QUIZ 4: CHAPTER 41: NURSING CARE OF A FAMILY WHEN A CHILD HAS A CARDIOVASCULAR DISORDER Flashcards
volume of blood in the ventricles at the end of diastole (the point just before contraction).
Preload
to the resistance against which the ventricles must pump.
Afterload
the ability of the ventricles to stretch, refers to the force of contraction generated by the myocardial muscle.
Contractility
DIAGNOSTIC TEST
Written record of the electrical voltages generated by the contracting heart.
Provides information about heart rate, rhythm, state of the myocardium, presence or absence of hypertrophy (thickening of the heart walls), ischemia or necrosis due to inadequate cardiac circulation, and abnormalities of conduction.
Provide information about the presence or effect of various drugs and electrolyte imbalances
ELECTROCARDIOGRAM
Furnish an accurate picture of the. heart size and the contour and size of the heart chambers
Reveal fluid collecting in the lungs or pulmonary artery from cardiac failure
Use to confirm the placement of pacemaker leads
RADIOGRAPHY
High frequency sound waves directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures, such as the size of chambers, thickness of walls, relationship of major vessels to chambers, and the thickness, motion, and pressure gradients of valves
ECHOCARDIOGRAPHY
Ultrasound cardiography
Diagram of heart sounds translated into electrical energy by a microphone placed on the child’s chest and then recorded as a diagrammatic representation of heart sounds.
Measures the timing of heart sounds that occur too quickly or at too high or too low a sound frequency for the human ear to detect by direct auscultation.
PHONOCARDIOGRAPHY
Using treadmill walking to demonstrate that the pulmonary circulation can increase to meet the increased respiratory demands of exercise may be performed with children, although these tests are not used as extensively with children as they are with adults
EXERCISE TESTING
Children with heart disease usually undergo a number of blood tests to support the diagnosis of heart disease or to rule out anemia or clotting disorders
LABORATORY TESTS
- Parents know that children with streptococcal infections from otitis media, streptococcal pharyngitis, and impetigo should receive adequate antibiotic therapy is essential for disease prevention.
Rheumatic fever
- high intake of sodium (such as table salt), lack of exercise, and obesity increase the chances that a susceptible child will develop the disorder by late childhood.
Hypertension
- Fat intake not to be restricted in infants because they need fat and the calories it provides for brain growth. School-age children and adolescents, however, should reduce their fat intake to 30% of total calories.
Hyperlipidemia
Procedure in which a small radiopaque catheter is passed through a major vein in the arm, leg, or neck into the heart to secure blood samples or inject dye, helps to evaluate cardiac function.
Interventional
THE CHILD HAVING CARDIAC CATHETERIZATION
(also called cardiac cath or coronary angiogram) is a procedure that allows your doctor to “see” how well your heart is functioning
Cardiac catheterization
Chief cure for congenital heart disease
Open-heart surgery
use of cardiopulmonary bypass or extracorporeal membrane oxygenation
Intra-catheter Surgery
Preoperative Care
Obtain vital signs (blood pressure, temperature, pulse, and respirations) to establish baseline
Record height and weight
Digoxin is withheld 24 hours before surgery because cardiac
surgery may cause arrhythmias in the presence of cardiac
glycosides
THE CHILD SCHEDULED FOR CARDIAC SURGERY
Hemorrhage - identify early signs of bleeding
Shock From Hypovolemia/ Cardiac Tamponade
Hypotension, oliguria, acidosis, and cyanosis.
Plasma volume expanders, continued mechanical ventilation or return to surgery
Heart Block Or Arrythmias
COMPLICATIONS OF CARDIAC SURGERY
Synthetic material (prosthetic) or human donors(homograft’s) are often used.
is technically more complicated in children than adults
THE CHILD WITH AN ARTIFICIAL VALVE REPLACEMENT
Candidates:
Hypoplastic left ventricle
Extensive cardiomyopathy from any cause Maintained on extracorporeal membrane oxygenation (ECMO) or a trial ventricular assist device while waiting for surgery.
THE CHILD UNDERGOING CARDIAC TRANSPLANTATION
Atrial Septal Defect
Ventricular Septal Defect
Atrioventricular
Canal Defect
Patent Ductus Arteriosus
Increased Pulmonary Blood Flow
Coarctation of the Aorta
Aortic Stenosis
Pulmonary Stenosis
Obstructive Disorders
Tetralogy of Fallot
Tricuspid Atresia
Decreased Pulmonary Blood Flow
Transposition of the Great Vessels (Arteries)
Total Anomalous Pulmonary Venous Connection
Trances Arteriosus
Hyposlastie Left Heart Syndrome
Mixed Defects
DISORDERS WITH INCREASED PULMONARY BLOOD FLOW
Most common type of congenital cardiac disorder
30% of all instances of congenital heart disease, or about 2 in every 1000 live births
An opening is present in the septum between the two ventricles.
Blood shunts from left to right across the septum (an acyanotic disorder).
Blood is shunted back into the pulmonary circulation
Results in right ventricular hypertrophy and increased pressure in the pulmonary artery
VENTRICULAR SEPTAL DEFECT
Abnormal communication between the two atria, allowing blood to shift from the left to the right atrium (an acyanotic defect).
More common in girls than boys
Causes an increase in the volume in the right side of the heart and generally results in ventricular hypertrophy and increased pulmonary artery blood flow, the same as with a VSD.
ATRIAL SEPTAL DEFECT
Also called an endocardial cushion defect, results from incomplete fusion of the endocardial cushion, which is the septum of the heart at the junction of the atria and the ventricles.
Usually there is a low ASD continuous with a high VSD and distortion of the mitral and tricuspid valves.
ATRIOVENTRICULAR DEFECT
Ductus arteriosus is an accessory fetal structure that connects the pulmonary artery to the aorta
Fails to close at birth - blood will shunt from the aorta (oxygenated blood) to the pulmonary artery (deoxygenated blood) because of the increased pressure in the aorta.
The shunted blood returns to the left atrium of the heart, passes to the left ventricle.
PATENT DUCTUS ARTERIOSUS
Narrowing of the pulmonary valve or the pulmonary artery just distal to the valve.
● Accounts for about 10% of congenital heart anomalies.
● Inability of the right ventricle to evacuate blood by way of the pulmonary artery because of the obstruction leads to right ventricular hypertrophy.
PULMONARY STENOSIS
● Stenosis, or stricture, of the aortic valve prevents blood from passing freely from the left ventricle of the heart into the aorta.
● Because the heart cannot force blood through the structured valve, increased pressure and hypertrophy of the left ventricle occur.
AORTIC STENOSIS
Narrowing of the lumen of the aorta due to a constricting band
Accounts for about 6% of instances of congenital heart disease). Occurs more frequently in boys than in girls and is the leading cause of congestive heart failure in the first few months of life.
COARCTATION OF THE AORTA
-the constriction occurs between the subclavian artery and the ductus arteriosus.
Preductal
- the constriction is distal to the ductus arteriosus.
Postductal
● The aorta arises from the right ventricle instead of the left, and the
pulmonary artery arises from the left ventricle instead of the right
● Blood enters the heart from
the vena cava to the right atrium, then flows to the right ventricle, and goes out into the aorta to the body completely deoxygenated; it returns
again by the vena cava.
TRANSPOSITION OF THE GREAT ARTERIES
The pulmonary veins return to the right atrium or the superior vena cava instead of to the left atrium.
TOTAL ANOMALOUS PULMONARY VENOUS RETURN
● Rare defect (approximately 1% of initial cardiac lesions.)
● One major artery or “trunk” arises from the left and right ventricles in place of separate aorta and pulmonary increases in the right side of the heart.
TRUNCUS ARTERIOSUS
● Rare disorder, 1% to 3% of congenital heart disease
● The left ventricle is nonfunctional
● Accompanying mitral or aortic valve
atresia
● Right ventricle hypertrophy
HYPOPLASTIC LEFT HEART SYNDROME
● Extremely serious disorder because the tricuspid valve is completely closed, allowing no blood to flow from the right atrium to the right ventricle.
● Blood crosses through the patent foramen ovale into the left atrium, bypassing the lungs and the step of oxygenation.
TRICUSPID ATRESIA
One of the first types of congenital heart disease described
● Occurs in about 10% of children with congenital cardiac disease
TETRALOGY OF FALLOT
● Structural abnormalities of the heart and/or great vessels occurring during fetal development
CONGENITAL HEART DISEASE
○ Cyanotic
○ Heart defect in which less than normal oxygen levels are delivered to the body
Right-to-Left Shunt
○ Acyanotic
○ Heart defect in which oxygen levels delivered to the body typically remain normal
Left-to-Right Shunt
Ventricular Septal Defects (VSD)
Atrial Septal Defect (ASD)
Patent Ductus Arteriosus (PDA)
Coarctation of the aorta
Aortic valve stenosis
Acyanotic
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Cyanotic
One great vessel leaving heart
Truncus Arteriosus
Tricuspid valve fails to form
Tricuspid Atresia
Transposition of Great Arteries
Two great vessels (pulmonary artery and aorta) are transposed
Tetralogy of Fallot
Tetrad of cardiac defects (pulmonary stenosis, RVH, overriding aorta, VSD)
Total Anomalous Pulmonary Venous Return
5 words; Pulmonary veins do not connect to left atrium
is an acute febrile illness of unknown cause that primarily affects children younger than 5 years of age. The disease was first described in Japan by Tomisaku Kawasaki in 1967, and the first cases outside of Japan were reported in Hawaii in 1976.
Kawasaki disease (KD), also known as Kawasaki syndrome,
is an inflammatory condition
is a condition that can inflame or make the heart, joints, brain, and skin swell.
is thought to be an immune response to an earlier infection. As the body’s defense system, the immune system is important in fighting off infections
Rheumatic fever
is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body.
Cardiomyopathy (kahr-dee-o- my-OP-uh-thee)
