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RN Nursing Care of Children > Pedi Cardiovascular Disorders > Flashcards

Pedi Cardiovascular Disorders Flashcards

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1
Q

Congenital Heart Disease (CHD)

Risk Factors

A

maternal factors - infection; alcohol/substance abuse; DM

genetic factors - family hx of congenital heart disease; Trisomy 21; congenital or chromosomal abnormalities

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2
Q

Congenital Heart Defect

Ventricular septal defect (VSD)

Manifestations

A

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

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3
Q

Congenital Heart Defect

Ventricular septal defect (VSD)

non-surg/surg**

A

closure during cardiac catheterization**
pulmonary artery banding
complete repair with patch

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4
Q

Congenital Heart Defect

Atrial septal defect (ASD)

Manifestations

A

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

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5
Q

Congenital Heart Defect

Atrial septal defect (ASD)

non-surg/surg

A

closure during cardiac catheterization

surgical procedure: patch closure

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6
Q

Congenital Heart Defect

Patent ductus arteriosus (PDA)

Manifestations

A 
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
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7
Q

Congenital Heart Defect

Patent ductus arteriosus (PDA)

non-surg/surg

A

indomethacin
insertion of coils to occlude PDA during cardiac catheterization
thoracoscopic repair

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8
Q

Congenital Heart Defect

Pulmonary stenosis

Manifestations

A

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

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9
Q

Congenital Heart Defect

Pulmonary stenosis

non-surg/surg**

A

balloon angioplasty with cardiac catheterization**

infants: Brock procedure**
children: pulmonary valvotomy**

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10
Q

Congenital Heart Defect

Aortic stenosis

Manifestations

A

narrowing of aortic valve

infants: faint pulse; hypotension; tachycardia; poor feeding tolerance
children: intolerance to exercise; dizziness; chest pain; possible ejection murmur

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11
Q

Congenital Heart Defect

Aortic stenosis

non-surg/surg

A

balloon dilation with cardiac catheterization
Norwood procedure
Aortic valvotomy

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12
Q

Congenital Heart Defect

Coarctation of the aorta

Manifestations

A 
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
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13
Q

Congenital Heart Defect

Coarctation of the aorta

non-surg/surg**

A

infants and children: balloon angioplasty**
adolescents: placement of stents
repair defect recommended for infants less than 6 months

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14
Q

Congenital Heart Defect

Transposition of the great arteries

Manifestations

A

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

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15
Q

Congenital Heart Defect

Transposition of the great arteries

non-surg/surg

A

surgery to switch arteries within first 2 weeks of life

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16
Q

Congenital Heart Defect

Tricuspid atresia

Manifestations

A

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

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17
Q

Congenital Heart Defect

Tricuspid atresia

non-surg/surg

A

Surgery in 3 stages: shunt placement, Glenn procedure, modified Fontan procedure

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18
Q

Congenital Heart Defect

Tetralogy of Fallot

Manifestations

A 
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)

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19
Q

Congenital Heart Defect

Tetralogy of Fallot

non-surg/surg

A

Shunt placement until able to undergo primary repair**

complete repair within 1st year

20
Q

Overriding aorta

A

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

21
Q

Heart Failure

Manifestations

A 
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)
22
Q

Hypoxemia

Manifestations

A 
cyanosis
poor weight gain
clubbing
tachypnea
dyspnea
polycythemia
hypercyanotic spells (blue, "tet" spells) - acute cyanosis, hyperpnea
23
Q

Diagnostic Procedures

A

EKG/ECG - dysrhythmias
Radiography - size and blood flow
Echocardiogram - defects and function
Cardiac Catheterization - diagnosing, repairing, evaluating dysrhythmias

24
Q

Cardiac Catheterization

Post-procedure

A

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

25
Q

Digoxin

Withhold

A

Hold if infant’s pulse less than 90/min

hold if child’s pulse less than 70/min

26
Q

Digoxin

Toxicity

A

bradycardia
dysrhythmias
N&V
anorexia

27
Q

Digoxin

Uses

A

improves myocardial contractility

28
Q

Captopril

Uses

A

ACE inhibitor
reduces afterload
causes vasodilation
= decreased pulmonary & systemic vascular resistance

29
Q

Captopril

Nursing Considerations

A

monitor BP before and after

watch for HYPERKALEMIA

30
Q

Metoprolol

Uses

A

beta-blocker
decrease HR and BP
promote vasodilation

31
Q

Metoprolol

Nursing Considerations

A

monitor BP and HR before

watch for dizziness, hypotension, headache

32
Q

Furosemide
Chlorothiazide

Uses

A

potassium-wasting diuretics rid body of excess fluid and sodium

33
Q

Furosemide
Chlorothiazide

Nursing Considerations

A

encourage high potassium foods
I&O
daily weights
watch for HYPOKALEMIA, N&V, dizziness

34
Q

Rheumatic Fever

A

inflammatory disease that occurs as a reaction to Group A B-hemolytic streptococcus (GABHS) infection of throat

35
Q

Hypoxemia

Nursing Actions

A

hypercyanotic spell = severe hypoxemia = an lead to cerebral hypoxemia = emergency
Immediately place child in knee-chest position, attempt to calm child, call for help

36
Q

Cardiac Catheterization

Complications

A 
N&V
low-grade fever
loss of pulse in catheterized extremity
transient dysrhythmias
acute hemorrhage from entry site
37
Q

Cardiac Catheterization

Complications
Nursing Actions

A

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

38
Q

Rheumatic Fever

Laboratory Tests

A

throat culture for GABHS
serum antistreptolysin-O (ASO) titer - most reliable DX test
C-reactive protein (CRP)
ESR

39
Q

Hyperlipidemia

A

excess lipids (fat) in circulating blood

40
Q

Hyperlipidemia

Laboratory Tests

A

Lipid profile - fast 12 hours prior

Fasting BG

41
Q

Cholestyramin
Colestipol

Uses

A

Hyperlipidemia

children 8+ with LDL greater than 190mg/dL, or 160 with risk factors

42
Q

Cholestyramin
Colestipol

Nursing Considerations

A

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

43
Q

Kawasaki Disease

A

acute systemic vasculitis

44
Q

Kawasaki Disease

Manifestations

A

Acute onset of high fever non-responsive to antipyretics

fever greater than 38.9/102 lasting 5 days to 2 weeks

45
Q

Gamma globulin (IVGG)

Uses

A

Kawasaki Disease

46
Q

Gamma globulin (IVGG)

Nursing Considerations

A 
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
47
Q

Kawasaki Disease

Aspirin

Nursing Considerations

A

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

RN Nursing Care of Children (10 decks)

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