Pediatric cardiovascular issues

Question 1

Atrial septal defect(ASD)

Answer 1

Infant maybe asymptomatic or may develop CHF Extra blood is coming high pressure left side, and lower pressure right side.
left to right shunt , dyspnea, Fatigue,poor growth,soft systolic murmur.
Diagnosed by echo, can be visualized by heart catheterization.
Need surgery to close the defect.

Question 2

ventricular septal defect (VST) signs and symptoms

Answer 2

Signs and symptoms of CHF commonly present respiration distress,
left to right shunt, dyspnea, fatigue,poor growth, palpable thrill , murmur at LSB(left sternum border).

Question 3

atrioventricular Canel defect.

Answer 3

Infant usually has mild to moderate CHF; cyanosis increases with crying.

Question 4

patent ductus arteriosus 

Answer 4

Normal fetal circulation Condit between the pulmonary artery and the aorta fails,to close.
widened pulse pressure(systole-Diastole =pulse pressure different between a lot).
bounding pulse present (strong kind of pulse),”matchine hum”, murmur.

Question 5

patent ductus arteriosus-Meds

Answer 5

Indomethacin or ibuprofen: indomethacin effects blood flow to organs and so many lead to complications such as renal failure.

Question 6

obstructive defects:

Answer 6

Blood exiting the heart meets area of anatomic narrowing (stenosis), causing obstruction of blood flow.
Infant ,children exhibit signs of CHF.

Question 7

obstructive Defects:Aortic Stenosis

Answer 7

Aortic Stenosis:a narrowing of the aortic valve.
Infants:faint pulse, hypotension , tachycardia, poor feeding tolerance.
Children: intolerance to exercise, dizziness, chest pain, possible ejection murmur, sign of exercise intolerance, when standing for long periods.

Question 8

Obstructive defect call-pulmonic stenosis

Answer 8

Narrowing of the pulmonary valve or pulmonary artery,that results in obstruction of blood flow from the ventricles, system ejection murmur, cardiomegaly, heart failure.
Newborns with severe narrowing are cyanotic.

Question 9

Coarctation of aorta 

Answer 9

narrowing of the lumen Of the Aorta,that results in obstruction of blood flow from the ventricle.

Question 10

Coarctation Aorta symptoms

Answer 10

Blood pressure higher, bounding pulses in upper extremities, versus lower and weak or absent pulses in lower extremities, versus upper extremities, as well as cool lower extremity.

Question 11

Coarctation of aorta signs.

Answer 11

signs self CHF(congestive heart failure):may occur in infants,
other signs: – elevated blood pressure in the arms,
bounding pulses in the upper extremities,
decreased blood pressure in the lower extremities (differences of 20 MM between upper and lower extremities).
Cool skin of lower extremities,
weak or absent femoral pulses,
heart failure in infants,
dizziness, headache, fainting, or nosebleeds in older children
decrease pulmonary blood flow,
obstructed pulmonary blood flow and anatomic defect between right and left sides of heart pressure and right side of the heart increases, exceeding pressure right and left sides of heart allows unoxygenated blood to enter system circulation.

Question 12

tetralogy of Fallot defects

Answer 12

4defects Thar result mixed in blood flow:-
Pulmonary stenosis,
ventricular septal defect,
overriding aorta,
right ventricular hypertrophy, or left ventricular smaller and thick muscle mass.

Question 13

tricuspid atresia

Answer 13

A complete closure of the tricuspid valve that results in mixed blood flow. An atrial septal opening need to be present to allow blood to enter the left atrium left atrium.
Infants - cyanosis, dyspnea, tachycardia.
older children- hypoxemia clubbing of the fingers.

Question 14

tetralogy of Fallot infants

Answer 14

Infants have acute episode of cynosis (hypercyanotic spells, blue spells,tetralogy TET spells) during periods of crying, feeding ,defecating. knee chest position is recommended.

Question 15

Tetralogy of Fallot in children

Answer 15

Children can present with squatting, clapping of finger, poor growth.
Children can develop polycythemia(RBS)as a compensatory mechanism due to prolong tissue hypoxia. Polycythemia will increase blood viscosity, placing an infant at risk for stroke heart thromboembolism.

Question 16

Mixed defects:

Answer 16

Fully saturated systemic blood flow mixes, with desaturated blood flow, causing the desaturation of systemic blood flow. Sign’s heart failure present.

Question 17

Hypoplastic left heart syndrome yet

Answer 17

Left side of the heart is under developed. an ASD or patent foramen ovale for oxygenation of the blood.
mild cyanosis, sign of cardiac heart failure occurs until ducts arteriosus closes.

Question 18

Transposition of the great vessels. (Opposite)

Answer 18

Aorta is connected to the right ventricle,and pulmonary artery is connected to the left ventricle.
A septal defect or a PDA must exit in order to oxygenate the blood.
Infants with minimal communication severely decreased cyanotic at birth.
Presence of largest septal defect or patent ductus arteriosus maybe less severelycynotic, but with the symptoms of CHF.

Question 19

Truncus arteriosus

Answer 19

Failure of septum formation, resulting in a single vessel that comes of the ventricles.
characteristics murmur present,
infant exhibit moderate to severe CHF, variable cyanosis, poor growth, activity intolerance.

Question 20

Intervention:cardiovascular defect

Answer 20

Monitor for signs of defects defects, vital signs closely
respiratory status for symptoms of respiratory distress
-auscultate lungs for presence of crakles,Rhonchai, Wheezes
-position in reverseTrendelenburg’s if respiratory effort increases
administer humidifier oxygen, provide endotracheal tube, ventilator care as prescribed
monitor for hypercyanotic spells, assess for signs of CHF, assess peripheral pulses.
maintain strict fluids restriction, monitor intake output daily rate.
provide high calorie diet, administer medication as prescribed
keep chilld,as stress-free as possible ,child should have maximal rest,
prepare child,parents for cardiac catheterization, if appropriate.

Question 21

Cardiac surgery

Answer 21

postoperative interventions: Monitor vital signs, maintain a septic technique
monitor for signs of sepsis, including diaphoresis, lethargy, fever, Altered level of consciousness,
monitor all lines, tubes, catheter as appropriate
assess for discomfort, pain, medicate as prescribed.
encourage provides of rest

Question 22

Rheumatic fever

Answer 22

Inflammatory,auto immune disease that affects connective tissue of heart,joints,subcutaneous tissue, blood vessels of central nervous system.
Presents 2 to 6 weeks after untreated or partially treated group A beta hemolytic streptococcal infection of upper respiratory tract

Question 23

Rheumatic fever assessment

Answer 23

fever,inflamed joints/nodules present, erythema marginatum, carditis(heart infection or inflammation).

Question 24

Rheumatic fluid diagnostics

Answer 24

Laboratory tests: throat culture for GABHS,
serum antistreptolysin -O(ASO)titer-elevated in rising titer, most reliable diagnostic test
CRP-C reactive proteins- elevated in response to an inflammatory reaction(Sensitivity,specificity)
Erythrocyte sedimentation rate-elevated in response to an inflammatory reaction.

Question 25

Rheumatic fever interventions

Answer 25

Administer a massage, heat and cold therapist as prescribed for joint pain.
bedrest during febrile phase.Limit physical exercise in child with carditis.
Administer salicylate’s (aspirin),anti-inflammatory agents as prescribed
sydenem Korea neurological disorder -seizure -from gabhs infection-seizures precaution
Instruct parent about follow up care, need for prophylactic antibiotic therapy prior to dental care and invasive procedures.

Question 26

Kawasaki disease: symptoms 

Acute systemic vasculitis

Answer 26

fever more than 102.Fahrenheit ,strawberry tongue and Red lips,
cervical lymphadenopathy and superficial skin layers desqumate easily(skin feel self off) red soles and palm,conjunctival redness,lethargy , irritability, cardiac complication in 5 to 20%, occasional intermittent colicky abdominal pain associated withMI, cramps, rash over Trunk and perineal area.

Question 27

Kowalski disease interventions:

Answer 27

Assess vital signs, heart sounds and rhythm.
Access extremities for Edema, redness,desquamation
assess mucous membrane for inflammation.
Daily weights,administer of soft foods, provide passive range of motion.
coronary artery aneurysm are the most serious potential sequelae in untreated clients,leading to complications such as myocardial infraction and death.
Echocardiography is used to monitor these cardiovascular complications.
Interventions immunoglobulin (IV I G )along with aspirin is used to prevent coronary aneurysm and subsequent occlusion.