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PEDS Cardiac Flashcards

1
Q

Congenital heart disorders can be classified into what 2 categories?

A

Acyanotic and cyanotic

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2
Q

5 examples of Acyanotic defects include:

A

ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of aorta, aortic stenosis (AS)

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3
Q

What are the 2 examples of cyanotic heart diseases *hint they both start with T

A

Tetralogy of Fallot (TOF),Transposition of great vessels (TGV). Truncus arteriosus is also one, but not a key player.

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4
Q

LEFT-to-right shunts, INCREASED blood flow, and OBSTRUCTIVE defects are categorized as:

A

Acyanotic

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5
Q

RIGHT-to-left shunts, DECREASED PULMONARY blood flow and MIXED blood is categorized as:

A

Cyanotic

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6
Q

ASD, VSD, PDA

A

Increased PULMONARY blood flow defects

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7
Q

Coarctation of aorta, Aortic Stenonis (AS)

A

obstructive defects

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8
Q

Tetralogy of Fallot

A

decreased PULMONARY blood flow defect

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9
Q

TGV, TA

A

Mixed Defect

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10
Q

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 _____?

A

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

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11
Q

True or False, small defect in VSD close spontaneously

A

TRUE

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12
Q

Due to the increase in pulmonary . Blood flow, VSD can lead to pulmonary ____ and _____?

A

pulmonary HTN and CHF

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13
Q

In the event a surgical closure is needed to close a hole in VSD, what is the timing dependent on?

A

The symptoms of the infant

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14
Q

Any large defect allowing free communication between the pulmonary and systemic circulation can lead to what?

A

Eisenmenger syndrome

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15
Q

Eisenmenger syndrome= ______

A

Eisenmenger syndrome = pulmonary hypertension

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16
Q

Is Eisenmenger syndrome reversible or non-reversible?

A

irreversible

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17
Q

What is going on in Patent Ductus Arteriosus (PDA)?

A

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

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18
Q

What usually closes 72 hours after birth?

A

PDA

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19
Q

How is the closure of PDA different in a newborn vs. preemie?

A

Preemie will close with Indomethacin and in newborns a surgery is usually indicated for closure.

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20
Q

Describe what is going on in an Atrial Septal Defect?

A

Hole between the ATRIA. Oxygenated blood from the left atrium is shunted to the right atrium and lungs.

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21
Q

True or False, surgical closure is recommended before high school in ASD patients

A

False, school age

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22
Q

What may happen if ASD is not corrected?

A

congestive heart failure or atrial dysrhythmias

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23
Q

Which way does blood flow- high to low pressure or low to high pressure?

A

High to low

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24
Q

What must you play close attention to after an ASD surgery?

A

heart rhythm because the defect is close to the SA/AV node

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25
2 most common OBSTRUCTIVE defects include:
coarctation of the aorta and aortic stenosis
26
TRUE or FALSE, most children with down syndrome will have some type of congenital heart defect
TRUE
27
In coarctation of the aorta, is the aorta narrowed or extended?
narrowed
28
What are the 2 most common sites for coarctation of the aorta?
aortic valve and the aorta near the ductus arteriosus
29
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
30
In coarctation of the aorta, the patient will be hypotensive or hypertensive?
Hypertensive- degree dependent on severity of narrowing (coarctation)
31
Name that disease- it is an OBSTRUCTIVE narrowing immediately before, at, or after the aortic valve. Most commonly valvular.
Aortic stenosis
32
True or False, in Aortic Stenosis (AS), DE-oxygenated blood flow from the left ventricle into systemic circulation is diminished
False, OXYGENATED blood
33
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
34
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
35
In darker skinned children, what do you look at for signs of cyanosis?
Sclera
36
What 4 defects make up Tetralogy of Fallot?
VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy
37
True or False, in TOF babies, they will initially be born pink and then transition into a bluish presentation
TRUE
38
_____ is common in children with cyanotic defects
Polycythemia
39
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.
40
What does a squatting position do to a TOF child?
decreases systemic venous return
41
Treatment for TOF includes:
oxygen, morphine, and indaral/propranolol
42
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.
43
Name this disease- the pulmonary circulation arises from the left ventricle and the systemic circulation arises from the right ventricle
Transposition of great vessels
44
Transposition of great vessels is incompatible with life unless _________?
unless coexisting VSD, ASD, and/PDA is present
45
What med is given to keep ductus open in transposition of the great vessels?
prostaglandin E (PGE)
46
Any long term consequences of VSD?
No, totally corrected and then pt. should be good
47
In COTA, how long until pt. needs another balloon procedure to open up the narrowing area?
Q 10 yrs.
48
True or False, TOF patients will have lifelong issues and need repeat procedures later in life?
TRUE
49
What congenital heart diseases are inoperable?
Eisenmenger, and hypoplastic left heart syndrome
50
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.
51
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)
52
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
53
Causes of CHF
excessive volume load (e.g. vsd, asa, pda), excessive pressure load (e.g. aortic stenosis, coarctation of aorta), dysrhythmias
54
2 common pediatric dysrhythmias
complete heart block and paroxysmal atrial tachycardia
55
Tx of bradycardic heart block caused by surgery or congenital in etiology includes:
pacemaker
56
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
57
Tx for SVT (supraventricular tachycardia)
usually cardioversion, will try drugs but doesn't usually work well
58
Cardinal signs of CHF
tachycardia, poor feeding, failure to thrive, poor weight gain
59
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
60
HR of child increases with ___ or ____
crying or fever
61
True or False, infants may require tube feeding to conserve energy?
TRUE
62
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
63
Signs of toxicity of digoxin in children. What is the antidote?
vomiting in infants, anorexia, diarrhea, abdominal pain, fatigue, muscle weakness, and drowsiness. Digibond.
64
What must the nurse do before administering digoxin?
apical pulse for 1 minute to assess for bradycardia
65
When do you hold digoxin dose for infant and older child?
infant/child 6 -70
66
What is the therapeutic digoxin level?
0.8-2.0ng/ml
67
As a nurse caring for a patient with CHF, how do you promote maximum nutrition?
increase caloric concentration, possible gavage feedings, and support parents
68
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.
69
S/S of hypoxemia
blueness of lips, sclera, gums, mucous membranes, clubbing of nail beds, slowed growth, decreased activity
70
The 2 hematologic problems with CHF include
polycythemia and anemia
71
How do you avoid hemoconcentration?
adequate hydration
72
When should you call the MD if you are worried about polycythemia?
fever, hot weather, vomiting/diarrhea
73
IF patient is suspected of having anemia, what lab do you check? What is the tx?
Hgb, iron replacement.
74
Why do patients with CHF get a brain abscess?
bacterial not filtered in lungs because of right to left shunting of blood
75
Why do patients with CHF get a CVA?
increase in viscosity and coagulability= venous thrombosis ( blood moving so slow they clot easily)
76
Medical mgmt. of cyanosis includes:
monitor for progressive cyanosis, anemia, dehydration. Educate parents to look for tet/cyanotic spells
77
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
78
What movie is helpful in preventing vulnerable child syndrome?
Finding Nemo

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