Pedi Cardiovascular Disorders Flashcards
Congenital Heart Disease (CHD)
Risk Factors
maternal factors - infection; alcohol/substance abuse; DM
genetic factors - family hx of congenital heart disease; Trisomy 21; congenital or chromosomal abnormalities
Congenital Heart Defect
Ventricular septal defect (VSD)
Manifestations
hole is septum between right and left ventricle = increased pulmonary flow; left-to-right shunt
loud, harsh murmur at left sternal border
HF
can close spontaneously
Congenital Heart Defect
Ventricular septal defect (VSD)
non-surg/surg**
closure during cardiac catheterization**
pulmonary artery banding
complete repair with patch
Congenital Heart Defect
Atrial septal defect (ASD)
Manifestations
hole is septum between right and left atria = increased pulmonary flow; left-to-right shunt
loud, harsh murmur with fixed split second heart sound
HF
asymptomatic
Congenital Heart Defect
Atrial septal defect (ASD)
non-surg/surg
closure during cardiac catheterization
surgical procedure: patch closure
Congenital Heart Defect
Patent ductus arteriosus (PDA)
Manifestations
normal fetal circulation conduit between pulmonary artery and aorta fails to close and results in increased pulmonary flow; left-to-right shunt murmur (machine hum) wide pulse pressure bounding pulses asymptomatic HF
Congenital Heart Defect
Patent ductus arteriosus (PDA)
non-surg/surg
indomethacin
insertion of coils to occlude PDA during cardiac catheterization
thoracoscopic repair
Congenital Heart Defect
Pulmonary stenosis
Manifestations
narrowing of pulmonary valve or pulmonary artery = obstruction of blood flow from ventricles
systolic ejection murmur
asymptomatic
cyanosis varies with defect, worse with severe narrowing
cardiomegaly
HF
Congenital Heart Defect
Pulmonary stenosis
non-surg/surg**
balloon angioplasty with cardiac catheterization**
infants: Brock procedure**
children: pulmonary valvotomy**
Congenital Heart Defect
Aortic stenosis
Manifestations
narrowing of aortic valve
infants: faint pulse; hypotension; tachycardia; poor feeding tolerance
children: intolerance to exercise; dizziness; chest pain; possible ejection murmur
Congenital Heart Defect
Aortic stenosis
non-surg/surg
balloon dilation with cardiac catheterization
Norwood procedure
Aortic valvotomy
Congenital Heart Defect
Coarctation of the aorta
Manifestations
narrowing of lumen of aorta, at or near ductus arteriosus = obstruction of flow from ventricle elevated BP in arms bounding pulses in upper extremities decreased BP in lower extremities cool skin of lower extremities weak/absent femoral pulses HF in infants dizziness, headaches, fainting, nosebleeds in older kids
Congenital Heart Defect
Coarctation of the aorta
non-surg/surg**
infants and children: balloon angioplasty**
adolescents: placement of stents
repair defect recommended for infants less than 6 months
Congenital Heart Defect
Transposition of the great arteries
Manifestations
aorta connected to right ventricle instead of left, pulmonary artery connected to left ventricle instead of right
septal defect of PDA must exist in order to oxygenate blood
murmur depending on presence of associated defects
severe to less cyanosis depending on size of associated defect
cardiomegaly
HF
Congenital Heart Defect
Transposition of the great arteries
non-surg/surg
surgery to switch arteries within first 2 weeks of life
Congenital Heart Defect
Tricuspid atresia
Manifestations
complete closure of tricuspid valve = mixed blood flow; atrial septal opening needs to be present to allow blood to enter left atrium
infants: cyanosis, dyspnea, tachycardia
older kids: hypoxemia, clubbing of fingers
Congenital Heart Defect
Tricuspid atresia
non-surg/surg
Surgery in 3 stages: shunt placement, Glenn procedure, modified Fontan procedure
Congenital Heart Defect
Tetralogy of Fallot
Manifestations
four defects that result in mixed blood flow Pulmonary stenosis Ventricular septal defect Overriding aorta Right ventricular
Cyanosis at birth - progressive over 1st year**
systolic murmur
episodes of acute cyanosis and hypoxia (blue spells)
Congenital Heart Defect
Tetralogy of Fallot
non-surg/surg
Shunt placement until able to undergo primary repair**
complete repair within 1st year
Overriding aorta
congenital
aorta positioned directly over VSD instead of over left ventricle…so…aorta receives some blood from right ventricle = mixing of oxygenated and deoxygenated blood = reducing amount of oxygen delivered to tissues
Heart Failure
Manifestations
impaired myocardial function (sweating, tachycardia, fatigue, pallor, cool extremities with weak pulses, hypotension, gallop rhythm, cardiomegaly) pulmonary congestion (tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, exercise intolerance systemic venous congestion (hepatomegaly, peripheral edema, ascites, neck vein distention, periorbital edema, weight gain)
Hypoxemia
Manifestations
cyanosis poor weight gain clubbing tachypnea dyspnea polycythemia hypercyanotic spells (blue, "tet" spells) - acute cyanosis, hyperpnea
Diagnostic Procedures
EKG/ECG - dysrhythmias
Radiography - size and blood flow
Echocardiogram - defects and function
Cardiac Catheterization - diagnosing, repairing, evaluating dysrhythmias
Cardiac Catheterization
Post-procedure
continuous cardiac monitoring and O2 sat.
assess for bradycardia, dysrhythmias, hypotension, hypoxemia
listen to heart and lungs for 1 full min
pulses - equality and symmetry
temp and color (cool extremity that blanches = arterial obstruction)
insertion site - bleeding/hematoma
clean dressing
affected extremity in straight position 4-8 hours
I&O
hypoglycemia (admin IV fluids w/ dextrose)
oral intake, clear liquids
void to excrete contrast medium
Digoxin
Withhold
Hold if infant’s pulse less than 90/min
hold if child’s pulse less than 70/min
Digoxin
Toxicity
bradycardia
dysrhythmias
N&V
anorexia
Digoxin
Uses
improves myocardial contractility
Captopril
Uses
ACE inhibitor
reduces afterload
causes vasodilation
= decreased pulmonary & systemic vascular resistance
Captopril
Nursing Considerations
monitor BP before and after
watch for HYPERKALEMIA
Metoprolol
Uses
beta-blocker
decrease HR and BP
promote vasodilation
Metoprolol
Nursing Considerations
monitor BP and HR before
watch for dizziness, hypotension, headache
Furosemide
Chlorothiazide
Uses
potassium-wasting diuretics rid body of excess fluid and sodium
Furosemide
Chlorothiazide
Nursing Considerations
encourage high potassium foods
I&O
daily weights
watch for HYPOKALEMIA, N&V, dizziness
Rheumatic Fever
inflammatory disease that occurs as a reaction to Group A B-hemolytic streptococcus (GABHS) infection of throat
Hypoxemia
Nursing Actions
hypercyanotic spell = severe hypoxemia = an lead to cerebral hypoxemia = emergency
Immediately place child in knee-chest position, attempt to calm child, call for help
Cardiac Catheterization
Complications
N&V low-grade fever loss of pulse in catheterized extremity transient dysrhythmias acute hemorrhage from entry site
Cardiac Catheterization
Complications
Nursing Actions
direct continuous pressure at 1 inch above catheter entry site to localize pressure over vessel puncture
position child flat
Call MD immediately
prep for fluids/meds to control emesis
Rheumatic Fever
Laboratory Tests
throat culture for GABHS
serum antistreptolysin-O (ASO) titer - most reliable DX test
C-reactive protein (CRP)
ESR
Hyperlipidemia
excess lipids (fat) in circulating blood
Hyperlipidemia
Laboratory Tests
Lipid profile - fast 12 hours prior
Fasting BG
Cholestyramin
Colestipol
Uses
Hyperlipidemia
children 8+ with LDL greater than 190mg/dL, or 160 with risk factors
Cholestyramin
Colestipol
Nursing Considerations
powder mixed in 4-6 oz water/juice
watch for constipation, abdominal pain, flatulence, nausea, abdominal bloating
monitor labs: liver function, CBC, creatinine kinase, fasting lipid profile at 4 and 8 week intervals and after dosage change
d/c and call MD - dark urine, muscle aches
Kawasaki Disease
acute systemic vasculitis
Kawasaki Disease
Manifestations
Acute onset of high fever non-responsive to antipyretics
fever greater than 38.9/102 lasting 5 days to 2 weeks
Gamma globulin (IVGG)
Uses
Kawasaki Disease
Gamma globulin (IVGG)
Nursing Considerations
admin via IV high dose: 2g/kg over 10-12 hr admin within first 7 days repeat if fever persists monitor VS watch for allergic rx
Kawasaki Disease
Aspirin
Nursing Considerations
high dose: 80-100mg/kg/day divided every 6 hrs
Once afebrile: 3-5mg/kg/day to continue until platelet count returns to expected range 6-8 weeks
use indefinitely if coronary abnormalities develop
