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54/64 Unit 3 > Peds Cardiac > Flashcards

Peds Cardiac Flashcards

1
Q

Changes that occur with baby’s first breath of air

A

Arterioles dilate significantly, high pressure system becomes low pressure system, shunts close

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2
Q

What are the two types of cardiac defects?

A

Congenital (CHD) and acquired

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3
Q

Characteristics of acquired cardiac defects

A

Disease or infection-related, autoimmune response, environmental factors, familial tendencies

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4
Q

Most common cause of congenital heart defect

A

Complex interaction between genetics and environmental factors

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5
Q

Prenatal risk factors for congenital heart defect

A

Chronic disease, alcohol/illicit drugs, infection, IUGR or macrosomia

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6
Q

Prenatal chronic diseases that increase risk of heart disease in infants

A

Autoimmune, lupus, diabetes

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7
Q

Prenatal infections that increase risk for fetal cardiac anomalies

A

Rubella, toxoplasmosis

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8
Q

Genetic risk factors for congenital heart defect

A

Marfan, hypertrophic cardiomyopathy, frequent loss or SIDS, Down syndrome or Turner syndrome

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9
Q

Causes of CHF

A

Volume overload, pressure overload, decreased contractility, high cardiac demands

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10
Q

HF characterized by elevated CVP and venous engorgement

A

Right-sided

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11
Q

HF characterized by increased pressure in pulmonary veins and LA, increased pulmonary pressures due to lungs congested with blood, and pulmonary edema

A

Left-sided

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12
Q

Cardiac and circulatory manifestations of CHF

A

Tachycardia during rest (compensatory mechanism), gallop rhythm, weak pulses, slow cap refill, low BP

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13
Q

Integumentary manifestations of CHF

A

Diaphoresis, mottled skin, cold extremities

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14
Q

Respiratory manifestation of CHF

A

Poor exercise tolerance (“unable to keep up with peers”)

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15
Q

Neurological manifestations of CHF

A

Fatigue and irritability

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16
Q

S/S of left sided heart failure (pulmonary congestion)

A

Tachypnea, dyspnea, hypoxemia, bronchial edema and coughing

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17
Q

S/S of right-sided heart failure (systemic venous congestion)

A

Hepatomegaly, weight gain, gravity dependent swelling, visually distended veins

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18
Q

CHF management: improving cardiac function

A

Digoxin, ACE inhibitors, vasodilation

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19
Q

CHF management: removing accumulated fluid

A

Lasix

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20
Q

CHF management: decreasing cardiac demands

A

Neutral-thermic (newborns), treat infections, semi-fowlers, sedation/rest

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21
Q

CHF management: improving oxygenation

A

O2 supplementation

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22
Q

Pediatric weights that are concerning

A

Major changes in weight percentiles, 5% or lower, 95th or higher

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23
Q

Non-specific CHF manifestations

A

Poor feeding, respiratory difficulty (tachypnea/tachycardia), FTT, developmental delays, non-cardiac congenital defects

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24
Q

Cardiac-specific manifestations of CHF

A

Clubbing of fingers, circumoral cyanosis, hypercyanotic/tet spells, sweating, polycythemia

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25
Hypercyanotic spells or “tet” spells are most often associated with
Tetralogy of Fallot
26
Interventions for tet spells
Stay calm, knee-chest position, morphine
27
Screening performed on newborns 4 hours after life that is highly effective at detecting congenital heart defects
Critical Congenital Heart Defect Screening (CCHD)
28
CCHD is highly effective at detecting what 7 congenital heart defects?
Hypoplastic left heart syndrome, pulmonary atresia, tetralogy of fallot, total anomalous pulmonary venous return, transposition of the great arteries, tricuspid atresia, and truncus arteriosis
29
Describe CCHD screening
Non-invasive and quick, pulse ox placed on foot and hand comparing oxygenation on different parts of body to help catch defects early
30
An infant would pass the CCHD screening of pulse ox is greater than ___% in RH or F AND a difference of ___% or less between RH and F
95; 3
31
An infant would fail CCHD screening if pulse ox is ___% or lower in RH or foot
89
32
If an infant’s pulse ox is between ___ and ___% in RH or F OR a difference of ___% or higher between RH and F, then repeat the CCHD screen in 1 hour
90-94; 4
33
What should be done If an infant reads the same pulse ox after repeating CCHD screening?
Repeat screen in 1 hour again; if no change, the infant fails the CCHD screen
34
Diagnostic that assesses the electrical conduction within the heart
ECG
35
Diagnostic that looks for signs of HF by assessing changes in size and position of organs
Chest X-Ray
36
Diagnostic that assesses/measures valves, chambers, and EF; may be ordered if CHF screening is failed
Echocardiography
37
Nursing considerations for CHF
Patients at risk for neurologic complications, developmental delays (cognitive and motor), thrombotic events, and bacterial endocarditis
38
Examples of increased pulmonary blood flow defects
Arterial septal defect, ventricular septal defect, and patent ductus arteriosis
39
Characteristics of atrial septal defect
Blood flow from left atria (high pressure) to right side (low pressure), right atrial/ventricular enlargement BUT HF is rare, pulmonary vasculature changes only occur after decades
40
S/S of atrial septal defect
Asymptomatic, HF after 3 or 4 decades, murmur, risk for atrial dysrhythmia
41
Increased pulmonary blood flow defects result from an abnormal connection between the two sides of the heart being either the _________ or the _____ _______
Septum; great vessels
42
Increased pulmonary blood flow defects lead to _________ blood volume on the right side of the heart, _________ pulmonary blood flow, _________ systemic blood flow, and symptoms of _____.
Increased; increased; decreased, HF
43
Treatment for patent ductus arteriosis
Indomethacin (Indocin)
44
Examples of obstructive defects
Coarction of the aorta, pulmonary stenosis
45
With coarction of the aorta, increased blood flow to the head and upper extremities causes _________ and _________ due to narrowing and high pressures
Headaches; epistaxis
46
Coarction of the aorta S/S
High pressure in arms and bounding pulses in upper extremities, low pressure, cool skin, and weak pulses in lower extremities, weak or absent femoral pulse, HF in infants
47
Obstructive defect by which less blood flows to lungs, causing blood to back up into body and venous system
Pulmonic valvar stenosis
48
Example of decreased pulmonary blood flow defect
Tetralogy of fallot
49
Decreased pulmonary blood flow defects, like Tetrology of Fallot, are characterized by ___ blood oxygen levels
Low
50
S/S of Tetrology of Fallot (related to low blood oxygen levels)
Circumoral cyanosis, tachypnea, systolic murmur, no edema, TET spells or acute cyanosis
51
Defect by which overriding aorta causes mixing of oxygenated and deoxygenated blood
Tetrology of fallot
52
With Tetrology of fallot, surgical repair is done within _____ _____ of life based on developmental hypercyanotic spells or “tet”
First year
53
Tetrology of fallot long-term complications
Chronic pulmonary regurge, R ventricular enlargement, valve replacements, aortic root dilation, sudden cardiac death
54
Example of mixed defect
Transposition of the great vessels
55
Defect in which cardiac structure are in the wrong place. The aorta connects to the right side and pulmonary artery connects to the left side preventing blood from going where it needs to go
Transposition of the great arteries
56
Operation for treatment of transposition of the great vessels
Arterial switch operation
57
Heart sounds that reflect turbulent blood flow through the heart, especially related to valves
Murmurs
58
Defects that are more likely to have a murmur
PDA, pulmonary stenosis
59
Surgical interventions for cardiac defects
Open or closed heart surgery
60
Incision is made in _________ for open-heart surgery
Breastbone
61
Cardiopulmonary bypass machine provides
Temporary oxygenated blood
62
Postoperative complications
HF, decreased CO syndrome, decreased peripheral perfusion, dysrhythmias, pulmonary complications, neuro complications, infection
63
Infection of the inner lining of the heart
Bacterial (infective) endocarditis (IE)
64
Children with cardiac anomalies are at risk for
Infective endocarditis (IE)
65
The most significant complication of Acute Rheumatic Fever (ARF) which caused permanent valve damage
Rheumatic heart disease
66
Abnormal inflammatory response causing inflammation of connective tissues
Acute Rheumatic Fever (ARF)
67
Infective endocarditis risk factors
Children with CHD, artificial heart valves, recent strep, staph infections elsewhere
68
Manifestations of infective endocarditis
Low-grade fever, myalgias, arthralgias, weight loss, new murmur or change in previous, splenomegaly, splinter hemorrhages, osler nodes, janeway spots, petechiae
69
IE in newborns S/S
Non-specific: S/S sepsis, S/S HF, feeding intolerance, respiratory distress, tachycardia, hypotension
70
S/S of respiratory distress in newborns
Grunting, retractions, flaring
71
Children with ARF and rheumatic heart disease are at risk for
Recurrent infections and ARF
72
ARF and RHD assessment
History of strep throat infection within the past 2-6 weeks that may or may not have been treated
73
Clinical findings of rheumatic fever/heart disease
Carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum
74
Pre-procedure goals for invasive procedures
Reduce anxiety, enhance coping and cooperation, improve trust
75
General invasive procedure nursing care
Meet pre-procedure goals, tours (cath lab/OR,ICU), EDUCATION! (Discharge planning & post-op)
76
Surgical explanation/education for school age and adolescents
Basic description and chronological explanation
77
Nursing management for cardiac catheter and surgery
Sedation, NPO, accurate weight and height, baseline vitals with bilateral pedal pulses
78
Cardiac catheterization post-procedural care
Monitor vitals every 15 min (assess HR and RR for full minute), maintain straight leg for 4-8 hours to prevent bleeding, limit activity for 24 hrs, monitor for bleeding and hypoglycemia
79
Patients who are intubated following cardiac surgery should not be suctioned for more than
5 seconds
80
Chest tube nursing care following cardiac surgery
Maintain water-seal, patency, sterility
81
Cardiac surgery complications
Dysrhythmias, cardiac tamponade, pulmonary changes, neurologic changes, hematologic changes, infection, postpericardiotomy syndrome
82
S/S of postpericardiotomy syndrome
Fever, leukocytosis, pericardia friction rub, pericardial or pleural effusion
83
Chest tubes that may be placed after cardiac surgery
Pleural or pericardial tubes
84
Following cardiac surgery, chest tube drainage should be monitored _____ for color and quantity
Hourly
85
Immediately post-op CT drainage should be
Bright red, but becomes serous within hours
86
CT drainage that requires nurse to notify surgeon
>3 mL/kg/hr x 3 consecutive hrs OR 5-10 mL/kg in any 1 hour
87
Best predictor of kidney perfusion
Urine output
88
Desired urinary output in children
1 mL/kg/hr (report if <1 mL/kg/hr = kidney failure!)
89
Inotropic medication that increases cardiac contractility
Digoxin (lanoxin)
90
Digoxin nursing considerations
Narrow therapeutic range (monitor for toxicity), take apical pulse prior to administration
91
Hold digoxin if HR < ___ in infants or < ___ for older child
90; 70
92
Digoxin toxicity S/S
Arrythmias, palpitations, N/V, visual changes
93
Diuretics given for venous congestion/R-sided HF
Furosemide (Lasix) or Chlorthiazide (Diuril)
94
Furosemide (Lasix) nursing considerations
Wastes K+ (monitor for signs of low K+)
95
Medications that reduce afterload
ACE inhibitors like captopril (Captopen) and enalapril (Vasotec)
96
Prostaglandin give to keep open PDA when there is transposition of the great vessels
Alprostadil (Prostin PR)
97
General nursing care of children with CHD
Conserve child’s energy, promote normalcy (nutrition, developmental milestones, family integration)
98
Rheumatic Heart Disease prevention
Early referral for throat cultures (Group A Strep), educate full completion of antibiotic regimen
99
Rheumatic heart disease management
Antibiotics, anti-inflammatories, management of HF, supportive care
100
Rheumatic heart disease supportive care
Rest, good nutrition, oxygen
101
Rheumatic heart disease lab monitoring
ASO titer, elevated CRP and ESR
102
Prophylactic antibiotic therapy for Rheumatic heart disease
Penicillin G q28 days; may be on long-term antibiotic therapy for 5, 10, or 40+ years
103
What is a common, serious complication of rheumatic fever?
Cardiac valve damage
104
Infective endocarditis patient education
Stress importance of follow-up visits, early diagnosis for future infections, and COMPLETION of antibiotic regimen (2-8 weeks likely with PICC line)
105
Infective endocarditis prophylaxis
Antibiotics prior to dental and surgical procedures; meticulous mouth care

54/64 Unit 3 (8 decks)

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