PEDS Cardiac Flashcards
Congenital heart disorders can be classified into what 2 categories?
Acyanotic and cyanotic
5 examples of Acyanotic defects include:
ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of aorta, aortic stenosis (AS)
What are the 2 examples of cyanotic heart diseases *hint they both start with T
Tetralogy of Fallot (TOF) & Transposition of great vessels (TGV). Truncus arteriosus is also one, but not a key player.
Left-to-right shunts, decreased BLOOD FLOW and obstructive defects are categorized as:
Acyanotic
Right-to-left shunts, decreased PULMONARY BLOOD FLOW and mixed blood is categorized as:
Cyanotic
ASD, VSD, PDA
increased pulmonary blood flow defects
Coarctation of aorta (COA), Aortic Stenosis (AS)
obstructive defects
Tetralogy of Fallot
decreased pulmonary blood flow defect
TGV, TA
Mixed Defect
In VSD, there is a hole in the septum, which results in Oxygen-___ blood in LEFT ventricle shunted to RIGHT ventricle and circulated to the _____
In VSD, there is a hole in the septum, which results in Oxygen- rich blood in left ventricle shunted to right ventricle and circulated to the lungs
True or False, small defect in VSD close spontaneously
TRUE
Due to the increase in pulmonary blood flow, VSD can lead to ____ and ____?
pulmonary HTN and CHF
In the event a surgical closure is needed to close a hole in VSD, what is the timing dependent on?
The symptoms of the infant
Any large defect allowing free communication between the pulmonary and systemic circulation can lead to what?
Eisenmenger syndrome
Eisenmenger syndrome= ______
Eisenmenger syndrome = pulmonary hypertension
Is Eisenmenger syndrome reversible or non-reversible?
irreversible
What is going on in Patent Ductus Arteriosus (PDA)?
there is an abnormal opening between the AORTA and the PULMONARY ARTERY, which results in oxygenated blood from the aorta returning to the pulmonary artery. Increased blood flow to the lungs causes pulmonary hypertension
What usually closes 72 hours after birth?
PDA
How is the closure of PDA different in a newborn vs. preemie?
Preemie will close with Indomethacin and in newborns a surgery is usually indicated for closure.
Describe what is going on in an Atrial Septal Defect?
Hole between the atria. Oxygenated blood from the left atrium is shunted to the right atrium and lungs.
True or False, surgical closure is recommended before high school in ASD patients
False, school age
What may happen if ASD is not corrected?
congestive heart failure or atrial dysrhythmias
Which way does blood flow- high to low pressure or low to high pressure?
High to low
What must you play close attention to after an ASD surgery?
heart rhythm because the defect is close to the SA/AV node
2 most common obstructive defects include:
coarctation of the aorta and aortic stenosis
TRUE or FALSE, most children with down syndrome will have some type of congenital heart defect
TRUE
In coarctation of the aorta, is the aorta narrowed or extended?
narrowed
What are the 2 most common sites for coarctation of the aorta?
aortic valve and the aorta near the ductus arteriosus
A common finding in Coarctation of the aorta is ____ (or bounding pulses) in the upper extremities and ____ or ____ pulses in the lower extremities
A common finding in coarctation of the aorta is HTN (bounding pulses) in the upper extremities and decreased or absent pulses in the lower extremities
In coarctation of the aorta, the patient will be hypotensive or hypertensive?
Hypertensive- degree dependent on severity of narrowing (coarctation)
Name that disease- it is an obstructive narrowing immediately before, at, or after the aortic valve. Most commonly valvular.
Aortic stenosis
True or False, in AS, deoxygenated blood flow from the left ventricle into systemic circulation is diminished
False, Oxygenated blood
Why is the wall of the left ventricle thickened (hypertrophy)?
Because of the pressure the left ventricle has to overcome to get blood out to the rest of the body
In critical aortic stenosis, what procedures may be preformed?
In this newborn emergency, the MD may perform an Aortic valvotomy in the OR right away, the doctor will later perform a artificial valve placement
In darker skinned children, what do you look at for signs of cyanosis?
Sclera
What 4 defects make up Tetralogy of Fallot?
VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
True or False, in TOF babies, they will initially be born pink and then transition into a bluish presentation
TRUE
_____ is common in children with cyanotic defects
Polycythemia
What are tet spells and how are they resolved?
Hypoxic episodes where child turns blue after screaming/crying. They are relieved by the child’s squatting or being placed in the knee-chest position. Parents should bring child to ED.
What does a squatting position do to a TOF child?
decreases systemic venous return
Treatment for TOF includes:
oxygen, morphine, and indaral/propranolol
What is the role of Indaral (propranolol) in TOF treatment? And what is the cardinal sign of toxicity?
decreases amount of thickening of valve, so it relaxes and opens, which results in less shunting of the blood.
Name this disease- the pulmonary circulation arises from the left ventricle and the systemic circulation arises from the right ventricle
Transposition of great vessels
Transposition of great vessels is incompatible with life unless _________?
unless coexisting VSD, ASD, and/PDA is present
What med is given to keep ductus open in transposition of the great vessels?
prostaglandin E (PGE)
Any long term consequences of VSD?
No, totally corrected and then pt. should be good
In COTA, how long until pt. needs another balloon procedure to open up the narrowing area?
Q 10 yrs.
True or False, TOF patients will have lifelong issues and need repeat procedures later in life?
TRUE
What congenital heart diseases are inoperable?
Eisenmenger, and hypoplastic left heart syndrome
What is hypoplastic left heart syndrome? Tx?
baby born with a very small LV and underdeveloped heart. Will need a transplant and/or surgery until heart available.
Name this disease- condition in which the heart is unable to pump effectively the volume of blood that is presented to it
Congestive heart failure (CHF)
What are the objectives in treating CHF?
reduce workload of heart, increase CO, facilitate growth for optimal timing of surgery, control failure, and maximize nutrition
Causes of CHF
excessive volume load (e.g. vsd, asa, pda), excessive pressure load (e.g. aortic stenosis, coarctation of aorta), dysrhythmias
2 common pediatric dysrhythmias
complete heart block and paroxysmal atrial tachycardia
Tx of bradycardic heart block caused by surgery or congenital in etiology includes:
pacemaker
Difference between supraventricular tachycardia (SVT) and sinus tachycardia
SVT- rate 240 and ABOVE, incessantly regular rhythm, idiopathic cause, rapid onset, P-wave buried in T- wave. Sinus Tachy- rate UNDER 200, variable rhythm, identifiable cause, gradual onset, usually visible P-wave
Tx for SVT (supraventricular tachycardia)
usually cardioversion, will try drugs but doesn’t usually work well
Cardinal signs of CHF
tachycardia, poor feeding, failure to thrive, poor weight gain
Other signs of CHF
murmur may or may not be heard, cyanosis (clubbing of fingers after age 2), frequent regurgitation, activity intolerance, tachypnea ( 80/min), hepatomegaly, dyspnea, pale cool skin, diaphoresis, periorbital/scrotal edema, hacking dry cough
HR of child increases with ___ or ____
crying or fever
True or False, infants may require tube feeding to conserve energy?
TRUE
What do you include in the parent education of digoxin therapy?
give q 12 hr, do not skip or make up doses, give one hour before or 2 hours after meals , KEEP IN LOCKED CABINET, check pulse before administering med
Signs of toxicity of digoxin in children. What is the antidote?
vomiting in infants, anorexia, diarrhea, abdominal pain, fatigue, muscle weakness, and drowsiness. Digibond.
What must the nurse do before administering digoxin?
apical pulse for 1 minute to assess for bradycardia
When do you hold digoxin dose for infant and older child?
infant/child 6 -70
What is the therapeutic digoxin level?
0.8-2.0ng/ml
As a nurse caring for a patient with CHF, how do you promote maximum nutrition?
increase caloric concentration, possible gavage feedings, and support parents
What is the daily calorie requirement for child with CHF? What do you concentrate formula to?
Caloric needs for CHF = 150 cal/kg/day. Concentrate formula to 24-30 cal per oz.
S/S of hypoxemia
blueness of lips, sclera, gums, mucous membranes, clubbing of nail beds, slowed growth, decreased activity
The 2 hematologic problems with CHF include
polycythemia and anemia
How do you avoid hemoconcentration?
adequate hydration
When should you call the MD if you are worried about polycythemia?
fever, hot weather, vomiting/diarrhea
IF patient is suspected of having anemia, what lab do you check? What is the tx?
Hgb, iron replacement.
Why do patients with CHF get a brain abscess?
bacterial not filtered in lungs because of right to left shunting of blood
Why do patients with CHF get a CVA?
increase in viscosity and coagulability= venous thrombosis ( blood moving so slow they clot easily)
Medical mgmt. of cyanosis includes:
monitor for progressive cyanosis, anemia, dehydration. Educate parents to look for tet/cyanotic spells
Treatment for CHD acyanotic vs. cyanotic
Acyanotic- control CHF/maximize feeding. Cyanosis- monitor increase in cyanosis, teach knee chest positioning. Prevent infective endocarditis penicillin 1 hr b4 dental work) and vulnerable child syndrome
What movie is helpful in preventing vulnerable child syndrome?
Finding Nemo
