lecture 8 [cardiovascular + congenital heart dysfunctions] Flashcards
why is the pressure higher in the right side of the heart than the left side of the heart?
venous return into the heart starts in the right atrium
why does the aorta have a higher pressure than the pulmonary artery?
the aorta determines the stroke volume of the heart, thus the cardiac output to sustain the body
what is congestive heart failure?
the heart fails to effectively circulate blood
CHF is the most common complication in children with heart defects
true
s/s of left heart failure
- pulmonary edema
- crackles
- rhonchi
- wheezing
- orthopnea
s/s of right heart failure
- peripheral edema
- HTN
- hepatomegaly
- ascites
what are the general s/s of CHF?
(6)
- tachycardia
- tachypnea
- weight gain (from excess fluids)
- anorexia
- clubbing
- retractions
a patient has a CXR showing an enlarged heart, what condition does the patient have?
CHF
what are the medications for CHF?
- Digoxin (inotrope)
- ACE inhibitors
- Furosemide (diuretics)
what are the side effects of Digoxin?
- diuresis
- increased PR interval
- bradycardia
- nystagmus
- NV
- hyperkalemia
what are the pharmacological actions of Digoxin that cause bradycardia?
- negative chronotropic
- positive inotropic
what are the nursing actions for Digoxin before administering it to a patient with CHF?
small children: hold when HR < 90 & do not give more than 1mL
older children: hold when HR < 70
what is the therapeutic range for Digoxin?
0.8 - 2mcg/ L
why does the nurse need to question an order for Digoxin when a child’s Potassium levels show less than 3.5mEq?
the effects of the medication will increase
what are the ACE inhibitors typically given to children?
- Enalapril
- Capoten
wha is the MOA of ACE inhibitors?
reduces cardiac afterload
what are the side effects of ACE inhibitors?
- hypotension
- cough
- diuresis
- hyperkalemia
what are the s/s for hypokalemia?
- muscle weakness
- hypotension
- dysrhythmia
- drowsiness
what are the s/s of hyperkalemia?
- muscle weakness
- twitching
- bradycardia
- V-fib
- oliguria
- apnea
what are the s/s of hypoxemia?
- cyanosis
- polycythemia
- clubbing
- squatting
- hypercyanotic episodes
what is the nursing management for a patient with CHF?
- improve cardiac function
- descrease cardiac demands
- improve oxygenation
- maintain nutrition
what can a nurse do to help decrease a patient’s cardiac demands?
- cluster care
- bed rest
- monitor for infection
- continuous checking of skin (prevent impairment)
what can a nurse do to help improve tissue oxgenation?
- HOB elevated
- O2 therapy
what are the congenital heart defects that increase pulmonary blood flow?
- atrial septal defect
- ventricular septal defect
- patent ductus arteriosus
- atrioventricular canal
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
what is the complication for PDA?
CHF
what heart sounds the nurse will hear in a child with PDA?
murmurs
what are two ways that PDA can be resolved?
- Indomethacin
- surgery
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
how does PDA present in a patient?
- rales
- HF
- bounding pulses
- systolic murmur
- wide pulse pressure
what are the manifestations of ASD?
- loud, harsh murmur w/ a fixed split second heart sound
- HF
what is ventricular septal defect?
a hole in the septum between the ventricles that cause an increase in pulmonary blood flow
VSD is the most common congenital heart defect
true
what is an atrioventricular canal?
a large hole within the middle of the heart that includes valvular defects & holes in between the chambers
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
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
what is total anomalous pulmonary venous return?
part of the pulmonary vein shunts into the SVC (resulting to increased blood flow into the RA)
why does the right side of the heart hypertrophy in TAPVR?
it becomes overworked due to the amount of blood it receives & pumps
the left side of the heart in TAPVR remains small
true
children with TAPVR typically have ASD or PDA to help compensate with abnormal blood flow
true
if the child with TAPVR has no other defects, what is the priority action?
surgery
what is truncus arteriosus?
failure of septum formation between the right & left ventricles, and the pulmonary artery & aorta fail to divide
when does the surgical repair for truncus arteriosus need to happen?
within 1 month of life
why is there more blood flowing into the lungs with truncus arteriosus?
there is less vascular resistance in the pulmonary artery
what is the second most common CHD?
hypoplastic left heart syndrome
what is hypoplastic left heart syndrome?
undervelopment of the left side of the heart, aortic valve, aorta, left ventricle, & mitral valve
what are the manifestations of hypoplastic left heart syndrome?
- pulmonary edema/ congestion
- mild cyanosis
- cold hands & feet
which other defect usually accompanies hypoplastic left heart syndrome?
PDA
which medication is used to keep PDA?
IV prostaglandin E
what are the obstructive defects of the heart?
- coarctation of the aorta
- aortic stenosis
- pulmonary stenosis
what is coarctation of the aorta?
narrowing of the part of the aorta that is distal to the ascending vessels
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
what is aortic stenosis?
narrowing of the aortic valve
what are the therapeutic procedures for aortic stenosis?
- balloon angioplasty
- aortic valvotomy
- Norwood procedure
what is the hallmark heart sound the nurse will hear in aortic stenosis?
bruit
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
what are the therapeutic procedures for pulmonary stenosis?
- balloon angioplasty
- brock procedure
- pulmonary valvotomy
what are the manifestations of pulmonary stenosis?
- systolic ejection murmur
- cyanosis
- cardiomegaly
- HF
what is bacterial endocarditis?
infection of valves & endocardium caused by Strep, Staph, & Candida
s/s of endocarditis
(8)
- fever
- Roth’s spots
- Osler’s nodes
- Janeway lesions
- arthralgia
- murmur + tachycardia
- splinter hemorrhage
- septicemia
what are the diagnostic results that show in endocarditis?
- increased ESR
- vegetations present in echocardiogram
what is the primary preventive measure for endocarditis?
administer prophylactic ABX prior to dental procedures
what is Rheumatic fever?
an inflammatory disease that occurs as a reaction to Group A strep infection
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)
what are the medications that can treat Rheumatic fever?
- penicillin G
- sulfadiazine
- penicillin V
what is Kawasaki diease?
acute systemic vasculitis that follow viral infections & toxic exposures
Kawasaki disease is the leading cause of acquired heart disease in children
true
ecstasia is one of the major complications of Kawasaki disease, what is it?
an aneurysm caused by overdilation of coronary artery
s/s of Kawasaki disease
(6)
- red eyes
- fever
- ring around the iris
- strawberry tongue
- nonblistering rash on the perineum
- joint pain
what are the medications for Kawasaki disease?
- IV globulins
- aspirin
wat are the cardiac defects that lead to a decrease in pulmonary blood flow?
- Tricuspid atresia
- Tetralogy of Fallot
defects that decrease pulmonary blood flow often have septal defects such as ASD or VSD & allow deoxygenated blood to enter the circulatory system
true
what is Tetralogy of Fallot?
it is an overaching defect that usually includes a set of 4 other defects
what are the conditions that are included under Tetralogy of Fallot?
(4)
- pulmonary stenosis
- overriding aorta
- right ventricular hypertrophy
- VSD
s/s of ToF
(4)
- cyanotic spells (Tet spells)
- polycythemia
- systolic murmur
- clubbing
what is the surgical procedure to resolve ToF?
shunt placement (as a primary measure until surgical repair is tolerated)
how are Tet spells relieved?
squatting position (bringing knees to chest)
what is tricuspid atresia?
a full closure of the tricuspid valve
which septal defect usually accompanies tricuspid atresia?
ASD
what are the stages of the surgical procedure for tricuspid atresia?
(3)
- shunt placement
- Glenn procedure
- modified Fontan procedure
increased pulmonary blood flow causes acyanosis
true
decreased pulmonary blood flow causes cyanosis
true
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
what does a CXR show in regards to the heart?
size & position
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
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
auscultation landmarks of the heart
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