Pediatrics- Cardiovascular Flashcards
 When does heart failure occur?
When the heart is unable to pump, adequate blood to meet the metabolic and physical demands of the body
What is congenital heart disease?
Anatomic defects of the heart prevent normal blood flow to the pulmonary, and or systematic systems
What are the different effects of congenital heart disease?
Increase pulmonary blood flow,
decrease pulmonary blood flow
obstruction to blood flow
mixed blood flow
What defects increase pulmonary blood flow
ASD (atrial septal defect)
VSD (ventricle septal defect)
PDA (patent ductus arteriosus )
What are risk factors to getting congenital heart disease?
Maternal factors -  infection alcohol during pregnancy, diabetes mellitus
Genetic factors- history of disease, down syndrome
What happens when there is a defect that increases pulmonary blood flow
Blood flow shifts from high-pressure left side of the heart to the right, lower pressure side of the heart
In defects that increase pulmonary blood flow, what side of the heart increases blood flow
Pulmonary blood volume on the right side
In defects that increase pulmonary blood flow, there is usually a finding of
Heart failure
What is ventricle septal defect (VSD)?
A hole in the septum between the right, and left ventricle that results in an increase pulmonary blood flow
What are findings in VSD (ventricle septal defect)?
Loud harsh murmur auscultated at the left sternal border
Many close spontaneously, early in life
What is atrial septal defect (ASD)?
A hole in the septum between the right, and left atria that results in an increase pulmonary blood flow
What are findings in an atrial septal defect (ASD)?
Load harsh murmur with a fixed split second heart sound
 Possibly asymptomatic
What is patent ductus arteriosus? (PDA)
A condition in which the normal fetal circulation conduit between the pulmonary artery in the aorta fails to close in result in increased pulmonary blood flow
What are findings in patent ductus arteriosus?
Systolic murmur,
wide, pulse pressure,
bounding, pulses,
possibly asymptomatic
rales
What is an obstructive defect in the heart
Blood flow exiting the heart meets the area of narrowing (stenosis) which causes obstruction of blood flow
What happens to the pressure in the heart when there is an obstructive defect?
The pressure that occurs before the defect is increased, (ventricle) and the pressure that occurs after the defect is decreased
In an obstructive defect, what happens to cardiac output?
There is a decrease in cardiac output
What is pulmonary stenosis?
A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
What defects, obstruct blood flow
Pulmonary stenosis,
aortic stenosis,
coarctation of the aorta
What are findings and pulmonary stenosis
Systolic ejection murmur,
possibly asymptomatic,
cyanosis worsens with severe narrowing
cardiomegaly
What is aortic stenosis?
Narrowing of the aortic valve
What are findings in infants with aortic stenosis?
 Saint pulses,
hypotension
tachycardia,
poor feeding tolerance
What are findings in children with aortic stenosis?
Intolerance to exercise,
dizziness,
chest pain,
possible ejection murmur
What is coarctation of the aorta
A narrowing of the lumen of the aorta, usually at or near the ductus arteriosus that results in obstruction of blood flow from the ventricles
What are findings in Coarctation of the aorta
Elevated blood pressure in arms
bounding pulse in upper extremities,
decrease blood pressure in lower extremities,
cool skin of lower extremities,
weak or absent femoral pulses,
dizziness, headaches, painting, or nose bleeds in older children
What defects decrease pulmonary blood flow
Tricuspid Artesia
Tetralogy of fallot
What creates defects that decrease pulmonary blood flow?
Have an obstruction of pulmonary blood flow and an anatomic defect ASD or VSD Between the right and left sides of the heart
What happens in defects that decrease pulmonary blood flow
There is a right to left shift, allowing deoxygenated blood to enter the systemic circulation
What is a common finding in defect that decrease pulmonary blood flow?
Hypercyanotic spells manifest as a cute cyanosis and hyperpnea
What is tricuspid Atresia?
A complete closure of the tricuspid valve that results in mix blood flow
An atrial septal opening needs to be present to allow blood flow to enter the left atrium
Findings in an infant with tricuspid, Atresia
Cyanosis
dyspnea
Tachycardia
Findings in a child with tricuspid atresia
Hypoxemia
clubbing of fingers
What is tetralogy of fallot
Four defects that results in mix blood flow : pulmonary stenosis,ventricle septal defect, overriding aorta, right ventricle hypotrophy
What are the four defects of tetralogy of fallot
pulmonary stenosis,
ventricle septal defect,
overriding aorta,
right ventricle hypotrophy
What are findings of tetralogy of fallot
 Cyanosis at birth,
progressive cyanosis over the first year of life,
systolic murmur,
episodes of a cute cyanosis and hypoxia
What makes up mixed blood defects?
Transposition of the great arteries
truncus arteriosus
hypoplastic left heart syndrome
What is transposition of the great arteries?
A condition in which the aorta is connected to the right ventricle. Instead of the left, the pulmonary artery is connected to the left ventricle instead of the right,
A septal defect or a PDA, must exist in order to oxygenate the blood
What are findings of transposition of the great arteries?
Murmur,
severe to Less cyanosis depending on size
cardiomegaly
What is truncus arteriosus
Failure of septum formation, resulting in a single vessel that comes off of the ventricles
What is findings in truncus arteriosus?
Murmur,
variable cyanosis,
delayed growth,
lethargy,
fatigue,
poor, feeding habits
What is hypoplastic left heart syndrome
Left side of the heart is under developed
an ASD allows for oxygenation of blood
What are findings in hypoplastic left heart syndrome
Mild cyanosis, lethargic, cold, hands, and feet.
PDA closes progression of cyanosis and decreased cardiac output results in eventual cardiac collapse
How do you fix a ventricle septal defect?
Closure during cardiac catheterization,
careful observation for spontaneous closure
Pulmonary artery banding
Complete repair with patch 
How do you fix an atrial septal defect?
Closure during cardiac catheterization
Diuretics
Low-dose aspirin, six months after procedure
Patch closure
Cardiopulmonary bypass
How do you fix patent ductus arteriosus?
Administration of indomethacin
Insertion of coils to include PDA during cardiac catheterization
Administration of diuretics (furosemide)
Provide extra calories for infants
Thoracoscopic repair
How do you fix pulmonary stenosis?
Balloon angioplasty with cardiac catheterization
Infants : brock procedure
Children: pulmonary valvotomy
How do you fix aortic stenosis?
Balloon dilation with cardiac catheterization, administer beta blockers, calcium channel blockers
Norwood procedure
Aortic valvotomy
How do you fix Coarctation of the aorta?
Infants and children: balloon angioplasty
Adolescencants: placement of stents
Repair of defect recommended for infants, less than six months of age
How do you fix tricuspid Artesia?
Surgery and three stages :
shot placement
Glenn procedure
modified Fontan procedure
How do you fix tetralogy of fallot
Shut placement until able to undergo primary repair
complete repair within the first year of life
How do you fix transposition of the great arteries?
Surgery to switch the arteries within the first two weeks of life
IV prostaglandin
How do you fix Truncus arteriosus?
Surgical repair within the first month of life
How do you fix hypoplastic left heart syndrome?
Surgery and three stages starting shortly after birth
Norwood procedure
Glenn shunt
Fontan procedure
What is pulmonary artery hypertension
Is high blood pressure in the arteries of the lungs that is a progressive and eventually fatal disease
Is there a cure for pulmonary hypertension?
There is no cure
What are risk factors for pulmonary hypertension?
Anyone can develop it, but there is a genetic link
What are findings in pulmonary artery hypertension
Dyspnea with exercise
Chest pain
Syncope
What organ might have to get transplanted in pulmonary artery hypertension
Lung transplant
What should you educate your patient who has pulmonary artery, hypertension to do?
Avoid high altitude because of hypoxia
Consider supplemental oxygen therapy, the prostacyclin infusion cannot be interrupted
What is infective bacterial endocarditis?
Infection of the inner lining of the heart in the valve that can enter the bloodstream
What causes infective endocarditis?
Streptococcus, Candida and staphylococcus
What are risk factors for infective endocarditis?
Congenital are required heart disease
Indwelling catheters
What would you find in a patient with infective endocarditis?
Fever
Malaise
New murmur
Diaphoresis
Weight loss
Splinter hemorrhage under fingernails
What would you find in a neonate with infective endocarditis
 Feeding problems
Respiratory distress
Tachycardia
Heart failure
Septicemia
How would you treat a patient was infective endocarditis
Administer antibiotics for extended time is length (2-8 weeks)
Maintain a high level of oral care,
advise dentist of existing cardiac problems
What medication do you take on infective endocarditis?
Hi does anti-infective’s are given for 2 to 8 weeks
What would you teach a patient with infective endocarditis?
You require a prophylactic antibiotics before dental and surgical procedures, if they are at high risk
What is cardiomyopathy?
Abnormalities of the myocardium, which interfere with its ability to contract effectively,
can lead to heart failure
What is DCM?
Dilated cardiomyopathy
most common
What is HCM?
Hyper trophic, cardiomyopathy,
autosomal genetic increases in heart muscle mass leads to have normal diastolic function
What is restrictive cardiomyopathy?
Rare
Prevents feeling of the ventricles in causes a decrease in diastolic volume
 What are risk factors for cardiomyopathy?
Genetic infection,
deficiencies,
metabolic conditions,
collagen disease,
drug toxicity
What are expected findings and cardiomyopathy
Tachycardia and dysrhythmias
Dyspnea
Hepatosplenomegaly
Fatigue and poor growth
What are expected findings and DCM
Palpations
Syncope
Infant poor feeding, and respiratory distress
Expected findings in HCM
Chest pain
Syncope
Dyspnea
Cardiomyopathy might need this kind of transplant
Heart transplant
What is cardiogenic shock?
Results from impaired, cardiac function, that leads to decrease in cardiac output
What is anaphylactic shock?
Hypersensitivity to a foreign substance that leads to a massive vasodilation and capillary leak
When can you see cardiogenic
Shock
Following cardiac surgery, and with acute dysrhythmias congestive heart, failure, trauma, or cardiomyopathy
Expected findings in shock
Dyspnea
breath sounds with crackles,
grunting,
hypotension,
tachycardia
week, peripheral pulses
Manifestations of impaired myocardial function
Sweating
tachycardia,
fatigue,
Pallor
, cool extremities with weak pulse,
hypotension
Gallup rhythm
cardiomegaly
Manifestations in pulmonary congestion
Tachypnea
Dyspnea
Retractions
Nasal flaring
Grunting
Wheezing
Cyanosis
Exercise intolerance
Manifestations of systemic venous congestion
Hepatomegaly
Peripheral edema
Ascites
Neck vein, distention
Periorbital edema
Weight gain
Manifestations of hypoxemia
Cyanosis
Poor Weight gain
Tachypnea
Dyspnea
Clubbing
What is an ECG monitoring?
Identify, cardiac dysrhythmias
What is a radiography?
Chest x-ray
To determine heart size and blood flow 
What is an echocardiography?
 To determine cardiac defects and heart function by use of ultrasound
What is cardiac catheterization?
An invasive test used for diagnosing, repairing some defects and evaluating dysrhythmias
What happens during cardiac catheterization
A catheter is peripherally inserted, and threaded into the heart with use of fluoroscopy what contrast medium is injected in images of the blood vessels and heart are taken as the medium is diluted and circulated throughout the body
What is a pre-procedure nursing action for cardiac catheterization?
Get a history
Check for evidence of infection, a severe diaper rash can cause cancellation
check for allergies to iodine and shellfish
Describe procedure to child
Provide NPO status 4 to 6 hours prior to procedure
Locate and mark dorsal, pedis and posterior tibial pulse is on both extremities
What are post procedure? Nursing actions for cardiac catheterization
Continuous, cardiac monitoring and oxygen
Assess heart rate for a full minute
This is pulses for equality in symmetry
Assess temperature in color of affected extremity
Assess insertion site
Prevent bleeding by maintaining in a straight position for 4 to 6 hours
What should your teacher patient about cardiac catheterization?
Fluid intake and help body with the removal of the day
Monitor for infection
No strenuous activities
How should you take care of your patient who has to have a cardiac catheterization
Conserve the child’s energy by providing frequent rest, periods, clustering care, small, frequent meals, bathing PRN, and keeping crying to minimum
Position infant car seat at 45° angle
Allow patient to sleep with several pillows
Decrease work load of heart
Maintain bed rest
What are the nutrition aspects after cardiac catheterization?
Administer potassium
Check fluid in sodium restrictions
Feeding schedule every three hours for infant should be rested
You soft, preemie, nipple, or regular nipple with slit to enlarge opening
Hold the infant semi upright position
Have infant Russ during feedings approximately 30 minutes to complete the feeding
Increase caloric density with high density formula, or fortified breastmilk
What is digoxin?
Improves myocardial contractility
What are nursing actions for digoxin
Monitor pulse if infants pulse is less than 90 medication should be withheld. Monitor for toxicity (dysrhythmias, nausea, vomiting, anorexia)
What is the antidote for digoxin toxicity
Digoxin immune fag
What is Captopril or enalapril
Is inhibitor reduces afterload by causing vasodilation, resulting in decrees, pulmonary and systemic vascular resistance
Adverse effect- hyperkalemia watch BP
What is metroprolol or cardedilol
Beta blockers decrease heart rate and blood pressure and promote vasodilation
Adverse effect - dizziness headache
What is furosemide or chlorothiazide
Potassium wasting diuretics, rid the body of excess fluid and sodium
Encourage diet high potassium
What are possible complications of cardiac catheterization?
Bleeding infection, thrombosis
Limit activity for 24 hours
Encourage fluids
Low-grade fever 
Loss of Pulse
How do you give digoxin
Take pulse prior to medication administration
Administer every 12 hours
Give water to prevent tooth decay
If child, vomits, or Misses dose do not re-administer dose
How do you give a diarrhetic?
Offer small amounts of fluid
Watch for manifestation of blood, potassium level imbalances (muscle weakness)
 Foods high in potassium
What are foods high in potassium?
Bran cereals
Bananas
Legumes
Leafy vegetables
Orange
Orange juice
What are you do during a cardiac catheterization if the patient begins to bleed
Apply, direct, continuous pressure above the catheter entry site to localize pressure over the location of the vessel
Puncture
Position the child flat
What position should you place the child and if they become hypoxic
 Knee to chest position
Attempt to calm child
and call for help
Route what is rheumatic fever
Inflammatory disease that occurs as a reaction to group a beta hemolytic streptococcus infection (Strep) of the throat
When does rheumatic fever usually occur?
2 to 6 weeks following an untreated or partially treated upper respiratory infection (Strep)
What is an expected finding in someone who has rheumatic fever
History of recent upper respiratory infection
Fever
Tachycardia cardiomegaly
Muffled heart sounds
Chest pain
Nontender subcutaneous nodules over bony prominences
Painful swelling in large joints
Pink, masculine rash on the trunk and inner surface of extremities
Involuntary purposeless muscle movements
Muscle weakness
Involuntary fascial movement
What is a diagnostic procedure for rheumatic fever
Radiography chest x-ray to assess for cardiomegaly
ECG to reveal presence of conduction disturbances
Jones criteria
What does Jones criteria?
The diagnosis of rheumatic fever
The child should demonstrate the presence of two major criteria, or the presence of one major and two minor criteria of following an acute infection of strep
What is the major criteria in Jones criteria?
Carditis
Subcutaneous nodules
Polyarthritis
Rash
Chorea
What is the minor criteria in Jones criteria?
Fever
Arthralgia (joint pain)
Nursing care for a patient with rheumatic fever
Encourage bedrest
Nutritionally, balanced meals
Assessed for chorea
What is chorea
Nervousness,
behavioral changes
decreased in attention span
Medication for rheumatic, fever
Prophylactic treatment
To daily oral doses of penicillin or monthly, IM injection 
Length of treatment varies, according to residual heart disease ranging from five years to indefinitely
What is dyslipidemia
Disorders of lipid metabolism that can result in abnormal days of the lipid profile cholesterol is part of the Lipo protein complex in blood
Where do triglycerides come from?
Two sources: naturally made in the body from carbohydrates
End product of fat ingestion
What is total cholesterol?
The sum of all forms of cholesterol
What is high density lipoprotein HDL cholesterol?
Good cholesterol
Having low levels of cholesterol and triglycerides in high level of protein
What is low density Lipo proteins LDL cholesterol
Bad cholesterol having high levels of cholesterol, low level of triglycerides and moderate levels of protein
Risk factors for dyslipidemia
History
Genetic
Obesity
Lack of exercise
Diabetes
Birth control pills
What do you have to do before a lipid profile test?
Fast for 12 hours prior
If a client is at risk, how often should they have screenings for dyslipidemia?
To screenings between two and eight years old
What is Kawasaki’s disease?
Acute systemic vasculitis resolves in less than eight weeks
Also known as mucocutaneous lymph node syndrome
What happens during the acute phase of Kawasaki’s disease?
Instead of high fever last in five days to two weeks, that is unresponsive to antipyretics
What are expected findings in the acute phase of Kawasaki’s disease
Irritability
Red eyes without drainage
Bright red chapped lips
Strawberry tongue with white coating
Read mucous membranes
Swelling of hands, and feet with a red palms
Non-blistering rash
Enlarged lymph nodes
What happens during the subacute phase of Kawasaki’s disease
Resolution of fever and gradual subsiding of other manifestations
What is expected findings in the subacute phase of Kawasaki’s disease
Peeling skin around nails in on pet palms and soles
Temporary arthritis
What is convalescent stage of Kawasaki’s disease
No manifestations seen except altered laboratory findings
Resolution in about 6 to 8 weeks from onset 
Nursing care for a patient with Kawasaki’s disease
Offer clear liquids and soft non-acidic food
Administer IV gammaglobulin
Perform oral hygiene, apply lip balm
Apply cool cloths to skim
Apply skin lotions
What is the medication for a Kawasaki’s disease?
Iv gammaglobulin
Highly dose: 2 g/kg over 8 to 12 hours
Administer within the first 10 days of illness
What do you teach a patient with Kawasaki’s disease?
The irritability can last two months
Arrhythmic manifestations can last several weeks
Skin manifestations are painless, but tender
Perform passive ROM EXERCISES IN BATHTUB
Avoid live immunization for 11 months
Avoid smoking
A nurse is assessing an infant who has a coarction of the aorta which of the following findings should the nurse expect( select)
Week femoral pulses
Cool skin of lower extremities
Severe cyanosis
Clubbing of the fingers
Low blood pressure
Week femoral pulse
Cool skin of lower extremities
Low blood pressure
A nurse is assessing an infant who has a heart failure which of the following findings should the nurse expect(select)
Bradycardia
Cool extremities
Peripheral edema
Increase urinary output
Nasal flaring
Cool extremities
Peripheral edema
Nasal flaring
A nurse is providing teaching to the caregiver of an infant who has prescription for digoxin which of the following instructions should the nurse include
“ do not offer your baby fluids after giving the medication”
“ digoxin increases your babies heart rate”
“ give the correct dose of medication at regular scheduled times”
“ if your baby vomit a dose, you should repeat the dose to ensure that the correct amount is received”
Give the correct dose of medication at regularly scheduled times
A nurse is caring for a two-year-old who has a heart defect and is scheduled for cardiac catheterization which of the following action should the nurse take
Place on NPO status for 12 hours
prior to the procedure
Check for iodine or shellfish allergies prior to the procedure
Elevate the affected extremity following the procedure
Limit fluid intake, following the procedure
Check for iodine or shellfish allergies prior to the procedure
A nurse is caring for a child who is suspected of having rheumatic fever, which of the following findings with the nurse expect(select)
Erythema marginatum (rash)
Continuous joint pain of the digits
Tender subcutaneous, nodules
Decrees, erythrocyte, sedimentation rate
Elevated C-reactive protein
Erythema marginAtum(rash)
Elevated C-reactive protein
