Test #4: Newborn & Pediatric: Cardiac Flashcards

Question

What are some early assessments for children with heart failure?

Answer 1

exercise intolerance Dyspnea tachypnea and tachycardia Abdominal pain Peripheral edema

Answer 2

Respiratory symptoms: Tachypnea, nasal flaring, retractions Cough, crackles Tachycardia Cardiomegaly Periorbital and facial edema Decreased urine output Cyanosis/pallor

Answer 3

Physical Examination Chest X-Ray ECG Echocardiogram

Answer 4

Decrease the workload of the heart Limit feeding times and increase caloric intake of formula or breast milk Elevate the head of the bed (HOB) Provide uninterrupted rest – block care Engage in self-limiting activities Provide oxygen – but be careful because with certain congenital heart defects (left-to-right shunt lesions) adding oxygen can cause vasodilation and therefore increase pulmonary blood flow and systemic congestion. Administer medications: Digoxin Diuretics Angiotensin-converting enzyme (ACE) inhibitors Prepare for surgical repair if indicated EDUCATION & TEACHINGS: Assess readiness to learn, anxiety level, ask open-ended questions, allow for therapeutic communication Understanding of medications – frequency, frequent side effects, complications, and proper administration Signs and symptoms of worsening heart failure Increased cyanosis Dehydration Prevention of infection – prophylaxis use of antibiotics Decreased nutritional intake Medical follow-up

Answer 5

Defects that cause an increased blood flow to the lungs Lead to Pulmonary Hypertension Untreated lead to Heart Failure, pulmonary hypertension and eventually death

Answer 6

Increased heart rate – tachycardia, tachypnea Feeding fatigue and diaphoresis during feeding Poor weight gain Murmur Heart failure if untreated

Answer 7

Monitor Facilitate diagnostics Educate, collaborate with cardiac team, refer to support groups Increase nutritional intake: Small frequent feedings Rest periods Supplement breast feeding with a high calorie formula Tube feed as necessary Health promotion – regular visits with PCP, regular immunizations as scheduled Maintain growth and development – age appropriate stimulation and play – help them to be as normal as possible.

Answer 8

Closure- Spontaneous Medication Devices Surgery Will be on antibiotics prophylactically for at least 2 months following surgery

Answer 9

The ductus arteriosus does not close, the term PDA is used. There is a mixing of blood from the aorta with the blood in the main pulmonary artery. The pressure in the aorta is greater than that of the pulmonary artery so more blood goes into the pulmonary artery and therefore, there is more blood flow to the lungs. This increase of blood flow to the lungs depending on the size of the hole can lead to heart failure. Recognize that increased pulmonary blood flow causes pulmonary hypertension which leads to heart failure and if not corrected, death.

Answer 10

Murmur will be heard Will have a widening pulse pressure Bounding pulses Cardiac enlargement.

Answer 11

A hole between the two top chambers of the heart (the atrium). ## Footnote When the foramen ovale does not close with birth from the changes in pressure and blood oxygen levels the left ventricle does not fill as easily as the right ventricle (due to system pressure) when the heart is at rest (the chambers fill) When there is a hole between the two atria the blood from the left atrium goes into the right atrium when the heart pumps – contracts, which then leads to an increase in blood flow to the right ventricle and thereby the lungs. Increase pulmonary blood flow leads to pulmonary hypertension, heart failure, and ultimately, if not corrected/treated, death. Mitral valve regurgitation is possible over time as well as heart failure and an increased risk for stroke if not repaired.

Answer 12

A murmur may be heard with a large hole and from increased blood flow to the pulmonic valve. Fatigue Dyspnea on exertion Palpitations Atrial dysrhythmias (irregular heart rhythms) may appear.

Answer 13

A hole between the two lower chambers of the heart (the ventricles). Due to the difference in pressure between systemic circulation and pulmonary circulation – systemic pressure is greater, when the heart contracts, the blood is forced through the hole from the left ventricle into the right ventricle and into the lungs thus increasing blood flow to the lungs … pulmonary hypertension… heart failure… death. If the hole is large, there will be an increase in symptomology. It is one of the more common heart defects seen. Some may not have any symptoms until later in life.

Answer 14

There may be a systolic murmur Diastolic murmur Gallop rhythm and palpable thrill depending on the size of the defect. Heart failure may occur if the defect is moderate to large.

Answer 15

This baby just flat out has problems. The defect can range from partial, intermediate, to complete. There are holes everywhere and most of the blood gets pushed into the lungs, again due to the pressure gradient. Complete defects are much more severe than partial or intermediate. All of these lead to heart failure.

Answer 16

Immediate PICU- once stable will be transferred to a surgical unit; our nursing interventions will be similar to all post-op patients with the addition of cardiac monitoring. TCDB, IS Splint incision with pillow or stuffed animal when changing positions, coughing, etc. Inspect routinely for signs of infection Administer antibiotics Monitor cardiac output and for arrhythmias Control pain DO NOT LIFT THE CHILD UNDER THE ARMS – this will stress the incision and cause pain Gradually increase oral fluids and food – parents may bring things the child likes to eat to encourage intake. Gradually increase activity Educate on homecare and regular cardiology visits Educate on any further intervention that may be needed and signs of potential complications.

Answer 17

In other words a narrowing or obstruction that reduces blood flow to somewhere within the heart which in turn decreases blood flow to either the body or the lungs depending on location.

Answer 18

Many do not have symptoms Decreased cardiac output Weak peripheral pulses Increased capillary refill time Murmur Decreased cardiac output Cooler feet than hands Leg cramps Heart failure

Answer 19

Administer Prostaglandin E1 Administer oxygen Assist with diagnostics and procedures Administer medications – digoxin, prostaglandin E1 CHF medications as needed Collaborate with cardiac team Educate and support family

Answer 20

This is a narrowing above, at, or under the pulmonic valve. This narrowing causes increased pressure in the right ventricle which leads to RT ventricular hypertrophy – enlargement, increase in size. When severe, it can cause blood to back up into the RT atrium which can force the foramen ovale back open leading to an atrial septal defect. It is one of the more common heart defects seen.

Answer 21

Many pts do not have any symptoms Often exercise intolerance Evidence of right sided heart failure There will be a murmur and possible palpable thrill in severe cases Cardiomegaly may be seen with a CXR May be cyanosis in severe cases due to a lack of blood flow to the lungs due to the restriction at the pulmonic valve.

Answer 22

This is a narrowing at, above, or under the entrance to the aorta (at the aortic valve). This causes an increase in pressure in the left ventricle, decreased cardiac output, and a decreased blood flow to the cardiac arteries. Doesn’t allow blood flow into the Aorta IF UNTREATED can lead to Heart Failure, necrotizing enterocolitis (death of intestinal tissue), or renal failure

Answer 23

**If it is mild to moderate-** May be asymptomatic or may have exercise intolerance Changes in ECG with exercise Murmur Could lead to sudden cardiac death with strenuous exercise. **In severe cases-** Severe heart failure Decreased cardiac output with decreased peripheral perfusion **If untreated could lead to-** Chest pain Dizziness Fainting (syncope).

Answer 24

A narrowing or constriction in the descending aorta - not near the valve but further from where the blood exits to heart, closer to where the ductus arteriosus was located.

Answer 25

You will see left sided heart failure with poor perfusion to the lower extremities and decreased cardiac output. If there is a PDA- you will see cyanosis in the lower extremities but not in the upper extremities. May be asymptomatic **May show a pulse and blood pressure difference between upper and lower extremities.** Weakness, tingling, and cramps in the lower extremities. A systolic murmur will be heard with an ejection click or thrill.

Answer 26

Educate the pt according to their age/developmental ability and the parents concerning the procedure and post procedural care Consents NPO after midnight if possible Baseline assessment – VS Mark pulse sites before surgery so you know where to look after surgery because they may be weaker following the procedure. Baseline blood work – coagulation studies and CBC

Answer 27

Keep the child as flat and still for as long as ordered – may need some sedation. Apply pressure to the site for amount of time ordered or per hospital policy Monitor for bleeding/hematoma frequently – if bleeding occurs, apply pressure and call PCP/surgeon Monitor for circulation in that extremity frequently – if pulselessness occurs, check with a Doppler first and if still no pulse, call the PCP/surgeon. Monitor for arrhythmias Monitor for s/s of infection both at the site and systemically or in the heart Increase fluids to help flush the body of the contrast used with the procedure Reassure the parents and educate on post procedure care

Answer 28

Cyanosis Murmur Dyspnea and fatigue with exertion Poor growth Polycythemia Toddlers may squat

Answer 29

Administer prostaglandin E1 Monitor and record assessment findings Assist with diagnostics and procedures May need surgical repair – see previous notes on pre and post-op care – surgery may be delayed until the child grows. Collaborate with cardiac team **Treat hyper cyanotic episodes (sometimes also referred to as “tet spells”) aggressively: Calm the child Give oxygen Administer morphine and propranolol IV Administer packed RBCs if anemic** **Have the child take the knee chest position to decrease systemic resistance – infant should be on the parent’s shoulder with knees tucked under them, older children can squat.**

Answer 30

This is a serious defect in which there are 4 (tetra) major defects happening all at the same time. There is a VSD, pulmonary stenosis, misplacement of the aorta, and rt ventricular hypertrophy Basically unoxygenated blood enters systemic circulation. It is one of the more common heart defects seen.

Answer 31

Immediate cyanosis in severe cases Initial pinking followed by a cyanosis when the ductus arteriosus close Extreme fatigue hyper cyanotic episodes chronic hypoxemia A murmur will be heard with a palpable thrill. The heart will appear boot-shaped on CXR.

Answer 32

Non-development of the tricuspid valve, patent foramen ovale or ASD, underdeveloped RT ventricle, VSD and there may be either a misplacement of the pulmonary artery or a transposition with the aorta, as well as pulmonary stenosis.

Answer 33

Profound cyanosis with decreased pulmonary blood flow Systolic murmur will be heard.

Answer 34

Failure of the pulmonary valve to develop, underdevelopment of the pulmonary artery and RT ventricle and possible underdeveloped tricuspid.

Answer 35

Profound cyanosis A murmur will be heard

Answer 36

Survival depends totally on a PDA – so you will need to administer: ## Footnote **Prostaglandin E1**

Answer 37

Pulmonary veins do not connect with the left atrium but connect somewhere else, such as to the superior vena cava. Basically oxygenated blood mixes with unoxygenated blood and gets sent to systemic circulation.

Answer 38

Cyanosis Severe respiratory distress Tachycardia Increasing pulmonary hypertension Possible death if not treated can occur A murmur will be heard Decreasing peripheral pulses Increasing heart failure Liver enlargement Failure to thrive Frequent pulmonary infections can also be present

Answer 39

These congenital heart defects cause cyanosis with increased pulmonary blood flow and heart failure.

Answer 40

Cyanosis soon after birth that does not respond to oxygen administration. Tachypnea Retractions Polycythemia Heart failure Systolic murmur Fatigue Poor feeding and delayed growth

Answer 41

**Priority is Administering Prostaglandin E1** May have respiratory depression and apnea requiring ventilation assistance – may need to be bagged. Monitor Hgb and Hct for polycythemia and anemia. Treat hyper cyanotic episodes aggressively: Calm the child Give oxygen Administer morphine and propranolol IV Administer packed RBCs is anemic Have the child take the knee chest position to decrease systemic resistance – infant should be on the parent’s shoulder with knees tucked under them, older children can squat. Child will be put in NICU Pre and post-op care – see previous notes. Collaborate with the cardiac team Educate and support the parents: Teach CPR, O2 sat monitoring, O2 administration in the home, develop an emergency plan and have medical information readily available. Report any vomiting and diarrhea and watch for dehydration especially in pt’s with polycythemia.

Answer 42

This is failure of the common great vessels to divide into the pulmonary artery, pulmonary valve, aorta, and aortic valve during fetal development. The common vessel receives blood from both right and left ventricles and takes a combination of oxygenated and unoxygenated blood into circulation. Ventricles have increased blood volume and increased pressure. Pulmonary blood flow is determined by the severity of the defect and will determine the amount of cyanosis and heart failure the pt has. The greater the blood flow to the lungs, the more the severe heart failure. The presence of pulmonary stenosis limits blood flow to the lungs and therefore increases cyanosis.

Answer 43

A murmur and click will be heard Bounding pulse Widened pulse pressure

Answer 44

This is an inadequate development of the left side of the heart. The left ventricle is too small and there is very little systemic blood flow. There is normal blood flow to the lungs but it has nowhere to go which causes the blood to back up in the lungs causing heart failure and pulmonary hypertension.

Answer 45

This is when the artery that usually takes blood to the body (aorta) from the left ventricle takes blood to the lungs and the artery that normally takes blood to the lungs (pulmonary artery) from the right ventricle takes the blood to the body. This is often associated with VSD.

Answer 46

Abnormal heart rhythm or dysrhythmia Electrocardiogram V/S SaO2

Answer 47

**Supraventricular Tachycardia (220-300bpm):** VAGAL STIMULATION **Ventricular Tachycardia:** CPR Cardioversion Lidocaine **Bradycardia:** Oxygen Ventilation Medication Pacing **Absent Rhythms:** CPR Epinephrine

Answer 48

Inflammatory disorder of connective tissue resulting from autoimmune response to some strains of Group A beta-hemolytic streptococci, usually after an infection in 5 year-olds to adolescence IF UNTREATED, may cause, long-term brain damage to heart valves, joints, brain or skin 10% develop rheumatic heart disease 1-3 weeks after untreated Strep

Answer 49

Carditis Friction Rub Edema Chest Pain 2 or more joints swollen Skin rash on trunk

Answer 50

Labs – Throat culture, CBC, Antistreptolysin O Titer, Streptozyme, Anti-DNase B assay CXR ECG- ST-T Abnormalities Echocardiogram

Answer 51

Prevention (throat cultures, completion of antibiotic regimen) Monitor temperature Bed rest Administer medications: Antibiotics to eradicate strep infection Aspirin to treat carditis, inflammation Steroids Long-term antibiotic prophylaxis Educate & support family, prepare for home recovery & return to school

Answer 52

Acute febrile, systemic vascular inflammatory disorder of unknown cause, affecting arteries including cardiac arteries Most often in children \< 5 yr.

Answer 53

Temp & V/S Conjunctiva Cervical lymph nodes Skin & mucosa (lips, tongue, palms, fingers, soles, toes) Heart, murmurs, serial echocardiograms LAB: CBC, erythrocyte sedimentation rate (ESR), CMP, UA

Answer 54

``` **Administer medications:** Intravenous immunoglobulin (Will decrease coronary lesions), Have epinephrine on hand, NO live vaccine for 11 months after ``` Aspirin (With milk/food): Anti-inflammatory dose initially Antiplatelet dose after fever decreases Monitor for coronary artery aneurysms Facilitate rest: Cluster care Passive ROM Dim lights Cool Compresses Change linens Promote comfort Cool compresses, lubricate lips Limit strenuous activity Educate & support family: Limit strenuous activity, postpone live virus vaccines

Answer 55

Begin healthy behaviors early in life Maintain normal weight: Nutrition Limit fat intake Promote fruits, vegetables, grains, lean meat & fish Vigorous exercise at least 30 minutes, 3-4 times/week Limit sedentary activities (TV, video games) **Encourage children not to smoke :)** Screening for dyslipidemia & hypertension