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Critical Care Pediatics > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

increased pulmonary blood flow

A
  1. patent ductus arteriosus
  2. Ventricular Septal Defect
  3. Atrial septal defect
  4. Atrioventricular Canal Defect
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2
Q

increased pulmonary blood flow is shunted…

A

from HIGH pressure (left) to LOW pressure (right)

-large amount of blood moved to lungs

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3
Q

decreased pulmonary blood flow

A
  1. pulmonary stenosis
  2. tetralogy of fallot
  3. tricuspid atresia
  4. R ventricular Hypertrophy
  5. overriding aorta
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4
Q

decreased pulmonary blood flow is shunted….

A

from HIGH pressure (right) to LOW pressure (left)

-blood moves through structural defect, deoxygenated blood enters blood system

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5
Q

mixed blood flow

A
  1. transposition of Great Arteries
  2. Truncus Arteriosus
  3. Hypoplastic L heart Syndrome
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6
Q

mixed blood flow contains…

A

lower O2 concentration and decreased cardiac output

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7
Q

obstructed blood flow

A
  1. coarctation of the aorta
  2. aortic stenosis
  3. pulmonary atresia
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8
Q

obstructed blood flow contains…

A

narrowing blood vessels interfering with free blood flow

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9
Q

congenital heart defect consequences

A
  1. increased flow –> HF
  2. obstructive flow –> L side = HF and R obstruction = cyanosis
  3. decreased flow –> BLUE BABIES , cyanosis
  4. mixed flow –> hypoxemia w/o or with cyanosis and HF
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10
Q

ventricular septal defect (VSD)

A

most common, 75% fix themselves

-cause stiffening of lungs and decreased ventilation

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11
Q

VSD s/s

A

-asymptomatic (small)
-easily tired (lethargy)
-poor feeding
-frequent pulmonary infection
-SOB
-tachypnea
-LOUD HARSH MURMUR

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12
Q

VSD risks

A

at risk for..
aortic valve regurgitation
infective endocarditis

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13
Q

VSD diagnosis

A

CXR
echo
MRI

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14
Q

VSD surgical tx

A

cardiac cath
open heart surgery

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15
Q

VSD cath lab

A

use septal occluding device, blocking the defect

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16
Q

VSD open heart surgery

A

pericardial patch or suturing

**MUST BE 6-12 months and 2,000 grams

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17
Q

VSD nonsurgical

A

digoxin and furosemide

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18
Q

digoxin consideration

A

HOLD MED when < 90 bpm

**toxicity = dysrhythmias and vomiting

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19
Q

post cardiac cath

A

-vitals –> manual pulse check
-apply pressure when needed
-keep extremity straight for 4-6 hours
-bath –> not for several days , shower sooner
-after 24 hours change to DRY dressing
-infection risk

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20
Q

what dressing is used 24 hours after cath

A

dry dressing

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21
Q

are there dietary considerations after a cath?

A

NO just keep strict I / O

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22
Q

tetralogy of fallot

A

-cyanosis with feeding and crying
-clubbing
-irritable
-tet spells

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23
Q

tet spells

A

acute episode of cyanosis and hypoxia

-occurs when O2 requirements exceed blood supply

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24
Q

tetralogy of fallot management

A

KNEES TO CHEST / bending to squat

-cluster care to decrease irritability

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25
tetralogy of fallot meds
morphine and O2
26
tetralogy of fallot palliative shunt
used until complete repair, infant cannot undergo primary surgery needed -blalock taussig shunt = provides blood flow to arteries
27
tetralogy of fallot complete repair
usually done within first year of life -complete closure of VSD -patch is placed enlarging pulmonary artery
28
coarctation of the aorta
narrowing of the aorta , blood flow is impeded causing increase pressure proximally and decreased distally
29
coarctation of the aorta s/s
asymptomatic BP higher in upper extremities : EXTREME weak / absent femoral pulse
30
coarctation of the aorta dx
CXR echo cardiac cath : E sign
31
coarctation of the aorta surgical
resect portion of the aorta
32
coarctation of aorta nonsurgical
balloon angioplasty or stent
33
aortic stenosis s/s
chest pain fatigue SOB syncope systolic ejection murmur
34
aortic stenosis dx
echo : cardiomegaly , enlarged L ventricle CXR EKG : inverted T waves
35
aortic stenosis tx
balloon valvuloplasty : cardiac cath valve replacement : open heart
36
pulmonary atresia s/s
cyanosis at birth tachypnea poor feeding **normally also have VSD **must have PDA or PFO to survive!!
37
pulmonary atresia dx
echo , normally dx prior to delivery
38
pulmonary atresia tx
surgical repair : valve opening --> replacement -most fatal , need to treat quickly -Fontan Surgery
39
PGE
needed with pulmonary atresia BEFORE SURGERY -prostaglandin E1 holds PDA / PFO open
40
TGA
cardiac emergency!!! if not tx will lead to HF -also needs PGE
41
TGA hyperoxia test
if babies get 100% O2 and still have no change
42
TGA tx
balloon atrial septostomy atrial switch operation : done within first weeks of life
43
hypoplastic L heart syndrome
asymptomatic at birth grayish skin color difficulty breathing poor feeding cold hands / feet lethargy O2 in 75-80 %
44
hypoplastic L heart syndrome can have...
murmur if a PDA is present -once PDA closes = deterioration with cyanosis and decreased CO --> cardiovascular collapse
45
cyanotic hypoplastic L heart syndrome
no PDA , ASD, PFO
46
acyanotic hypoplastic L heart syndrome
free mixing at atrial level (ASD)
47
hypoplastic L heart syndrome CHF....
presents within 48 hours of life , must be corrected within first year of life
48
hypoplastic L heart syndrome dx
echo
49
hypoplastic L heart syndrome tx
therapeutic meds : prostaglandin surgery : 3 stages
50
3 stage surgery
1. Norwood procedure 2. Glenn procedure 3. Fontan procedure
51
Norwood procedure
done within first week of life , R ventricle pumps to lungs -shunt placed
52
Glenn procedure
done 4-6 months of life , reduce R ventricle workload -place patch
53
Fontan procedure
done at 18 months --> 2 years -patch removed -NOW LESS BLUE!!!
54
nursing considerations
1. maintain O2 2. prevent infection 3. ensure adequate tests 4. promote nutrition 5. vitals 6. I / O assessment : no fluid overload
55
cardiac health maintenance
promote normal growth / development nutrition prevent infection
56
prevent complications of CHF
promote adequate CO minimize metabolic demands
57
post op care
incision heals in 6 weeks immunization schedule remains the same bath cant be too long
58
infant post op
keep child from crying too long : 3-4 weeks LIFT USING SCOOP METHOD : 4-6 weeks no physical activity causing blow to chest no lifting arms over head : 4-6 weeks no living heavier than 5 lbs
59
CHF in peds
pump failure over circulation failure compensation
60
septal occluding device
not recommended for pts with coagulation concerns or active bacterial infections
61
infants CHF
growth failure persistent tachypnea hepatomegaly respiratory distress
62
toddlers CHF
respiratory distress poor appetite decreased activity hepatomegaly
63
school age CHF
fatigue exercise intolerance poor appetite hepatomegaly orthopnea
64
adolescent CHF
chest pain dyspnea abd pain , nausea / vomiting hepatomegaly orthopnea ascites dependent edema
65
CHF tx goal
improve function : increase contractility , decrease afterload decrease sodium decrease cardiac demand decrease excess fluid
66
heart transplant rejection
fever low urine output tachycardia tachypnea weight gain fatigue irritability poor appetite palpitations anxiety lightheadedness
67
transplant mortality...
remains high , smallest children normally last
68
immediately post transplant....
children can go back to new activities
69
transplant education
med regimen prep family transplant is not a cure chronic immunosuppression -extensive criteria to meet

Critical Care Pediatics (4 decks)

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