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CAM 1 Cardiac > STABLE > Flashcards

STABLE Flashcards

1
Q

Normal Neurological Status

A

no signs of distress
active
alert
good tone
strong cry
normal feeding pattern

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2
Q

abnormal neurological status

A

Early signs:
-poor feeding, weak suck, disinterest
change in LOC
-increased sleepiness, difficulting awakening
Signs of Shock
-irritability
-weak cry
-lethargy, poor tone
-unresponsiveness, comatose

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3
Q

abnormal skin color
-central cyanosis

A

central cyanosis:
-bluish tongue, mucus membranes caused by desaturations of arterial blood.

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4
Q

abnormal skin color
-acrocyanosis
-cyanosis
-why is it important to interpret saturation values and cyanosis in context of infants hemoglobin

A

peripheral cyanosis - bluish hands/feet
NO mucus membrane involvement
-R/O hypothermia

Cyanosis: the color of reduced hemoglobin (Hb) or Hb that is not bound to O2 is purple. It takes 3-5g per dL of reduced Hb for cyanosis to be apparent.
-Hb of 15gm/dL - cyanosis will be visible when O2 sats are 67-80%
-Hb of 10gm/dL, cyanosis will be visible when the O2 saturation is 50-70%.

-If a patient is anemic, they won’t appear “dusky” until their saturations are lower and significantly hypoxemic.

this becomes a problem when your anemic pt. is desaturating and hypoxemic but they “look fine.”

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5
Q

Physical Assessment for CHD

A

vitals:
-RR
-HR and Rhythm
-BP

color
pulses
skin perfusion
liver size and location
neuro status
physical appearance
precordial activity
heart sounds
murmurs

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6
Q

Normal RR for newborn

A

30-60
easy breathing effort

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7
Q

comfortably tachypneic

A

> 60 breaths per minute

may be first sign of congenital heart disease

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8
Q

sign of exhaustion

A

<30 breaths per minute
labored breathing

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9
Q

gasping

A

ominous sign of impending cardiopulmonary arrest
-intubation

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10
Q

Respiratory signs of severe CHF

A

labored breathing
sternal and intercostal retractions
grunting
nasal flaring

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11
Q

Normal HR

A

120-160BPM
range (80-200)

lower at rest
higher with activity or crying
normal sinus rhythm

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12
Q

bradycardia in newborn

A

<70 bpm

usually pathologic

evaluate for shock

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13
Q

pathologic causes of bradycardia

A

hypoxia - apnea
hypertension, hyperkalemia, hypercalcemia
hypothermia, hypothyroidism
increased ICP

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14
Q

differential dx for bradycardia

A

sinus bradycardia
complete heart block

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15
Q

ECG of sinus bradycardia

A

PR interval is regular and p wave precedes each QRS complex

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16
Q

Complete heart block (third degree AV block)

A

sinus atrial impulses are not conducted to teh ventricles
ventricular rate (QRS) ranges between 45-80bpm

17
Q

ECG of complete heart block

A

P waves are unrelated to QRS complex –> atrial impulses not conducted into ventricles –> blocked at AV node

18
Q

causes of complete heart block
-congenital
-autoimmune
-acquired

A

-congenital: structural heart disease
-autoimmune: Sjogren syndrome, lupus
-acquired: complication of heart surgery

19
Q

tachycardia in newborn

A

HR sustained >80bpm at rest

may indicate poor cardiac output, shock, or CHF

20
Q

what should you evaluate for in a newborn with tachycardia

A

Shock/CHF –> Respiratory status, labs, perfusion

others
-anemia
-fever
-pain
-meds - catecholamines, methylxanthines
-arrythmias

21
Q

Supraventricular Tachycardia (SVT)

A

sustained HR >220
-may be present with HR >180bpm

well tolerated unless hydrops or structural CHD

22
Q

What to assess for when your pt. in SVT

A

assess for signs of shock

perfusion, pulses, BP, O2 saturations, NIRS if available, Respiratory status/effort, LOC,
development of met acid and lactate

23
Q

What happens to a BP measurement if your cuff size is too small or too large?

A

undersized cuff –> overestimates BP

oversized cuff –> underestimates BP

24
Q

Late sign of shock

A

hypotension

  • always look at HX, patient baseline, labs, dx
25
Q

systolic RA BP 15mmHg > Systolic leg BP - what is the differential diagnosis

A

coarctation of the aorta

26
Q

what does central cyanosis indicate

A

-indicates cardiac and or respiratory dysfunction

27
Q

Hemoglobin carrying no O2 appears what color

28
Q

How to determine pulse pressure

A

systolic bp - diastolic bp = pulse pressure

29
Q

normal pulse pressure for a term infant

30
Q

normal pulse pressure for a preterm infant

31
Q

bruits heard in the liver or anterior fontanelle suggest?

A

Arteriovenous malformation (AVM)

32
Q

abnormal precordial activity

A

hyperactive precordium
PMI shifted to right or left
Thrill

33
Q

differential dx for PMI shifted to right

A

-dextrocardia
-tension left pneumothorax
-CDH

34
Q

differential dx for PMI shifted to left

A

left tension pneumothorax

35
Q

Thrill

A

loud harsh murmur

CAM 1 Cardiac (3 decks)

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