Perfusion exam 3

Question 1

foramen ovale

Answer 1

allows oxygenated blood to travel from RA to LA

Question 2

ductus arteriosus

Answer 2

allows fetal blood to bypass the lungs

Question 3

patent

Answer 3

remain open

Question 4

congenital heart disease

Answer 4

missing or poorly formed parts of the heart

Question 5

shunt

Answer 5

refers to the flow of blood through an abnormal opening between two vessel of the heart

Question 6

diagnosis

Answer 6

• screening- CCHD for all newborns at 24hr age
  electrocardiography
  echocardiography
  MRI
  cardiac catheterization

Question 7

assessment

Answer 7

positive fam hist of cardiac disease
- poor feeding
- tachypnea/tachycardia
- arrhythmia/murmur
- failure to thrive/ poor weight gain
- activity intolerance
- developmental delays
- abnormal color-cyanosis and pallor
- clubbing of fingers
- chest deformities

Question 8

acyanotic shunts

Answer 8

do not impair blood flow to the lungs, and the oxygenation process is intact. These shunts cause increased pulmonary blood flow

Question 9

cyanotic shunts

Answer 9

impair oxygenation of blood by the pulmonary system and result in cyanosis. These defects cause decreased pulmonary blood flow

Question 10

ASD

Answer 10

abnormal hole in the septum that divides the atria of the heart

Question 11

ASD pathophysiology

Answer 11

• acyanotic defect- increase pulmonary bd flow
• left to the right shunt- blood leaks from the left atrium to the right atrium delivering extra oxygenated blood back to the lungs
• a large ASD over a period of time, can cause damage to the heart and the lungs

Question 12

ASD symptoms

Answer 12

• fatigue
• feeding intolerance
• shortness of breath especially during any physical activity
• swelling in abdomen, legs
• murmur on auscultation
• may not have any symptoms

Question 13

ASD treatment

Answer 13

• may close on its own
• some defects may not close, and may need treatment
• surgical correction done via cardiac cath or open heart surgery

Question 14

VSD

Answer 14

a hole in the septum of heart ventricles

Question 15

VSD pathophysiology

Answer 15

-acyanotic defect- increase pulmonary bd flow
- left to right shunt- blood leaks from the left ventricle to the right ventricle delivering extra oxgenated blood back to the lungs
- large VSD over a period of time can cause damage to the heart and the lungs

Question 16

VSD symptoms

Answer 16

• fatigue
• feeding intolerance
• shortness of breath especially during any physical activity
• swelling in abdomen or legs
  murmur on auscultation
  may not have any symptoms

Question 17

VSD treatment

Answer 17

• may close on its own
• some defects may not close and may need treatment
• surgical correction done via open heart surgery

Question 18

coarctation of aorta

Answer 18

a constriction or narrowing of the aortic arch or of the descending aorta

Question 19

coarctation of aorta pathophysiology

Answer 19

• acyanotic defect
• restricts blood flow to the body due to stenosis of aorta
• L ventricle hypertrophy over time (working harder to pump through narrow aorta

Question 20

Coarctation of aorta symptoms

Answer 20

• may not develop symptoms until adulthood
• pulses and BP will differ between upper and lower extremities
• fatigue
• feeding intolerance
• shortness of breath especially during any physical activity
• heavy sweating
• irritability
• pale skin

Question 21

coarctation of aorta treatment

Answer 21

• balloon angioplasty with stent placement
• surgical repair
• if untreated, leads to HTN, heart failure, and endocarditis

Question 22

Tetralogy of fallot

Answer 22

it’s a combination of four heart defects that change the way blood flows through the heart and to the lungs

Question 23

TF pathophysiology

Answer 23

• cyanotic defect (decrease pulmonary bd flow)
• Righ ventricular hypertrophy- thickening of muscle in right ventricleaorta displacement- opening to aorta collection from both ventricles
• pulmonary stenosis- narrowing of the pulmonic valve
• ## ventricular septal defects- hole between ventricles

Question 24

TF symptoms

Answer 24

• low SpO2- blue skin, lips, and fingernails
• TET spells
• fatigue
• feeding intolerance
• shortness of breath especially during any physical activity
• murmur on auscultation

Question 25

TF treatment

Answer 25

- tet spell- knee to chest - surgery temporary shunt (increase pulmonary blood flow and relieve hypoxia surgical correction via open heart surgery soon after birth, or after baby gets stronger

Question 26

heart failure

Answer 26

the inability of the heart to pump an adequate amount of blood into the systemic circulation

Question 27

Heart failure clinical cues

Answer 27

- impaired myocardial function- tachycardia at rest, feeding intolerance, weight gain - pulmonary congestion- tachypnea, dyspnea - system venous congestion- hepatomegaly

Question 28

HF diagnostic evaluation

Answer 28

- made on the basis of clinical symptoms - echocardiography and other diagnostic imaging

Question 29

defects that have potential to lead to heart failure

Answer 29

- in children, occurs as result of structural abnormalities - heart muscle may become damaged if left untreated - right- or- left sided failure

Question 30

Managing heart failure steps

Answer 30

#1 improve cardiac function #2 remove accumulated fluid and sodium #3 decrease cardiac demands

Question 31

digitalis glycosides

Answer 31

improves contractility; slows HR - monitor K+; check HR (hold <90 infant; <70 older child) - adverse effects: N/V, visual disturbances, anorexia, bradycardia, or dysrhythmia

Question 32

ACE inhibitors

Answer 32

prevents compensatory vasocontriction - monitor for cough, edema, hyperkalemia, hypotension

Question 33

beta blockers

Answer 33

decreased HR and BP, vasodilation - monitor for bradycardia, hypotension, fatigue

Question 35

nursing considerations diuretics

Answer 35

- strict intake and output - fluid assessments - watch for hyponatremia, hypotension, and monitor for dehydration -monitor potassium

Question 36

remove accumulated fluid and sodium

Answer 36

- loop diuretic- furosemide - thiazide diuretics- chlorothiazide - potassium-sparing diuretic- spironolactone

Question 37

decrease cardiac demands

Answer 37

- limit activity - preserve body temp - treat infections - reduce effort of breathing - improve tissue oxygenation, reduce respiratory distress - maintain nutritional status

Question 38

heart failure nursing considerations

Answer 38

Monitor fluid status (I/O, daily weight) Decrease energy expenditure/promote rest Freq rest, small/frequent feeds, minimize crying, prevent cold stress Prevent infections Reduce respiratory distress Upright or knee-chest (squatting) for cyanotic heart disease Provide adequate nutrition Promote growth and development Establish daily caloric requirements Consider gavage feedings Consider nipple type Family-centered care Help the family adjust to the disorder and the new life at home (Discharge and homecare) Educate the family about the disease Prepare child and family for invasive procedures