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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
Q

tetralogy of fallot meds

A

morphine and O2

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26
Q

tetralogy of fallot palliative shunt

A

used until complete repair, infant cannot undergo primary surgery needed

-blalock taussig shunt = provides blood flow to arteries

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27
Q

tetralogy of fallot complete repair

A

usually done within first year of life

-complete closure of VSD
-patch is placed enlarging pulmonary artery

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28
Q

coarctation of the aorta

A

narrowing of the aorta , blood flow is impeded causing increase pressure proximally and decreased distally

29
Q

coarctation of the aorta s/s

A

asymptomatic
BP higher in upper extremities : EXTREME
weak / absent femoral pulse

30
Q

coarctation of the aorta dx

A

CXR
echo
cardiac cath : E sign

31
Q

coarctation of the aorta surgical

A

resect portion of the aorta

32
Q

coarctation of aorta nonsurgical

A

balloon angioplasty or stent

33
Q

aortic stenosis s/s

A

chest pain
fatigue
SOB
syncope
systolic ejection murmur

34
Q

aortic stenosis dx

A

echo : cardiomegaly , enlarged L ventricle
CXR
EKG : inverted T waves

35
Q

aortic stenosis tx

A

balloon valvuloplasty : cardiac cath
valve replacement : open heart

36
Q

pulmonary atresia s/s

A

cyanosis at birth
tachypnea
poor feeding
**normally also have VSD

**must have PDA or PFO to survive!!

37
Q

pulmonary atresia dx

A

echo , normally dx prior to delivery

38
Q

pulmonary atresia tx

A

surgical repair : valve opening –> replacement
-most fatal , need to treat quickly
-Fontan Surgery

39
Q

PGE

A

needed with pulmonary atresia BEFORE SURGERY

-prostaglandin E1 holds PDA / PFO open

40
Q

TGA

A

cardiac emergency!!! if not tx will lead to HF
-also needs PGE

41
Q

TGA hyperoxia test

A

if babies get 100% O2 and still have no change

42
Q

TGA tx

A

balloon atrial septostomy
atrial switch operation : done within first weeks of life

43
Q

hypoplastic L heart syndrome

A

asymptomatic at birth
grayish skin color
difficulty breathing
poor feeding
cold hands / feet
lethargy
O2 in 75-80 %

44
Q

hypoplastic L heart syndrome can have…

A

murmur if a PDA is present
-once PDA closes = deterioration with cyanosis and decreased CO –> cardiovascular collapse

45
Q

cyanotic hypoplastic L heart syndrome

A

no PDA , ASD, PFO

46
Q

acyanotic hypoplastic L heart syndrome

A

free mixing at atrial level (ASD)

47
Q

hypoplastic L heart syndrome CHF….

A

presents within 48 hours of life , must be corrected within first year of life

48
Q

hypoplastic L heart syndrome dx

A

echo

49
Q

hypoplastic L heart syndrome tx

A

therapeutic meds : prostaglandin
surgery : 3 stages

50
Q

3 stage surgery

A
  1. Norwood procedure
  2. Glenn procedure
  3. Fontan procedure
51
Q

Norwood procedure

A

done within first week of life , R ventricle pumps to lungs

-shunt placed

52
Q

Glenn procedure

A

done 4-6 months of life , reduce R ventricle workload

-place patch

53
Q

Fontan procedure

A

done at 18 months –> 2 years

-patch removed
-NOW LESS BLUE!!!

54
Q

nursing considerations

A
  1. maintain O2
  2. prevent infection
  3. ensure adequate tests
  4. promote nutrition
  5. vitals
  6. I / O assessment : no fluid overload
55
Q

cardiac health maintenance

A

promote normal growth / development
nutrition
prevent infection

56
Q

prevent complications of CHF

A

promote adequate CO
minimize metabolic demands

57
Q

post op care

A

incision heals in 6 weeks
immunization schedule remains the same
bath cant be too long

58
Q

infant post op

A

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
Q

CHF in peds

A

pump failure
over circulation failure
compensation

60
Q

septal occluding device

A

not recommended for pts with coagulation concerns or active bacterial infections

61
Q

infants CHF

A

growth failure
persistent tachypnea
hepatomegaly
respiratory distress

62
Q

toddlers CHF

A

respiratory distress
poor appetite
decreased activity
hepatomegaly

63
Q

school age CHF

A

fatigue
exercise intolerance
poor appetite
hepatomegaly
orthopnea

64
Q

adolescent CHF

A

chest pain
dyspnea
abd pain , nausea / vomiting
hepatomegaly
orthopnea
ascites
dependent edema

65
Q

CHF tx goal

A

improve function : increase contractility , decrease afterload
decrease sodium
decrease cardiac demand
decrease excess fluid

66
Q

heart transplant rejection

A

fever
low urine output
tachycardia
tachypnea
weight gain
fatigue
irritability
poor appetite
palpitations
anxiety
lightheadedness

67
Q

transplant mortality…

A

remains high , smallest children normally last

68
Q

immediately post transplant….

A

children can go back to new activities

69
Q

transplant education

A

med regimen
prep family
transplant is not a cure
chronic immunosuppression
-extensive criteria to meet

Critical Care Pediatics (4 decks)

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