Nursing Care of the Child With an Alteration in Perfusion/Cardiovascular Disorder Flashcards
Exam 2
Circulatory Changes From Gestation to Birth:
When is the fetal heart rate present?
The fetal heart rate is present on about postconceptual day 17.
In gestational weeks 2-8, what forms?
The four chambers of the heart and arteries are formed during gestational weeks 2 through 8.
During fetal development, where does oxygenation of the fetus occur?
During fetal development, oxygenation of the fetus occurs via the placenta;
What does NOT perform oxygenation or perfusion in the fetus?
the lungs, though perfused, do not perform oxygenation and ventilation.
The foramen ovale
an opening between the atria,
What does the foramen ovale allow for?
allows blood flow from the right to the left atrium.
The ductus arteriosus allows for what?
allows blood flow between the pulmonary artery and the aorta, shunting blood away from the pulmonary circulation.
What does the newborn’s first breath lead to?
Newborn’s first breath –> inflates the lungs and decreases Pulmonary Vascular Resistance to blood flow
In the newborn, what does a decrease in Pulmonary Vascular Resistance to blood flow lead to?
Pulmonary Artery Pressure drops –> promoting closure of the Ductus Ateriosus –> pressure in the Right Atrium decreases.
What occurs when bloodflow to the left side of the heart increases?
Blood flow to the left side of the heart increases,
Left Atrium pressure increases which leads to closure of the Foramen Ovale.
How are the ventricles of newborns?
The ventricle walls are similar in thickness, but with time the Left Ventricular wall thickens and it becomes more dominant over the next few months.
Cardiovascular Changes in Childhood:
What is effected?
Heart Rate
Blood pressure
Respiratory Rate
Cardiovascular Changes in Childhood:
How is HR in infancy? How does it change in childhood?
Faster in infancy (120-130 bpm), decreases as the child ages
Cardiovascular Changes in Childhood:
How is BP in infancy? How does it change in childhood?
Lower in infancy (80-55 mmhg)
Increases as the child ages
Cardiovascular Changes in Childhood:
How is RR in infancy? How does it change in childhood?
Faster in infancy, decreases as the child ages.
Cardiovascular Changes in Childhood:
How do BP, RR, HR values change in adolescence?
By adolescence, values approach adult levels.
Past Health History
History of maternal viral illnesses, i.e. Coxsackie, CMV, influenza, mumps, rubella.
Problems occurring after birth (associated congenital malformation).
Birth history (any NICU stays?)
Frequent infections.
Chromosomal abnormalities.
Prematurity.
Autoimmune disorders.
Use of medications, such as corticosteroids.
Family History of Risk Factors for Cardiovascular Disorders
Family history of heart disease or CHD (investigate the history further if heart disease occurred in a first-degree relative)
Sudden death in a young family member
Hyperlipidemia
Diabetes mellitus
Signs and Symptoms of a Cardiac Disorder (name first 5)
Cyanosis
Irregular heart rate
Edema
Clubbing of fingertips
Fever
Signs and Symptoms of a Cardiac Disorder (name last 4)
Retractions or increased work of breathing
Prominence of precordial chest wall
Visible, engorged, or abnormal pulsations
Abdominal distention
Health History of Present Illness should include what about illness?
When the symptoms started and how they progressed.
Health History of Present Illness should include what medications?
Any treatments and medications used at home.
Health History of Present Illness should include what about symptoms?
History of orthopnea, dyspnea, easy fatigability, growth delays, squatting, edema, dizziness, frequent pneumonia.
Poor feeding, fatigue, lethargy, vomiting, failure to thrive.
Diaphoresis, delays in motor development, cyanosis, tachypnea.
Health History of Present Illness should include what when comparing pt to peers?
Activity level compared to peers.
Diagnostic Tests for Cardiovascular Disorders:
Pulse oximetry
Electrocardiogram (ECG) and Holter monitoring
Echocardiogram
Chest radiograph
Exercise stress testing
Laboratory tests
Arteriogram and cardiac catheterization
Diagnostic Tests for Cardiovascular Disorders: lab tests include?
CBC, BMP, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR)
Congenital heart disease
Interference in the development of the heart during fetal life.
What are examples of issues associated with Congenital heart disease?
Septal walls or valves may fail to develop, vessels or valves may be stenotic, narrowed, or transposed
In congenital heart disease, what is present at birth?
Structural anomalies that are present at birth.
What accounts for the largest percentage of all birth defects?
CHD accounts for the largest percentage of all birth defects.
Congenital heart disease:
What is often associated with CHD?
Many Chromosomal defects are associated with CHD, (Downs, Trisomy 13, Trisomy 18, Williams syndrome)
Acquired heart disease
Disorders that occur after birth (heart failure, most common reason for admission).
Acquired heart disease
How does it develop?
Develops from a wide range of causes, or can occur as a complication or long-term effect of CHD.
Risk Factors for Cardiovascular Disorders in Childhood:
Congenital
Acquired
Risk Factors for Cardiovascular Disorders in Childhood: Congenital
Congenital malformations, genetic syndromes, family history, maternal drug or alcohol exposure, prematurity
Risk Factors for Cardiovascular Disorders in Childhood: Acquired
Infections (rheumatic fever, Kawasaki disease, endocarditis), obesity, diabetes, drug or alcohol exposure, hypertension, chemotherapy, other diseases (connective tissue disorders, autoimmune or endocrine diseases), organ transplant, hyperlipidemia
ACyanotic lesions (left to shunts): is what? What kind of heart defects can it lead to?
Increased Pulmonary blood flow –> ASD, VSD, PDA
Congenital Cardiovascular Lesions:
Acyanotic lesions: Are what kind of shunts
(left to right shunts)
Congenital Cardiovascular Lesions include:
Acyanotic lesions: (left to right shunts)
Cyanotic lesions: (right to left shunts)
Congenital Cardiovascular Lesions:
Cyanotic lesions: Are what kind of shunts
(right to left shunts)
Acyanotic lesions ( left to right shunts): is what? Can lead to Obstruction; What does obstruction lead to?
Coarctation of aorta, pulmonary and aortic stenosis
Congenital Cardiovascular Lesions:
Cyanotic lesions: Are what kind of shunts
Cyanotic lesions: (right to left shunts)
Congenital Cardiovascular Lesions:
Cyanotic lesions: is what? What kind of defects are examples?
Decreased pulmonary blood flow –> Tetralogy of fallot, tricuspid atresia
Congenital Cardiovascular Lesions:
Cyanotic lesions: causes mixed blood flow; what are examples?
Mixed blood flow –> Transposition of the great vessels, truncus arteriosus
How is bp categorized in kids?
Age, Height, Gender- how bp is categorized in kids.
Types of CHD are classified as cyanotic or acyanotic based upon what?
Types of CHD are classified as Cyanotic or Acyanotic based upon the relative degree of compromised pulmonary circulation.
What are examples of disorders with decreased pulmonary blood flow?
Tetralogy of Fallot, Tricuspid Atresia.
What are examples of disorders with increased pulmonary blood flow?
Patent Ductus Arteriosus (PDA),
Atrial Septal Defect (ASD), and
Ventricular Septal Defect (VSD).
What are examples of obstructive disorders?
Coarctation of the Aorta,
Aortic Stenosis, and
Pulmonary Stenosis.
What are examples of mixed disorders?
Transposition of the Great Vessels (TGV),
Total Anomalous Pulmonary Venous Return (TAPVR),
Truncus Arteriosus, and
Hypoplastic Left Heart Syndrome.
Congenital Anomalies: Symptoms of Heart Disease
When can defects may identified?
Defects may be identified by echocardiography prior to birth.
Congenital Anomalies: Symptoms of Heart Disease
How are symptoms of heart disease?
Symptoms of heart defects can be subtle and possibly missed during assessment.
Congenital Anomalies: Symptoms of Heart Disease
How can some infants appear?
Some infants will appear normal at birth and begin to decompensate as the ductus arteriosus closes
Congenital Anomalies: Symptoms of Heart Disease
Symptoms of defects after birth include:
Cyanosis
Tachypnea
Pulmonary edema
Cardiogenic shock
Slide 20
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Infective Endocarditis
Bacterial infection of endothelial surfaces of the heart including valves (most common), chamber walls, or septum.
Infective Endocarditis: Turbulence that occurs is associated with what?
Turbulence associated with narrowed or incompetent valves.
Infective Endocarditis: What forms and how?
Thrombi and platelets adhere to the endothelium and form vegetations.
Infective Endocarditis: What happens to the vegetation that forms?
The microbe uses the vegetation as a breeding ground.
Clumps (septic Emboli) may break off and travel throughout the body causing significant damage.
What is the causative agent associated with Infective Endocarditis?
Causative agent is usually Staphylococcus aureus or Fungal.
Infective Endocarditis: Who is at greatest risk for forming this?
Children with prosthetic valves are at higher risk than general population.
Infective Endocarditis: How is a diagnosis made?
Diagnosed based upon modified Jones Criteria
Modified Jones Criteria (American Heart Association)
What is part of the major criteria?
Carditis
Migratory polyarthritis
Subcutaneous nodules
Erythema marginatum
Syndenham chorea
Modified Jones Criteria (American Heart Association)
What is part of the minor criteria?
Arthralgia
Fever
Elevated ESR
Elevated C-reactive protein
Prolonged PR interval
What does Acute Rhematic fever diagnosis require?
Acute rheumatic fever diagnosis requires presence of 2 major criteria or 1 major + 2 minor criteria from the modified jones criteria (AHA)
Cardiomyopathy
Definition: inflammation of the myocardium so that it cannot contract properly.
What are the three types of cardiomyopathy?
- Restrictive
- Dilated
- Hypertrophic
Restrictive Cardiomyopathy
The atria fill but due to a stiffened ventricle muscles, atrial enlargement occurs
Dilated Cardiomyopathy
the ventricle is enlarged and weakened contractility does not allow the heart to relax and fill with blood as it should.
Most common type in children.
Familial tendency is noted
What is the most common type of cardiomyopathy?
Dilated Cardiomyopathy
What is noted about dilated cardiomyopathy?
Familial tendency is noted
Hypertrophic cardiomyopathy:
Hypertrophy of the heart muscle, particularly the L Ventricle which affects the hearts ability to to fill. Mostly seen in adolescence.
Risk Factors for developing cardiomyopathy:
Congenital heart defect, genetic disorders, inflammatory or infectious processes, post-transplant or postoperatively after cardiac surgery, hypertension, Duchenne and Becker muscular dystrophy.
What is the most common cause of cardiomyopathy?
Most commonly, no known reason (idiopathic).
How may cardiomyopathy present?
May present as heart failure or cardiac arrest (in adolescents with hypertrophic version).
What does treatment for cardiomyopathy target?
Treatment: targets improving heart function.
Kawasaki Disease
Acute systemic vasculitis (autoimmune disease)
Who does Kawasaki Disease primarily affect?
primarily affects children <5 years of age.
What is the leading cause of acquired heart disease?
Kawasaki Disease
What does Kawasaki Disease cause?
Causes inflammation and thrombi in coronary arteries, and coronary aneurysm.
What are symptoms of Kawasaki Disease?
high fever for 5 days that is unresponsive to antibiotics; chills, headache, malaise, extreme irritability, vomiting, diarrhea, abdominal and joint pain, distinctive rashes (strawberry tongue, palmar erythema), desquamation of perineum, fingers and toes.
What is the treatment for Kawasaki Disease?
Treatment: Acute phase is high dose aspirin, IV immunoglobulin (IVIG) initially then and long-term aspirin therapy.
What does treatment of Kawasaki Disease require?
Requires long-term monitoring of coronary arteries.
Congestive Heart Failure in Children: What are examples?
Impaired myocardial function (Left and right)
Pulmonary congestion
Systemic venous congestion
Congestive Heart Failure in Children
What are symptoms of impaired myocardial function ( left and right):
Tachycardia; fatigue; weakness; restlessness; pale, cool extremities; decreased BP; decreased urine output
Congestive Heart Failure in Children
What are symptoms of pulmonary congestion?
Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
Congestive Heart Failure in Children
What are symptoms of systemic venous congestion?
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
What do infants with congestive heart failure have a need for?
Infants with congestive heart failure (CHF) have a need for increased calories
CHF medications
Digoxin
Furosemide
Characteristics of Heart Murmurs are in relation to what?
Relation to the heart cycle and duration.
Characteristics of Heart Murmurs are measured in intensity how?
grade I—soft and hard to hear;
grade II—soft and easily heard;
grade III—loud without thrill;
grade IV—loud with a precordial thrill (felt with the heel of the hand at the sternal border);
grade V—loud, audible with a stethoscope;
grade VI—very loud, audible with a stethoscope or with the naked ear.
Quality: harsh, musical, or rough; high, medium, or low pitch.
Variation in sound with position (sitting, lying, standing).
