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Pediatrics-MJ > Final: Focus Cardiac (mainly from ATI) > Flashcards

Final: Focus Cardiac (mainly from ATI) Flashcards

1
Q

Anatomic abnormalities present at birth can lead to ___

A

CHD (congenital heart disease)

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2
Q

When does HF occur?

A

When the heart is unable to pump adequate blood o meet the metabolic and physical demands of the body

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3
Q

What CHD can cause increased pulmonary blood flow?

A

Atrial septal defect
Ventricular defect
Patent ductus arteriosus

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4
Q

What CHD can cause decreased pulmonary blood flow?

A

Tetralogy of fallot

Tricuspid atresia

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5
Q

What CHD causes obstruction to blood flow?

A

Coarctation of the aorta
Pulmonary stenosis
Aortic stenosis

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6
Q

What CHD can cause mixed blood flow?

A

Transposition of the great arteries
Truncus arteriosus
Hypo plastic left heart syndrome

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7
Q

A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow

A

VSD

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8
Q

What kind of shunt in VSD?

A

Left to right

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9
Q

Where is murmur for VSD?

A

Loud, harsh murmur ausculated at the LEFT STERNAL BORDER

*also HF

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10
Q

T/F: Many VSD close spontaneously

A

True

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11
Q

A hole in the septum between the right and left ATRIA that results in increased pulmonary blood flow

A

ASD

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12
Q

What kind of shunt for ASD?

A

Left to right

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13
Q

How is murmur in ASD?

A

Loud, harsh murmur with a fixed split second heart sound

  • HF
  • may be asymptomatic
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14
Q

A condition in which the normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow

A

PDA

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15
Q

What kind of shunt in PDA?

A

Left to right

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16
Q

What kind of murmur in PDA?

A

Machine hum

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17
Q

PDA: How is pulse pressure? How are pulses?

A

Pulse pressure=widened
Pulses= bounding

  • may be asymptomatic
  • HF
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18
Q

A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood from from the ventricles

A

Pulmonary stenosis

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19
Q

What kind of murmur for pulmonary stenosis?

A

Systolic ejection murmur

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20
Q

Pulmonary stenosis:
Can you be asyptomatic?
Is there cyanosis?
What heart issues come with this?

A

Asymptomatic: possibly

Cyanosis: Varies with defect, worse with severe narrowing

Other heart prblems= cardiomegaly and HF

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21
Q

A narrowing of the aortic valve

A

Aortic stenosis

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22
Q

What are signs of aortic stenosis in INFANTS?

A

Faint pulse
Hypotension
Tachycardia
Poor feeding

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23
Q

What are signs of aortic stenosis in children?

A

Intolerance to exercise
Dizziness
Chest pain
Possible ejection murmur

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24
Q

A narrowinf to the lumen of the aorta, usually at or near the ductus arterioles, that results in obstruction of blood flow from the ventricle

A

Coarctation of the aorta

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25
Q

Coarctation of the aorta:

  1. Where is there elevated BP?
  2. Where is there bounding pulses?
  3. Where is there decreased BP?
  4. How is skin at lower extremities?
  5. What are femoral pulses like?
  6. What is in infants?
  7. What is in children?
A
  1. Elevated BP= Arms
  2. Bounding pulses= Upper extremities
  3. Decreased BP= Lower extremities
  4. Skin at lower extremities= Cool skin
  5. Femoral pulses: Weak or absent
  6. Infants= HF
  7. Children: Dizzy, headache, faiting, nosebleeds
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26
Q

A condition in which the aorta is connected to the R. ventricle instead of the left! and the pulmonary artery is connected to the L. ventricle instead of the right!! What condition is that?

What must be present in order to oxygenate blood?

A

Condition: Transposition of the great arteries

Septal defect or PDA must exist in order to oxygenate blood

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27
Q

What murmur in transposition of the great arteries?

A

Murmur dependsin on presence of associated defects

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28
Q

Is there cyanosis in transposition of the great arteries?

A

Severe to less cyanosis depending on size of associated defect

*Cardiomegaly and HF is with T.of great. arteries

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29
Q

A complete closure of the tricuspid valve that results in mixed blood flow

What must be present to allow blood to enter L atrium?

A

Tricuspid atresia

Atrial septal opening must be present to allow blood to enter L. atrium

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30
Q

Infant manifestations if they have tricuspid atresia?

A

Cyanosis
Dyspnea
Tachycardia

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31
Q

Older children if they have tricuspid atresia?

A

Hypoexemia

Clubbing of fingers

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32
Q

Four defeats that result in mixed blood flow

A

Tetralogy of fallot

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33
Q

What are the 4 defects of teratlogy of fallot?

A

Pulmonary stenosis
Ventricular septal defect
Overriding aorta
R. Ventricular hypertrophy

34
Q

What is at birth if you have teratology of fallot?

A

CYANOSIS and progressive over first year of life

*episoder of acute cyanosis and hypoxia (blue spells)

35
Q

What murmur with tetralogy of fallot?

A

Systolic

36
Q

Failure of septum formation, resulting in a single vessel that comes off the ventricles

A

Truncus arteriosus

37
Q

What are manifestations of trunks arteriosus?

A 
HF
Murmur
Variable cyanosis
Delayed growth
Lethargy
Fatigue
Poor feeding habits
38
Q

Left side of the heart is underdeveloped. An ASD or patent foramen oval allows for oxygenation of the blod

A

Hypo plastic left heart syndreom

39
Q

Manifestations of hypo plastic left heart syndrome?

A 
Mild cyanosis
HF
Lethargy
Cold hands and feet
Once PDA closes, progression of cyanosis and decreased CO result in eventual CARDIAC COLLAPSE
40
Q

How do tet spells manifest?

A

Acute cyanosis and hyperpnea

41
Q

An invasive test used for diagnosing, repairing some defects, and evaluating dysrhythmias

A

Cardiac catherization

42
Q

What may cancel a cardiac cath procedure?

A

Infection–like severe diaper rash if femoral access is required

43
Q

What allergies need to be checked before cardiac cath?

A

Iodine and shellfish

44
Q

How long should NPO be before cardiac cath?

A

4-6 hr prior to procedure

45
Q

Post cardiac cath procedure…what needs to be assessed for 1 full minute?

A

HR and RR

46
Q

Where is the typical insertion site of cardiac cath?

A

Femoral or antecubital area—post procedure check for bleeding and/or hematoma

47
Q

Post cardiac cath: Prevent bleeding by maintain the affected extremity in a straight position for ____

A

4-8 hr

48
Q

How is dye from cardiac cath removed?

A

Encourage fluid intake to help rid the dye from the body

49
Q

What kind of meals in heart patients?

A

Small, frequent

50
Q

If a child is currently taking an ACE inhibitor, what supplement may we not want to give?

A

Potassium

51
Q

What position is good for an infant to decrease workload of the heart?

A

Car seat or hold at 45 degree angle–keep safety restraints low and loose on abdomen

52
Q

What position in good for child to decrease workload of heart?

A

Sleep with several pillows and be in semi-fowler or fowlers while awakw

53
Q

How often is infant with cardiac problems fed?

A

Every 3 hours–the infant should be rested, which occurs soon after awakening

54
Q

What kind of nipple is used to feed infant with heart problems?

A

Soft preemie nipple or reg nipple with a slit to provide an enlarged opening

55
Q

How is infant held when feeding

A

Semi-upright position

56
Q

How long should it take to complete a feeding for an infant with heart problems?

A

30 minutes; allow the infant to rest during feedings

57
Q

How can we feed the infant if he is unable to consume enough formula or breast milk?

A

Gavage feed

58
Q

How do we increase caloric density of formula?

A

Gradually from 20kcal/oz to 30kcal/oz

59
Q

How often is ox sat monitored?

A

q2-4 hr

60
Q

What medication can be given to improve myocardial contractility? Nursing actions?

A

Digoxin

  • Hold if infant pulse is less than 90/min
  • Hold if child pulse is less than 70/min
61
Q

What are signs of digoxin toxicity?

A

Bradycardia
Dysrhythmias
N/V
Anorexia

62
Q

What med can we give to reduce after load by causing vasodilation, resultin in decreased pulmonary and systemic vascular resistance?

A

Captopril or enalapril (ACE inhibitors)

-Monitor for HYPERkalemia

63
Q

What can be given to decrease HR and BP and promote vasodilation?

A

Metoprolol or carvedilol (BB)

AE: dizzy, hypotension, headache

64
Q

What can we give that is a potassium wasting diuretic to rid body of excess fluid and sodium?

A

Furosemide or chlorthiazide

*encourge diet high in potassium!!

65
Q

How do we fix VSD?

A

Closure during cardiac cath

Surgery: pulmonary artery banding; complete repair with patch

66
Q

How do we fix ASD?

A

Closure during cardiac cath

Surgery: Patch closure

67
Q

How do we fix PDA?

A

Administer indomethacin

Insert of coils to occlude PDA during cardiac cath

Surgery: Thoracoscopic repair

68
Q

How do we fix pulmonary stenosis?

A

Balloon angioplasty with cardiac cath

Surgery
Infant: Brock
Children: Pulmonary valvotomy

69
Q

How do we fix aortic stenosis?

A

Balloon angioplasty with cardiac cath

Surgery: Norwood procedure; aortic valvotomy

70
Q

How do we fix Coarctation of aorta?

A

Infant and children: Balloon angioplasty
Adolesecnt: Placement of stents

Surgery: Repair defect recommended for infants less than 6m of age

71
Q

Transposition of great arteries: When is surgery to switch arteries?

A

W/in first 2 weeks of life

72
Q

What are 3 stages of tricuspid atresia surgery?

A

Shunt placement
Glenn procedure
Moditifed Fontan procedure

73
Q

How do we fix Tetralogy of Fallot?

A

Shunt placement until able to do primary repair

Complete repair w/in first year of life

74
Q

When is surgical repair for trunks arteriosus?

A

w/in first month of life

75
Q

What are 3 stages of surgery for hypo plastic left heart syndrome?

A

Begin shortly after birth

Norwood procedure
Glenn shunt
Fontan procedure

76
Q

What do we do if there is a cardiac cath complication?

A

Apply direct continuous pressure 1 inch above the catheter entry site to localize pressure over the location of the vessel puncture

Put child in flat position to reduce the gravitational effect and rate of bleeding

Notify provider immediately

77
Q

What are the nursing actions for a hyper cyanotic spell?

A

Immediately place the child in the knee-chest position, attempt to calm the child, and call for help

78
Q

Children with congenital or acquired heart disease are at increased risk for _____

A

Infection of the valves lining the heart (bacterial endocarditis or subacute bacterial endocarditis)

79
Q

A nurse is caring for an infant. Which of the following are clinical manifestations of coartation of the aorta? (SATA)

A. Weak femoral pulses
B. Cool skin of lower extremities
C. Severe cyanosis
D. Clubbing of fingers
E. HF
A

A, B, E

80
Q

A nurse is assessing an infant. Which of the following should the nurse recognize as clinical manifestations of HF? (SATA)

A. Bradycardia
B. Cool extremities
C. Peripheral edema
D. Increaed urinary output
E. Nasal flaring
A

B, C, E

81
Q

A nurse is providing teaching to the mom of an infant who is starting to take digoxin. Which of the following instructions should the nurse include?

A. Do not offer your baby fluids after giving med
B. Digoxin increase baby HR
C. Give the correct dose of med at regular scheduled times
D. If your baby vomits a dose, you should repeat dose to make sure he gets correct amount

A

C

82
Q

A nurse is caring for a 2 year old who is cyanotic and is in the hospital for a cardiac cath to repair cardiac defects. The child will be transferred to ped ICU following procedure. Which of the following is an appropriate nursing action when providing care to this child?

A. Place NPO for 12 hr prior to procedure
B. Check for iodine and shellfish allergies prior to procedure
C. Elevate affected extremity following procedure
D. Limit fluid intake following procedure

A

B

Pediatrics-MJ (61 decks)

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