lecture 8 [cardiovascular + congenital heart dysfunctions] Flashcards
1
Q
why is the pressure higher in the right side of the heart than the left side of the heart?
A
venous return into the heart starts in the right atrium
2
Q
why does the aorta have a higher pressure than the pulmonary artery?
A
the aorta determines the stroke volume of the heart, thus the cardiac output to sustain the body
3
Q
what is congestive heart failure?
A
the heart fails to effectively circulate blood
4
Q
CHF is the most common complication in children with heart defects
A
true
5
Q
s/s of left heart failure
A
- pulmonary edema
- crackles
- rhonchi
- wheezing
- orthopnea
6
Q
s/s of right heart failure
A
- peripheral edema
- HTN
- hepatomegaly
- ascites
7
Q
what are the general s/s of CHF?
(6)
A
- tachycardia
- tachypnea
- weight gain (from excess fluids)
- anorexia
- clubbing
- retractions
8
Q
a patient has a CXR showing an enlarged heart, what condition does the patient have?
A
CHF
9
Q
what are the medications for CHF?
A
- Digoxin (inotrope)
- ACE inhibitors
- Furosemide (diuretics)
10
Q
what are the side effects of Digoxin?
A
- diuresis
- increased PR interval
- bradycardia
- nystagmus
- NV
- hyperkalemia
11
Q
what are the pharmacological actions of Digoxin that cause bradycardia?
A
- negative chronotropic
- positive inotropic
12
Q
what are the nursing actions for Digoxin before administering it to a patient with CHF?
A
small children: hold when HR < 90 & do not give more than 1mL
older children: hold when HR < 70
13
Q
what is the therapeutic range for Digoxin?
A
0.8 - 2mcg/ L
14
Q
why does the nurse need to question an order for Digoxin when a child’s Potassium levels show less than 3.5mEq?
A
the effects of the medication will increase
15
Q
what are the ACE inhibitors typically given to children?
A
- Enalapril
- Capoten
16
Q
wha is the MOA of ACE inhibitors?
A
reduces cardiac afterload
17
Q
what are the side effects of ACE inhibitors?
A
- hypotension
- cough
- diuresis
- hyperkalemia
18
Q
what are the s/s for hypokalemia?
A
- muscle weakness
- hypotension
- dysrhythmia
- drowsiness
19
Q
what are the s/s of hyperkalemia?
A
- muscle weakness
- twitching
- bradycardia
- V-fib
- oliguria
- apnea
20
Q
what are the s/s of hypoxemia?
A
- cyanosis
- polycythemia
- clubbing
- squatting
- hypercyanotic episodes
21
Q
what is the nursing management for a patient with CHF?
A
- improve cardiac function
- descrease cardiac demands
- improve oxygenation
- maintain nutrition
22
Q
what can a nurse do to help decrease a patient’s cardiac demands?
A
- cluster care
- bed rest
- monitor for infection
- continuous checking of skin (prevent impairment)
23
Q
what can a nurse do to help improve tissue oxgenation?
A
- HOB elevated
- O2 therapy
24
Q
what are the congenital heart defects that increase pulmonary blood flow?
A
- atrial septal defect
- ventricular septal defect
- patent ductus arteriosus
- atrioventricular canal
25
what is *PDA (patent ductus arteriosus)*?
the failure of the fetal duct between the pulmonary artery & aorta to close, leading to increased pulmonary blood flow
26
what is the complication for *PDA*?
CHF
27
what heart sounds the nurse will hear in a child with *PDA*?
murmurs
28
what are two ways that *PDA* can be resolved?
* Indomethacin
* surgery
29
what is an *atrial septal defect*?
hole between the atria where the foramen ovale failed to close or due to another unrelated reason that leads to increased pulmonary blood flow
30
how does *PDA* present in a patient?
* rales
* HF
* bounding pulses
* systolic murmur
* wide pulse pressure
31
what are the manifestations of *ASD*?
* loud, harsh murmur w/ a fixed split second heart sound
* HF
32
what is *ventricular septal defect*?
a hole in the septum between the ventricles that cause an increase in pulmonary blood flow
33
*VSD* is the most common congenital heart defect
true
34
what is an *atrioventricular canal*?
a large hole within the middle of the heart that includes valvular defects & holes in between the chambers
35
what are the congenital ***mixed defects*** that can be found in children?
* transposition of the great vessels
* total anomalous pulmonary venous return
* truncus arteriosus
* hypoplastic left heart syndrome
36
what is the *transposition of the great arteries*?
a condition in which the aorta is connected to the right ventricle *instead* of the left, & the pulmonary artery is connected to the left ventricle *instead* of the right
37
what is *total anomalous pulmonary venous return*?
part of the pulmonary vein shunts into the SVC *(resulting to increased blood flow into the RA)*
38
why does the right side of the heart hypertrophy in *TAPVR*?
it becomes overworked due to the amount of blood it receives & pumps
39
the left side of the heart in *TAPVR* remains small
true
40
children with *TAPVR* typically have ASD or PDA to help compensate with abnormal blood flow
true
41
if the child with *TAPVR* has no other defects, what is the priority action?
surgery
42
what is *truncus arteriosus*?
failure of septum formation between the right & left ventricles, and the pulmonary artery & aorta fail to divide
43
when does the surgical repair for *truncus arteriosus* need to happen?
within 1 month of life
44
why is there more blood flowing into the lungs with *truncus arteriosus*?
there is less vascular resistance in the pulmonary artery
45
what is the second most common *CHD*?
hypoplastic left heart syndrome
46
what is *hypoplastic left heart syndrome*?
undervelopment of the left side of the heart, aortic valve, aorta, left ventricle, & mitral valve
47
what are the manifestations of *hypoplastic left heart syndrome*?
* pulmonary edema/ congestion
* mild cyanosis
* cold hands & feet
48
which other defect usually accompanies *hypoplastic left heart syndrome*?
PDA
49
which medication is used to keep *PDA*?
IV prostaglandin E
50
what are the ***obstructive defects*** of the heart?
* coarctation of the aorta
* aortic stenosis
* pulmonary stenosis
51
what is *coarctation of the aorta*?
narrowing of the part of the aorta that is distal to the ascending vessels
52
what are the manifestations of *coarctation of the aorta*?
* elevated BP in upper extermities *(> 20mmHg difference)*
* bounding pulses in upper extremities
* cool skin in lower extremities
* nosebleeds *(epistaxis)*
* absent femoral pulses
53
what is *aortic stenosis*?
narrowing of the aortic valve
54
what are the therapeutic procedures for *aortic stenosis*?
* balloon angioplasty
* aortic valvotomy
* Norwood procedure
55
what is the hallmark heart sound the nurse will hear in *aortic stenosis*?
bruit
56
what is *pulmonary stenosis*?
it is the narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
57
what are the therapeutic procedures for *pulmonary stenosis*?
* balloon angioplasty
* brock procedure
* pulmonary valvotomy
58
what are the manifestations of *pulmonary stenosis*?
* systolic ejection murmur
* cyanosis
* cardiomegaly
* HF
59
what is *bacterial endocarditis*?
infection of valves & endocardium caused by *Strep, Staph, & Candida*
60
s/s of *endocarditis*
| (8)
* fever
* ***Roth's spots***
* ***Osler's nodes***
* ***Janeway lesions***
* arthralgia
* murmur + tachycardia
* splinter hemorrhage
* septicemia
61
what are the diagnostic results that show in *endocarditis*?
* increased ESR
* vegetations present in *echocardiogram*
62
what is the primary preventive measure for *endocarditis*?
administer prophylactic ABX prior to dental procedures
63
what is *Rheumatic fever*?
an inflammatory disease that occurs as a reaction to *Group A strep infection*
64
s/s of *Rheumatic fever*
| (7)
* ***Aschoff bodies*** *(tiny lesions of the heart)*
* carditis
* murmur
* ***polyarhritis***
* ***rash in trunk & extremities***
* subcutaneous nodules
* CNS involvement *(uncoordination + involuntary mvmnts)*
65
what are the medications that can treat *Rheumatic fever*?
* penicillin G
* sulfadiazine
* penicillin V
66
what is *Kawasaki diease*?
acute systemic vasculitis that follow viral infections & toxic exposures
67
***Kawasaki disease*** is the leading cause of *acquired* heart disease in children
true
68
***ecstasia*** is one of the major complications of *Kawasaki disease*, what is it?
an aneurysm caused by overdilation of coronary artery
69
s/s of *Kawasaki disease*
| (6)
* red eyes
* fever
* ring around the iris
* ***strawberry tongue***
* ***nonblistering rash on the perineum***
* joint pain
70
what are the medications for *Kawasaki disease*?
* IV globulins
* aspirin
71
wat are the cardiac defects that lead to a ***decrease*** in pulmonary blood flow?
* Tricuspid atresia
* Tetralogy of Fallot
72
defects that decrease pulmonary blood flow often have septal defects such as *ASD* or *VSD* & allow deoxygenated blood to enter the circulatory system
true
73
what is *Tetralogy of Fallot*?
it is an overaching defect that usually includes a set of 4 other defects
74
what are the conditions that are included under *Tetralogy of Fallot*?
| (4)
* pulmonary stenosis
* overriding aorta
* right ventricular hypertrophy
* VSD
75
s/s of *ToF*
| (4)
* ***cyanotic spells*** *(Tet spells)*
* ***polycythemia***
* systolic murmur
* clubbing
76
what is the surgical procedure to resolve *ToF*?
shunt placement *(as a primary measure until **surgical repair** is tolerated)*
77
how are *Tet spells* relieved?
squatting position *(bringing knees to chest)*
78
what is *tricuspid atresia*?
a full closure of the tricuspid valve
79
which septal defect usually accompanies *tricuspid atresia*?
ASD
80
what are the stages of the surgical procedure for *tricuspid atresia*?
| (3)
* shunt placement
* Glenn procedure
* modified Fontan procedure
81
*increased pulmonary blood flow* causes ***acyanosis***
true
82
*decreased pulmonary blood flow* causes ***cyanosis***
true
83
a pediatric patient is admitted presenting cardiac difficulties, what does the nurse expect to be ordered throughout their stay?
| (6)
* CXR
* ECG
* ECHO
* cardiac catheterization
* stress test
* MRI
84
what does a *CXR* show in regards to the heart?
size & position
85
what are the nursing responsibilities before *cardiac catheterization*?
| (4)
* determine allergies to iodine & latex
* mark their pulse sites
* obtain baseline O2 sats
* determine presence of diaper rash
86
what are the nursing responsibilities post-cath procedure?
| (6)
* stop bleeding
* immobilize extremities
* determine if pulses are gradually increasing
* VS
* bed rest ***4-6 hrs***
* neuro checks of extremities
87
auscultation landmarks of the heart
| APTM
