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Peds > Lecture 05 Cardiology > Flashcards

Lecture 05 Cardiology Flashcards

1
Q

What’s the most common congenital heart defect?

A

VSD

  • Abnormal opening between right and left ventricle
  • Classified according to location (membrane or muscle)
  • Varies in size from small pin hole to absence of septum
  • Frequently associated with other defects
  • 20 to 60 % thought to close spontaneously within first year (may not know present)
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2
Q

Murmurs occur in VSDs. What cuases the sound?

What does this put them at risk for?

A
  • Murmur is present, this is common in a left-to-right shunt as murmuring sound is caused as blood is pumped through hole in septum.
  • Child is at risk for bacterial endocarditis and pulmonary vascular obstructive disease
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3
Q

What’s the second most common CHD?

Where is the strucutral defect?

A
  • Patent Ductus Arteriosus connects the aorta with the pulmonary artery at its bifurcation.
  • Second most common CHD

•

•Normally closes spontaneously beginning 10 to 12 hours after birth (when PaO2 > 90) and completed by 2 to 3 weeks

•

•Failure of PDA to close results in left to right shunt

•

•Portion of blood from aorta diverted to pulmonary system causing increased left ventricle volume & workload; increased pulmonary blood flow results in pulmonary congestion, CHF and FTT

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4
Q

KNOW; To close PDA, what drug would be used?

A

KNOW: To close the PDA, use Prostaglandin inhibitors (Indomethacin)

  • Given shortly after birth
  • Act as systemic vasoconstrictor to facilitate PDA closure
  • Supplemental oxygen may help as it á PaO2
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5
Q

How does PDA surgery anatomically correct the heart?

A

Purpose of Surgical closure of the PDA prevents the return of oxygenated blood to the lungs & decreases pulmonary vascular congestion

  • PDA ligation; can be done via thoracotomy, thorascopic or cardiac cath
  • Excellent prognosis
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6
Q

Describe ASD

When does it typically close by?

A

ASD is an abnormal opening

between the right and left atria

(patent foramen ovale)

  • Normally closes by 2 months to 1 year
  • :Left to R shunting again.
  • Small amount shunting; may be asymptomatic
  • Large ASD allows large amount of blood to shunt and produces symptoms

ASD results in increased

pulmonary blood flow

Blood flows from the left atrium

(higher pressure) into the right atrium

(lower pressure) and then to the lungs

via the pulmonary artery

•

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7
Q

KNOW: What’s Coarctation of the Aorta?

A

Stricture is typically where ductus arterioles is.

Notice the constriction prevents lower extremities from getting blood flow, and upper extremities are getting ample blood flow.

So you may see higher BP in upper extremities vs lower extremities. Lower extremities may be cooler, lower circulation. GI tract has lower motility. Decreased cap refills.

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8
Q

Left side obstruction results in

A

CHF

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9
Q

R side obstruction in the heart leads to

A

cyanosis

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10
Q

KNOW: In Coarctation of the Aorta, what are the BPs like in the upper and lower body?

A

•Increased pressure/blood flow proximal to defect (head & upper extremities)

–Higher BP & bounding pulses in arms

•Decreased pressure/blood flow distal to obstruction (body & lower extremities)

–Weak or absent femoral pulses, & cool lower extremities with lower BP

•CHF especially in infants

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11
Q

What are treatments for coarctation of the aorta?

A

Treatment

  • Balloon angioplasty/dilatation initially
  • Resection of aorta end to end anastomosis
  • Defect outside heart so by-pass not needed
  • Repair indicated 1st 2 years of life to prevent hypertension
  • Post-op may have abdominal pain/GI disturbances r/t sudden á blood flow to those areas
  • May have post-op tingling of legs and feet
  • Excellent prognosis

•

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12
Q

What are some assessments findings for Coarctation of Aorta?

A

Assessment

•Bounding pulses in head, arms & chest

–Headaches, dizziness, nosebleeds, CVA

•Decreased pulses in legs, feet, GI system

–Cool, mottled legs, abdomen, feet

–Decreased peristalsis, constipation

•SBE risk

Subacute bacterial

endocarditis

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13
Q

KNOW: What are the 4 defects of the heart that makes up the Tetralogy of Fallot

A
  1. So know the 4 defects and what they are.
  2. Ventricular septal defect (VSD)
  3. Overriding aorta
  4. Pulmonic Stenosis
  5. R Venticular Hypertrophy
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14
Q

What are Tetralogy of Fallot Assessment Findings?

A
  • Mild to severe symptoms
  • Murmur
  • Mild cyanosis
  • Possible blue/cyanotic or “tet” spells

–Persistent blue or cyanotic color

–Cyanosis with feeding

–Limpness, unresponsiveness

–Hypotonic extended position

•Older child- self limited activity

–Assumes squatting position after exertion

–Prefers knee-chest position vs. flat lying

•Clubbing & shunted growth

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15
Q

What is polycythemia?

A

Increase number of RBC (In response to low O2) as an attempt to increase O2 carrying capactity of blood.

Blood viscosity is inscreased and clotting ability diminished as increased RBC’s crowd out, clotting factors.

Hydration is important to reduce risk for Cerebrovascular event

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16
Q

What is Clubbing?

A

Thickening and flattening of finger tips or toes related to chronic hypoxia and polycythemia

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17
Q

What are Hypercyanotic Spells?

A

Acute cyanosis and hypoxia caused by increaed oxygen demands.

Early morning hunger, feedings, crying & BM may precipitate episode; blood draws, hurtful procedures

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18
Q

KNOW: Order of priority for prevention and treatment of chronic hypoxia?

A

•Knee chest position (same effects as squatting)

  • Calm, comforting approach
  • 100 % Oxygen
  • Morphine (IV/SC)
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19
Q

What occurs in the Transposition of Great Vessels?

A

Major blood vessels are switched.

There needs to be other defects present for the child to live

No communication between systemic & pulmonary circulation

20
Q

Which of the following is a complication

that may occur with a cardiac catheterization?

  • Cardiac arrhythmia
  • Hypostatic pneumonia
  • Congestive heart failure
  • Rapidly increasing blood pressure
A

Cardiac arrhythmia

21
Q

Why is it important to prepare children for surgery?

A
  • Often have misconceptions
  • Younger children: shorter attention span
  • Imagination can increase fears
  • May regress in stressful situations
  • Assess knowledge level: Ask chidl what they think will happen, so that you’ll be able to assess it
  • Role playing: via dolls
22
Q

72 hours after cardiac surgery, a young child

has a temp of 101 degrees F. The nurse should:

  1. Keep child warm with blankets
  2. Apply a hypothermia blanket
  3. Record temperature on nurse’s notes
  4. Report findings to physician
A

4.Report findings to physician

23
Q

Which is an important nursing consideration when

suctioning a young child who has had heart

surgery?

  1. Perform suctioning at least every hour
  2. Suction for no longer than 30 seconds at a time
  3. Administer supplemental oxygen before and after suctioning
  4. Expect symptoms of respiratory distress when suctioning
A

3.Administer supplemental oxygen before and after suctioning

24
Q

The nurse is caring for a child after heart

surgery. Which should the nurse do if

evidence is found of cardiac tamponade?

  1. Increase analgesia
  2. Apply warming blankets
  3. Immediately report this to physician
  4. Encourage child to cough, turn, and breath deeply
A

1.Immediately report this to physician

25
Q

Which is an important nursing consideration

when chest tubes are removed from a child?

  1. Explain that it is not painful
  2. Explain that only a Band-Aid will be needed
  3. Administer analgesics before procedure
  4. Expect bright red drainage for several hours after removal
A

1.Administer analgesics before procedure

26
Q

What is CHF?

A

“Congestive Heart Failure is the inability of the

heart to pump an adequate amount of blood to

the systemic circulation at normal filling

pressure in order to meet the metabolic needs

of the body.”

27
Q

what causes CHF in Peds Population?

A

•Increased blood volume and pressure within the heart from structural defects

–most common cause in pediatric population

–consequence of an underlying cardiac defect

  • Myocardial failure with impaired ventricular contractility (cardiomyopathy, dysrhythmias, severe electrolyte disturbance)
  • Excessive demands placed on normal heart (sepsis, severe anemia)
28
Q

CHF: Impaired Myocardial Function S&S?

A

–Inappropriate sweating, fatigue, pallor, cool extremities, weak pulse, gallop rhythm, hypotension, cardiomegaly, decreased urinary output

29
Q

CHF: Pulmonary Congestion S&S?

A

•Pulmonary Congestion

–Tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, exercise intolerance

30
Q

CHF: Systemic Venous Congestion S&S

A

•Systemic Venous Congestion

–Hepatomegaly, peripheral edema, ascites, neck vein distention, peri-orbital edema, weight gain,

31
Q

What are 4 Goals for CHF?

A
  1. Improve Cardiac Function
  2. Remove Accumulated Fluid & Sodium
  3. Decrease Cardiac Demands
  4. Improve Tissue Oxygenation
32
Q

What are ways to Improve Cardiac Function in CHF pts?

A

Digitalis Gylcosides

•Increase cardiac output by rate, improves myocardial contractility *, decrease heart size, decrease venous pressure, relief of edema

•Digoxin used in pediatrics based on rapid onset and availability in elixir form.

  • Digitalizing dose (2 divided doses either oral/IV) given over 24 hours to produce optimum cardiac effects.
  • BID dosing to maintain levels (0.8 to 2.0 ug/L)
  • Careful, precise dosing, administration, parent teaching & monitoring for toxicity indicated
  • Child is monitored for toxicity

–Early (Nausea, vomiting, anorexia, headache, drowsiness)

–Late (bradycardia, dysrrhythmias, heart block, vision disturbance)

–Dose held if pulse < 70 children or < 90-110 infant (Below % Baseline)

33
Q

How does ACE Inhibitors improve cardiac funciton?

A

ACE Inhibitors

  • Inhibit renin-angiotensin system in kidneys resulting in vasodilatation.
  • Vasodilatation decreases pulmonary & SVR decrease BP and afterload

•Example Captopril (decreases afterload) *

34
Q

How do you evaluate effectiveness of diuretic?

A

•Evaluate effectiveness of diuretic by monitoring I & O and Daily Weights (age appropriate weight gain)

35
Q

What are ways to Decrease Cardiac Demands for CHF patients?

A
  • Metabolic needs minimized
  • Provide rest & decrease environmental stimuli
  • Maintain normal body temperature (increases place more demands on metabolism)
  • Treat infections
  • Position
  • Comfort Measures
36
Q

What are expected outcomes for an Infant with CHF?

A

–Infant will have adequate cardiac output as evidenced by pink/baseline mucous membranes, cap refill less than 2 seconds, warm extremities, palpable peripheral pulses, adequate UO, baseline HR, baseline activity level, (infants: appropriate weight gain for age; indicative of successful feeding and Ü caloric loss secondary to the CHF)

37
Q

What are Acquired CV diseases? (5)

A
  • Subacute Bacterial Endocarditis (SBE)
  • Rheumatic Heart Disease
  • Kawasaki Disease
  • Hyperlipidemia
  • Cardiomyopathy
38
Q

Where does Bacterial Endocarditis typically occur?

A
  • Subacute bacterial endocarditis is an infection of valves and inner lining of the heart.
  • Sequela children with acquired or congenital defects of heart or great vessels; especially those with valvular abnormalities, prosthetic valves, recent cardiac surgery with invasive lines, rheumatic heart disease; also drug abuse
  • Streptococcus is most common agent
39
Q

What occurs during a Rheumatic Fever (RF)?

What is it?

A

•Rheumatic Fever (RF) is an inflammatory disease that affects the heart, joints, CNS & subcutaneous tissues

–Systemic infection that affects most connective tissue in body

•RF often preceded by group A beta hemolytic strep infection usually upper respiratory by 7 to 10 days

40
Q

KNOW: What are clinical manifestations of RF?

A

•Clinical Manifestations

–Low grade fever

–Non-tender subcutaneous nodules over bony prominence

–Painful swelling over large joints

–Erythema marginatum (rash)

•Elevated ASO, C-reactive protein and Erythrocyte Sedimentation Rate

41
Q

What are Medications to treat Rheumatic Fever?

A

Medications

  • Antibiotics (infection)
  • Analgesics & Antipyretics for fever and/or joint pain

–ASA (salicylates) to control inflammatory process

•Corticosteroids for severe symptoms

–Acute joint involvement

  • Digoxin/Lanoxin & Lasix if in CHF
  • Med Compliance (may be up to 5-years of therapy)
42
Q

What Interventions are necessary during RF?

A

Bedrest & Activity Restrictions

•Important during acute phase to Ü work load heart

Promote Adequate Nutrition

Provide Emotional Support

Prophylactic Treatment to

Prevent Recurrence

  • SBE prophylactics (dental/procedural)
  • Prevent strep throat or skin infection

Pediatric Cardiologist Follow Up

•Indicated for at least 5 years after disease onset

•

43
Q

What kind of disease is Kawasaki Disease?

A

Vascular Dysfunciton

Acute systemic vasculitis

•Primarily affects cardiovascular system

–Acute phase self limiting; without treatment 15-25% develop coronary artery aneurysms

–Initially inflammation of arterioles, venules, & capillaries

–Later coronary artery aneurysms may form leading to coronary thrombosis, severe scar formation & main coronary artery stenosis with MI

44
Q

What are medications for Kawasaki?

A

Medications

•High dose IV gamma globulin (IgG)

–Prevents aneurysms if given within first 7-10 days

•ASA

45
Q
A

Peds (11 decks)

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