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Nursing 3 > Peds cardiac > Flashcards

Peds cardiac Flashcards

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1
Q

Fetal circulation

A
  • Heart develops between 4th& 8thweeks
  • Intrauterine circulation
  • Foramen ovale: pumps blood from R to L atrium
  • Ductus arteriosus: shunts blood from pulmonary artery to descending aorta
  • Ductus venosus: shunts most of blood around fetal liver
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2
Q

Transitional and Neonatal Circulation

A

After birth:

  1. Pulmonary vessels dilate & dec. pulmonary vascular resistance as lungs expand
  2. Umbilical cord clamping(?) causes inc. in systemic vascular resistance, causes inc. in pressure in L. side of heart
  3. Foramen ovaleusually closes shortly after birth
  4. Ductus arteriosus usually closes by 4th day of life
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3
Q

Congenital Cardiac problems factors

A
  • Present at birth
  • Family history
  • Down Syndrome
  • Trisomy 13 and others
  • High risk maternal factors:
  • Age > 40 years old
  • Diabetes
  • ETOH abuse
  • Rubella during pregnancy
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4
Q

Acquired cardiac problems factors

A
  • Develops after birth:
  • Technically, heart failure
  • Cardiomyopathy
  • Infection
  • Toxins
  • Hypertension/ hyperlipidemia
  • Kawasaki disease*
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5
Q

4 classifications of congenital defects

A

Increased pulmonary blood flow
•Abnormal structure pushes more blood to lungs, less blood to body. Heart works harder

Decreased pulmonary blood flow
•Abnormal structure pushes less blood to lungs, deoxygenated blood to body.

  • Obstructive –narrowing, stricture, heart works harder
  • Mixed
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6
Q

Type of increased blood flow defect

A
  • (Left-to-right shunt)
  • Oxygenated blood re-enters pulmonary circulation.
  • R. ventricular strain, dilation, hypertrophy
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7
Q

3 Ex. of defects with increased Pulmonary blood flow

A
  • VSD (ventriculoseptal defect): Abnormal opening in the ventricular septum
  • ASD (atrioseptal defect): Abnormal opening in the atrial septum
  • PDA (patent ductus arteriosus): ductus arteriosus fails to close
  • In all of these:
  • Blood is recirculated throughlungs
  • Less blood available to rest of body
  • Heart works harder
  • If symptoms not severe, may be “watched”
  • May correct themselves
  • If not, usually require one surgery with excellent prognosis
  • If defect persists, worsens, and/or is not treated:
  • Heart Failure
  • Pulmonary Hypertension
  • VSD is most common congenital heart defect
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8
Q

Obstructive Congenital heart defect ex.

A
  • Coarctationof aorta:
  • Narrowing of aorta,
  • Dec blood flow below defect
  • Inc. pressure above defect
  • Femoral pulses weak or absent
  • Radial pulses bounding
  • Upper extremity hypertension
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9
Q

Defect with decreased pulmonary blood flow

A 
Right-to-left shunts
•deoxygenated blood enters systemic circulation = “blue babies”
• dec pulmonary blood flow
•Tetralogy of Fallot*
•Transposition of great arteries
•Hypoplastic Left Heart Syndrome
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10
Q

Tx of Defects with decreased pulm. blood flow

A

Often requires emergency treatment
Surgery in several stages
Prognosis varies with extent of defect

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11
Q

Tetralogy of Fallot

A 
(Most common complex lesion)
•4 anomalies
1.VSD
2.Pulmonic valve stenosis
3.Overriding aorta
4.R. ventricular hypertrophy
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12
Q

Medical Mgmt TOF

A
  • keep DA patent: prostaglandins*
  • Vasodilator, diuretics, digoxin, ACEI*
  • Activity/Rest balance to prevent fatigue
  • (All the interventions used to treat heart failure + prostaglandins)
  • Surgical management necessary
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13
Q

TOF what will you see?

A
  • Hypercyanotic/blue called ”TET” spells = Specific to TOF
  • Choking spells with periods of dyspnea
  • Relief from squatting or place infant in knee-chest position to inc. blood flow to lungs
  • Clubbing (not specific)
  • Polycythemia (not specific)
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14
Q

Screening for defects

A
  • Newborn cardiac screening using pulse ox:
  • Pre and post ductal screening (right hand, foot).
  • Both should be >95%.
  • Baby should be 25-48 hours old*
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15
Q

Ex of cardiac screening tests

A 
Echocardiogram
•Electrocardiogram
•Chest x-ray
•Cardiac MRI
•Cardiac Cath
•Older kids: stress test
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16
Q

Gen. manifestations of congenital heart disease in newborns

A
  • May be none!
  • Intercostal retractions, difficulty breathing, tachypnea >80/min, crackles, wheezing
  • Central cyanosis at rest or on exertion
  • Tachycardia (> 160/min)
  • Uncontrollable crying, irritability
  • Altered LOC, drowsiness
  • limp extremities
  • seizure, cardiac arrest
17
Q

Heart failure, what happens?

A

•Heart does not pump enough blood to meet body’s demand for energy
1.Heart pumps well, but volume is insufficient or structure doesn’t work
OR
2. Weak heart muscle not pumpingenough blood.

Backup of blood and fluid
•Into the lungs:left sided failure
•Into the liver & veins: right sided failure
•Everywhere if both sides of heart are failing

•Backup into lungs is most common in pediatrics

18
Q

S/S of HF - decreased perfusion

A

** Heart muscle having to work harder than with healthy kids = decreased perfusion:
•Fatigue; falling asleep when feeding; too tired to eat
•Change in skin temperature and color (pale, cold and clammy, or sweaty, flushed, and warm)
•Jugular venous distention
•Fast breathing during rest or exercise: needing to take frequent breaks when playing (tachypnea)
•Sweatingwhile feeding, playing, or exercising
•Loss of interest in feeding(poor appetite, loss of muscle mass, ↓ weight ), which leads to….
•Failure to gain weight* (as in growth and development)

19
Q

S/S of HF - Fluid retention (RAAS)

A
  • Edema–FACE!, legs, ankles, eyelids (periorbital), abdomen, flanks
  • Pain over liver –hepatomegaly
  • Weight gain over a short period of time, even when the appetite is poor (as in EDEMA weight)
  • Cough and congestion in the lungs (rales/ crackles)
  • *As lungs fill with fluid, short of breath
20
Q

S/S of HF- Resp sx

A

Due to •Backup of fluid in lungs
•Trying to keep up with increased workload of heart
•Symptoms already discussed above:

Cough and congestion in the lungs (rales/ crackles)
As lungs fill with fluid, short of breath
Fast breathing during rest or exercise: needing to take frequent breaks when playing
Tachypnea, orthopnea
Clubbing, polycythemia

21
Q

Tx of HF in children

A
  • Congenital heart defect or rheumatic valve disease surgery or transplant
  • Some surgeries can be done less invasively
  • Medications* (will address later)
  • O2 therapy
  • Sometimes fluid restriction
  • NGT feedings (can use breastmilk) or hi calorie formula
  • (Pacemaker?
  • LVADs?)
22
Q

Nsg Interventions

A
  • Position for comfort & inc. oxygenation
  • Medications
  • Cluster care to provide rest** –activity as tolerated
  • Provide diversion to meet developmental needs (child life)
  • Anticipate child’s needs to minimize stress –parents can help!
  • Avoid extremes of temperature to avoid stress of hypothermia/hyperthermia
  • Breastfeeding ok if tolerated
  • Low sodium formula (Lonalac)
  • Strict I & O
  • Daily weights
  • Standard precautions to prevent infection –why?
  • Prone to URI’s
  • Infections = Increased work for heart

•Teach parents
•Good handwashing
•Limit visitors with infections
Explain diagnostic procedures, blood tests
Review dietary restrictions & medications

23
Q

Cardiac Meds

A
  • Digoxin(Lanoxin):
  • cardiac glycoside to slow & strengthen heart beat
  • Potassium:
  • electrolyte to replace loss from diuretic
  • Furosemide(Lasix):
  • diuretic to reduce preload by dec. reabsorption of sodium
  • Propranalol(Inderal):
  • beta-blocker to reduce cardiac oxygen demands/ decrease pulse –blocks sympathetic stimulation
  • Enalapril(Vasotec), Captopril, (Capoten):
  • Ace inhibitor to dec. afterload; cause vessel dilation
  • Spironolactone (Aldactone)
  • Aldosterone antagonist, K+ sparing diuretic
24
Q

Use of digoxin ***

A

Forarrhythmias and heart failure.
 inc. strength and efficiency of the heart
Controls rate and rhythm of the heartbeat.
Available in tablet, liquid, IV
Give q 12 h: 1 hour before or 2 hours after feeding
Measure the oral liquid medicine with a marked measuring spoon or medicine cup.
Check heart rate for 1 minute
Hold if apical pulse is < than 90-110 in small child, <70 older child

Do not mix with other foods or fluids
If child has teeth, brush them or rinse mouth after giving
If child vomits, do notgive second dose

TWO nurses check dose before admin

25
Q

Parent teaching - digoxin

A
  • Write down dose and time after giving
  • Refill prescription before previous one all used
  • If doseis missed and more than 4 hours elapsed, skip dose; if 2 doses missed, call health care provider
  • Do not increase or double doses
  • Keep in safe place
  • Do not give any other medicine, prescription or over-the-counter drugs without provider approval
26
Q

Digoxin Toxicity signs

A 
Bradycardia*
•Dysrhythmias*
•Anorexia*
•Nausea, vomiting*
•stomach pain
  • CNS disturbances
  • Drowsiness
  • Confusion
  • Headache
  • (visual disturbances)
27
Q

Evaluation of Tx

A
  • Child’s O2is maintained AEB pink nailbedsand pink mucous membranes
  • Child’s fluid and calorie requirement is adequate for physical growth at normal rate
  • Family (and child) verbalize understanding of CHD, treatment and prognosis
  • Family and child demonstrate effective coping to deal with CHD
28
Q

Ex of Acquired HD

A

•Cardiomyopathy
•Rheumatic Heart Disease
Kawasaki Disease

29
Q

Kawasaki Disease

A
  • Acute systemic vasculitis of unknown cause
  • Arteries, veins, capillaries are extensively inflammed
  • May progress to
  • Coronary artery aneurysms
  • Coronary thrombosis
  • Severe scar formation & stenosis of coronary artery
  • Death from MI (rare)
30
Q

Kawasaki S/S

A
  • Fever 5+ days
  • -Conjunctival inflammation
  • -Change in oral mucosa (red, dry)
  • -Change in extremities (edema, redness, peeling of skin)
  • -Rash
  • -Cervical lymphadenopathy
31
Q

Kawasaki Mgmt

A
  • Medication
  • Hi dose IV gamma globulin
  • ASAq 6 hours
  • Coumadin if giant aneurysm exists
  • Nursing care
  • I & O
  • Daily weight
  • Relieve symptoms
  • Assess for CHF
  • Quiet environment
  • Discharge teaching

Nursing 3 (10 decks)

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