PEDS CARDIAC Flashcards
What how types of cardiac defects are there? What are they?
Congential (CHD) which are anatomic/abnormal function and happens during development
Acquired which can occur from infection, environmental factors
Is congenital heart defects (CHD) common? What is the cause?
What are some Risk factors?
Most common type of defect
Cause stems from a complex interaction between genetics and environmental influences
Risk factors include:
prenatal–> chronic disease like automimmune(lupus, diabetes) which increases risk of heart disease in infants; Alcohol or illicit drug increase risk, infection (rubella, toxoplasmosis, etc.) causes risk for anomalies; IUGR or macrosomia
Genetic: frequent loss of SIDS; Mafan; Down or Turner Syndrome
Enviromental
What can occur with altered hemodynamics in neonates/infants? What major complications can occur?
Any alteration is blood flow can significantly alter cardiac function and oxygen status.
Congestive Heart Failure and Hypoxemia can occur as a result
What happens after delivery with an infant’s heart and its pressures?
Pressure will become higher in the L-sid and lower in the R-side
What causes Congestive Heart Failure (CHF)? HINT: Caused by 4 things
How many types of CHF is there?
Causes by Volume overload, Pressure overload, Decreased contractility, High Cardiac Demands
2 types of CHF
R-sided (pt will have increase CVP and venous engorgment)
L-side (there's an increased pressue in the pulm veins and L-artium; lungs are congested with blood causing increased pulmonary pressures and pulmonary edema is a result)
What are some manifestations (s/s) of CHF?
Tachycardia during rest (compensatory mechanism);
Diaphoresis;
Poor exercise tolerance (sitting down often, not being able to keep up with peers)–> IMPORTANT SIGN
Fatigue; Irritability; Gallop rhythm; Weak pulses; Slow cap refill; Low BP; Mottled skin; Cold extremities
What are some manifestations (s/s) of CHF? CONT’D
HINT: these are sign of L and R-sided HF
Pulmonary congestion (which is left side failure) –>
Tachypnea;Dyspnea;Hypoxemia
Bronchial edema and coughing
Systemic Venous Congestion (right side failure)–>
Hepatomegaly; Weight gain;
Gravity dependent swelling;
Visually distended veins
What is include in the management of CHF?
Improve cardiac function (Digoxin, ACE inhibitor to cause vasodilation)
Remove accumulated fluid (Lasix)
Decrease cardiac demands (treat any infection, position (Semi-folwer’s), sedation/rest
Improve oxygenation (give O2 when needed)
What causes an infants to be Neutral thermic?
S/N (is part of decreasing cardiac demands when completing CHF management)
any change in temp cause major problems, feeding causes too much demand on body-tube feedings is needed
When taking the history of a 3-year-old child, which of the following would alert the nurse to a potential cardiac problem?
A: The child’s weight for age is in the 40th percentile.
B: The child’s respiratory rate is 28 breaths per minute.
C: Child reports he is frequently hungry before lunch at school.
D: Parents report he cannot keep up with his friends while playing soccer.
Parents report he cannot keep up with his friends while playing soccer.
Rationale: Poor feeding, tachypnea, can’t keep up with friends, pale, fussy, mother has chronic conditions, multiple miscarriages, SIDs, syndromes
What are examples of NON-SPECIFIC MANIFESTATION that should be ruled out before suspecting there’s a cardiac issue?
Poor feedings,
Tachypnea/tachycardia- respiratory difficulty (nose flaring, retractions, elevated VS, grunting)
Failure To Thrive (FTT)–> Poor weight gain and/or Activity intolerance
Developmental delays (r/t to hypoxia)
Non-cardiac congenital defects (index of suspicion)
What are examples of SPECIFIC cardiac manifestations?
Clubbing of fingers: Chronic hypoxemia (long-term)
Circumoral cyanosis (only your mouth or lips turn blue)
Hypercyanotic spells or “tet” spells
Most often- Tetralogy of Fallot
Knee/chest position (place
infants in this position)
Morphine
Stay calm
Sweating
Polycythemia: (r/t Chronic hypoxemia
A child with a congenital heart defect comes to the office for a checkup. Which of these findings would require immediate intervention by the nurse?
A: Heart rate of 105
B: Clubbing of fingers
C: Circumoral cyanosis
D:Bruises along shins
Circumoral cyanosis
When should the criticial congenital heard defect screeing (CCHD) occur?
Why is it conducted?
Performed on newborns after 24 hrs. of life
Highly effective at detecting these 7 CCHDs
What are examples of Diagnostic procedure?
ECG (shows Electrical conduction within the heart)
Chest x-ray (Signs of HF)
Echocardiography(shows Valves, chambers, ejection fraction, Cardiac catheterization)
A chest x-ray is ordered for a child with suspected cardiac problems. The child’s parent asks the nurse, “What will the x-ray show about the heart?” The best response from the nurse would be?
A: “It will show the bones of the chest, but not the heart.”
B: “It shows a measurement of electrical activity from the heart.”
C: “It permanently records the heart size and configuration.“
D: “It is a computerized image of the heart vessels and tissue.”
“It permanently records the heart size and configuration.“
What are the labs that help indicated a potential cardiac issue?
What are examples of nursing considerations when these lab values are abnormal?
Hemoglobin, Hematocrit
Serum electrolytes
Blood gases—arterial
sometimes venous or even capillary
Nursing considerations
Pts at risk for neurological
complications
Thrombotic events
Bacterial endocarditis
Developmental delays (cognitive
and motor)
What are examples of defects that INCREASE Pulmonary Blood flow?
Artial septal defect (ASD)
Ventricular Septal defect (VSD)
Patent ductus arterious (PDA)
What occurs with an Artial septal defect (ASD)? HINT: 3 things
What are some S/S?
A hole in the septum between the R and L atria resulting in increased pulmonary blood flow
Blood flow from left atria (high pressure) to right side (low pressure) resulting in loosing pressure where its needed
(L to R shunt)
Right Atrial/ventricular enlargement BUT HF is rare
Pulmonary vascular changes only occur after DECADES
S/S include: pts can be ASYMPTOMATIC!!!; HF after 3 or 4 decades; murmur; risk for artial dysrhythmias
What occurs with an Ventricular septal defect (VSD)? HINT:
What are some S/S?
A hole in the septum between the R and L ventricle resulting in increased pulmonary blood flow
Blood goes from L-side to R-side (aka L to R shunt)
S/S: can lead to HF (may show signs); loud and harsh murmur
What is Patent ductus arteriosus (PDA)?
What are some S/S? What med treats this condition?
A condition in which normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (Aka L to R shunt)
S/S: Systolic murmur, wide pulse pressure, bounding pulses, HF
Indomethacin (Indocin)
What occurs with Increased Pulmonary Blood flow defects?
HINT: 4 Things
Defects that allow blood to shift from the high pressure (L-side) to the lower pressure (R-side) of the heart
Theres is an increase in blood volume on the RIGHT SIDE of the heart
Pt can have symptoms of HEART FAILURE
Increase in pulmonary blood flow and decrease in systemic blood flow
What are examples of Obstructive defects? HINT: There are TWO
Coarctation of the Aorta
Pulmonary Stenosis
What occurs with Pulmonary Stenosis?
What are some S/S?
A narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles
S/S include: Pt may be asymptomatic, systolic ejection murmur. Cardiomegaly; Cynanosis varies, HF
What occurs with Coartation of the Aorta?
S/S: HINT to major ones with the extremities
A narrowing of the aorta, usually at or near the ductus arteriosus, that results in obstruction of blood flow from the ventricle
S/S include: Elevated BP in the arms, bounding pulses in the upper extremities (TEST Q), decreased BP in the lower extermities, Cool skin of the lower extremities (TEST Q),
RESULTS IN HF IN INFANTS,
Weak or absent femoral pulses
A nurse is assessing a child who has coarctation of the aorta. Which of the following findings should the nurse expect?
A: Cool, pale fingers
B: Vomiting
C: Low blood pressure
D: Weak femoral pulses
Weak femoral pulses
What are examples of DECREASED PULMONARY BLOOD FLOW defects?
HINT: Both start with the SAME LETTER
Tetralogy of Fallot
Tricuspid Atresia
What are the 4 defects associated with Tetralogy of Fallot?
What are the S/S of this defect?
Pulmonic stenosis, Right ventricular hypertrophy, ventricular septal defect, and overriding aorta
S/S: LOW BLOOD O2 Levels
Cyanosis at birth that progresses to cyanosis over the 1st yr of life
Systolic murmur
Episodes of acute cyanosis and hypoxia (blue or “TET” spells)
When does surgery occur with Tetralogy of Fallot?
What are the long-term effects with Tetralogy of Fallot?
Surgical repair within first year of life based on development hypercyanotic spells or “tet”
Long term effects include:
Chronic pulmonary regurgitation
R-ventricular enlargement
Valve replacements
Aortic root dilation
Sudden cardiac death
What are examples of Mixed Defects?
Transposition of the Great Arteries
Truncus Arteriousus
Hypoplastic L-heart Syndrome
What occurs with Transposition of the Great Arteries?
What must exist in order for blood to be oxygenated?
A condition in which the aorta is connected to the R-ventricle instead of the L-ventricle and the Pulmonary artery is connected to the L-ventricle instead of the R-venticle
A septal defect or a PDA MUST EXSIST in order to oxygentate the blood
What are Murmurs?
Heart sounds that reflect turbulent blood flow through the heart, esp related to valves
What are examples of Post-op complications?
Heart failure (HF)
Decreased cardiac output syndrome
Decreased peripheral perfusion
Dysrhythmias
Pulmonary complications
Neuro complications
Infection
What are examples of Acquired CV disorders?
Bacterial (infective) endocarditis
Infection of inner lining of heart
Children with cardiac anomalies
are at risk
Rheumatic Heart Disease
The most significant complication
of Acute Rheumatic Fever (ARF)
ARF (Inflammation of connective
tissues- abnormal
inflammatory response)
Cardiac valve damage can be the result
What are some risk factors for Infective Endocarditis?
What are examples of S/S?
Children with CHD
Artificial heart valves
Recent Strep, Staph infections elsewhere (TEST Q)
S/S: (low grade) Fever, myalgias, weight loss (TEST Q)
New murmur or change in previous
Splenomegaly;Splinter hemorrhages; Osler nodes; Janeway spots; Petechaie
What should be assessed with Rheumatic fever/Heart disese?
Auscultate heart sounds, ECG, Echo
for Carditis
Assess large joint for pain, swelling
for Polyarthritis
Assess skin for rash, esp trunk & inner surfaces of extremities
Erythema marginatum
Subcutaneous nodules over
bony prominence
Assess for neuro status—movement, emotional changes, poor fine motor skills
Chorea
What is special about Erythema marginatum and Subcataneous nodules?
Less common but very specific (signs)
