heart cannot pump blood into systemic circulation
Mixed Defects, Hypoplastic Left heart Syndrome (HLHS), Health Hx: What will you notice about infant?
Cyanosis, poor feeding and history of tiring. WIll have tachycardia and tachypnea.
Mixed Defects, Hypoplastic Left heart Syndrome (HLHS), Labs: What will be used?
Fetal echocardiogram , or maternal ultrasound.
Nursing Management for Child with CHD: Nursign care focuses on wht?
Providing oxygenation, promoting nutrition , assisting family with coping, providing postop care, and preventing infection
Nursing Management for Child with CHD, Improving Oxygenation: Position child should be in?
Fowler or Semi-Fowlers position.
Nursing Management for Child with CHD, Improving Nutrition: Breastfeeding before and after cardiac surgery may help with what
booster ifants immune system, which can fight postoperative infection
Nursing Management for Child with CHD, PreOp Care: Preoperative Physical Assessment includes?
Temp/Wt Measurement
Exam extremities for peripheral edema
Auscultation of ehart
Respiratory assessment
Nursing Management for Child with CHD, PreOp Care: Child and Parent Education includes?
Heart Anatomy
Events before surgery
Location of child after surgery/appearance
Approximate location of incision
Postop activity level
Heart Failure: What does this refer to?
Set of clinical signs and symptoms that reflect the hearts inability to pump effectively to provide adquate blood, oxygen.
Heart Failure - Patho: What happens when ventricular contraction impaired (Systolic dysfunction)?
Reduced ejection of blood occurs, and therefore cardiac output is reduced
Heart Failure - Patho: What is activated due to decreased CO?
RAAS system activated. Fuid and sodium retention and vasoconstriction occur. Overtime, heart cannot respond to these mechanisms and fails.
Heart Failure - Therapeutic Mx: Management of this is what?
Supportive. Promototion of oxygenation and vnetilation is important
Heart Failure - Therapeutic Mx: What medicines have been used
Digitalis, Diuretics, Inotropic Agents, Vasodilators, and Antithrombotics
Heart Failure - Nursing Assess, Health Hx: Common complaints include?
Failure to gain weight, Failure to thrive
Difficulty feeding
Fatigue
Dizziness
Exercise Intolerance
Heart Failure - Nursing Assess, Health Hx: Infants display what sigins
Difficuly feeding and tiring easily.
Heart Failure - Nursing Assess, Health Hx: What statement should alert you of this?
“The baby drinks a small amount of breast small and stops, but then wants to eat very soon afterwards:
Heart Failure - Nursing Assess, Physical Exam: What to report about weight?
Weigh the child and note rapid recent weight gain or lack of
Heart Failure - Nursing Assess, Physical Exam: VS here?
Tachypnea, Tachycardia.
Heart Failure - Nursing Assess, Physical Exam: What signs may child exlicit?
Diaphoresis (Excessive sweating). Edema on body. And observe for increased work of breathing.
Heart Failure - Nursing Assess, Physical Exam: Auscultate the heart and lungs which may indicate what?
Murmurs or gallops.
And listen for crackles or whezing sugesting congestion.
Heart Failure - Nursing Assess, Lab; Lab tests performed?
Chest X-Ray, revealing enlarged heart
Electrocardiogram
Echocardiogram
Heart Failure - Nursing Assess, Lab; Electrolyte levels may reveal what?
Hyponatremia, secondary to fluid retention and hyperkalemia, seconday to tissue destruction
Heart Failure - Nursing Mx, Promoting Oxygenation: How should they be positioned?
In a semi-upright position to decrease work of breathing.
Heart Failure - Nursing Mx, Promoting Oxygenation: What do to with extra secretions?
Suctio, and chest physiotherapy and postural drainage may be beneficial.
Heart Failure - Nursing Mx, Promoting Oxygenation: Why is oxygen beneficial?
Serves as vasodilator and decreases pulmonary vascular resistance.
Heart Failure - Nursing Mx, Promoting Oxygenation: For child with left-to-right shunt, what will oxygen do?
Decrease pulmonary vascular resistance while increasing systemic resistance, leading to increased left-to-right shunting.
Heart Failure - Nursing Mx, Supporting Cardiac Function: What medications may be prescribed?
Digitalis, ACE Inhibitors and Diuretics
Heart Failure - Nursing Mx, Supporting Cardiac Function: How does Digoxin therapy begin?
Digitalizing dose divided into several doses over 24 hour period to reach maximum cardiac efect.
Heart Failure - Nursing Mx, Supporting Cardiac Function: Digoxin doses given how often
Every 12 hours/
Heart Failure - Nursing Mx, Supporting Cardiac Function: How precautions to take with ace inhibitors?
Measure BP before/After admin. Withhold if drops by more than 15.
Heart Failure - Nursing Mx, Supporting Cardiac Function: Signs of hypotension with ACE Inhibitors includes?
Lightheadedness, Dizziness, or Fainting.
Heart Failure - Nursing Mx, Providing Adequate Nutrition: How many calories will infant require
150 kcal/kg
Heart Failure - Nursing Mx, Providing Adequate Nutrition: How should meals be offered?
Small, frequent
Heart Failure - Nursing Mx, Providing Adequate Nutrition: Infant formula will be concentrated to what
24-28 calories/oz
Heart Failure - Nursing Mx, Promoting Rest: Decreasing metabolic needs does what
decreases cardiac demand.
Acute Rheumatic Fever: What is this?
Delayed sequela of Group A Strep Pharyngeal infection.
Acute Rheumatic Fever: What age does this affect?
5-15
Acute Rheumatic Fever: When does this develop?
2-4 weeks after initial streptococcal infection.
Acute Rheumatic Fever: Antibodies react with antigens in cardiac muscles causing what?
Carditis, arthritis and chorea (involuntary, random movements)
Acute Rheumatic Fever: This affects what?
Joints, CNS, Skin ,And Subcutaneous Tissue.
Acute Rheumatic Fever: Diagnosis of this based on what?
Modified Jone sCriteria.
Acute Rheumatic Fever: Therapeutic management is directed toward what
managing inflamamtion and fever, eradicating bacteria, preventing permanent heart damage, and prevent recurrences
Acute Rheumatic Fever: Treatment?
10 day course of penicillin therapy used with corticosteroids and NSAIDs
Acute Rheumatic Fever: Children without valvular disease will continue what treatment?
Monthly intramuscular injections of penicillin G benzathine or daily oral doses of penicillin. Prophylaxis continued until adulthood
Acute Rheumatic Fever, Nursing Assess: What chief complaints should we note
fever and joint pain
Acute Rheumatic Fever, Nursing Assess: Look for risk factors such as what
documented strep infection or sore throat whthin past 2-3 weks.
Acute Rheumatic Fever, Nursing Assess: Observe cihildren for what signs?
Sydenham chorea, movement disorder of face and upper extremities.
Acute Rheumatic Fever, Nursing Assess: Skin appearance?
Classic rash, erythema marginatum, and red rash.
Acute Rheumatic Fever, Nursing Assess: whatwill provide definitive diagnosis of infection
throat culture
Acute Rheumatic Fever, Nursing Assess: What determines if carditis present
echocardiogram
Acute Rheumatic Fever, Nursing Mx: Management focuses on what
compliance with acute course of antibiotics as well as prophylaxis following initial recovery
Acute Rheumatic Fever, Nursing Mx: Education child what about chorea movements?
How the sudden jerky movements will eventually disappear, though they may last as long as several months
Acute Rheumatic Fever, Nursing Mx: What managed chorea?
Haloperidol (Haldol)
Acute Rheumatic Fever, Nursing Mx: What controls join pain and swelling?
Corticosteroids or NSAIDs
Kawasaki Disease: What is this?
Acute systemic vasculitis occuring in children from 6 months to 5 years.
Kawasaki Disease: Can cause what cardiovascular complications?
Coronary artery aneurysm and cardiomyopathy
Kawasaki Disease: Therapetuic management focuses on what?
Reducing inflammation in walls of coronary arteries and preventing coronary thrombosis
Kawasaki Disease: Chronic management?
Prevent myocardial ischemia
Kawasaki Disease: What is treatment in acute phase?
High dose aspirin divided into four daily doses and a single infusion of IV Immunoglobulin. Best wehn given within first 7-10 days of illness
Kawasaki Disease - Patho: What happens inside the body?
Autoimmune response. Neutrophils, followed by mononuclear cells, T Lymph, and Immuno A infiltrate vessels. Integrity of vessel then impaired
Kawasaki Disease - Patho: Inflammation of blood vessels throughout body can lead to what?
Coronary dilation or aneurysm
Kawasaki Disease - Health Hx: Which should you note?
Fever, Chills, Headache, Malaise, Extreme Iritability
Kawasaki Disease - Health Hx: What should you note about high fever?
FEer of 39.9 that lasts 4 days that is unresponsive to antibiotics
Kawasaki Disease - Physical Exam: What appearance can you look for
Bilateral Conjunctivitis without Exudate
Mouth and Throat dry, with fissured Lips and Strawberry tongue.
Pharyngel and oral mucosa erythem a
Kawasaki Disease - Physical Exam: Evaluate skin for what
Diffuse, rash
Edema of hands and feet
Erythema and painful induration of palms
Desequamtion peeling of perineal region, fingers, and toes.
Kawasaki Disease - Physical Exam: Palpate the neck for what?
Cervical lymphadenopathy and joints for tenderness
Kawasaki Disease - Lab: CBC reveals what?
Mild-to-moderate anemia, elevated WBC count and significant thrombocytosis (platelet 500,00 to 1 million)
Kawasaki Disease - Lab: Cardiogram performed why?
To evaluate for coronary artery involvement
Kawasaki Disease - Monitoring Cardiac Status: What should you assess for?
Signs of developing ehart fialure like tachycardia, gallop, decreased urine output or respiratory distress
Kawasaki Disease - Promoting Comfort: How to control fever?
Acetaminophen and apply cool clothes.
Kawasaki Disease - Promoting Comfort: Teach parents that what is a prominent sign of this?
Irritability
Kawasaki Disease - Providing Education: Teach parents to do what?
Monitor childs temp after discharge until child without fever for several days.
Kawasaki Disease - Providing Education: Children with prologned fever may require what
second dose of IVIG
Kawasaki Disease - Providing Education: Irritiability may last how long
2 months
Kawasaki Disease - Providing Education: Report what toxic effects of aspirin?
headache, confusion, dizziness, or tinnitus
Kawasaki Disease - Providing Education: What to avoid after IVIG administration?
Avoid mealsea and varicella vaccination for 11 months
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess?
obesity from overeating clubbing of the nail beds squatting during play activities exercise intolerance
obesity from overeating
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding?
gallop and rales blood pressure discrepancies in the extremities right ventricular hypertrophy on ECG heart murmur
heart murmur
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem?
previous streptococcal throat infection history of open heart surgery at 5 years of age playing too much soccer and not getting enough rest exposure to a sibling with pneumonia
previous streptococcal throat infection
The nurse is caring for a child after a cardiac catheterization. What is the nursing priority?
Allow early ambulation to encourage activity participation. Check pulses above the catheter insertion site for strength and quality. Assess extremity distal to the insertion site for temperature and color. Change the dressing to evaluate the site for infection.
Assess extremity distal to the insertion site for temperature and color.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action?
Provide supplemental oxygen by face mask. Administer a dose of IV morphine sulfate. Begin cardiopulmonary resuscitation. Place the infant in a knee-to-chest position.
Place the infant in a knee-to-chest position.
