Test #4: Newborn & Pediatric: Cardiac Flashcards
What is is blueness of the extremities (the hands and feet), is typically symmetrical. It is marked by a mottled blue or red discoloration of the skin on the fingers and wrists and the toes and ankles. Profuse sweating and coldness of the fingers and toes may also occur?
Acrocyanosis
What is a condition in which the heart beats with an irregular or abnormal rhythm?
Arrhythmias
What is abnormally slow heart action?
Bradycardia
What is is the volume of blood being pumped by the heart, in particular by a left or right ventricle in the time interval of one minute?
Cardiac Output
What is an abnormal enlargement of the heart?
Cardiomegaly
What is defined as elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol, is an important risk factor for coronary heart disease (CHD) and stroke?
Dyslipidemia
What is inflammation of the inside lining of the heart chambers and heart valves (endocardium)?
Endocarditis
What is literally “blood flow, motion and equilibrium under the action of external forces”, is the study of blood flow or the circulation. It explains the physical laws that govern the flow of blood in the blood vessels?
Hemodynamics
What is an abnormally high level of bilirubin in the blood, manifested by jaundice, anorexia, and malaise, occurring in association with liver disease and certain hemolytic anemias. An abnormally high concentration of bilirubin in the blood?
Hyperbilirubinema
What is an abnormally low concentration of oxygen in the blood?
Hypoxemia
What is deficiency in the amount of oxygen reaching the tissues?
Hypoxia
What is a medical condition with yellowing of the skin or whites of the eyes, arising from excess of the pigment bilirubin and typically caused by obstruction of the bile duct, by liver disease, or by excessive breakdown of red blood cells?
Jaundice
What is a disorder that is due to severe jaundice in the newborn, with deposition of the pigment bilirubin in the brain that causes damage to the brain, potentially leading to athetoid cerebral palsy, hearing loss, vision problems, or mental retardation. Also known as bilirubin encephalopathy?
Kernicterus
What is an abnormally increased concentration of hemoglobin in the blood, through either reduction of plasma volume or increase in red cell numbers. It may be a primary disease of unknown cause, or a secondary condition linked to respiratory or circulatory disorder or cancer?
Polycythemia
What is the mechanical state of the heart at the end of diastole, the magnitude of the maximal (end-diastolic) ventricular volume or the end-diastolic pressure stretching the ventricles?
Preload
What is is a condition presenting as a rapid heart rhythm originating at or above the atrioventricular node?
supraventricular tachycardia
What is an abnormally rapid heart rate?
Tachycardia
What does APGAR stand for?
A-Attitude (flexion, muscle tone)
P-Pulse (heart rate)
G-Grimace (reflex response)
A-Appearance (color)
R-Respirations
What do you do for an immediate newborn assessment?
Heart rate
Auscultate or palpate Umbilicus
Normal HR > 100, normal respiratory effort, crying vigorously
Color: cyanosis=arterial O2 saturation <79%
BP: 65-95/30-60
Pulse: 120-160 (100 sleeping, 180 crying)
Respirations: 30-60, SaO2: Rises slowly to 95-98%
Acrocyanosis or central cyanosis
What is Hyperbilirubinemia?
Jaundice
3 types:
Physiologic
Pathologic
Jaundice associated with breastfeeding
How do you assess for Hyperbilirubinemia?
Observing for icterus (yellow coloring) when skin on forehead or nose is blanched
Total serum bilirubin & transcutaneous bilirubin
Screenings:
Bilirubin nomogram
Bilirubin not to exceed 13mg/dL
What can hyperbilirubinemia cause if left untreated?
Neurotoxicity
Premanent Brain Damage
What is Heart Failure?
Heart failure happens when the cardiac output is less than what the body needs
In other words…..
There is not enough oxygenated blood leaving the heart with enough force to meet the demands of the body.
What are some early assessments for heart failure in infants?
Mild tachypnea
tiring during feedings
frequent rest periods – sleeps a lot
Weight-loss or lack of weight gain leading to failure to thrive
Diaphoresis
Frequent infections
What are some early assessments for children with heart failure?
exercise intolerance
Dyspnea
tachypnea and tachycardia
Abdominal pain
Peripheral edema
What are some late assessment findings with heart failure?
Respiratory symptoms:
Tachypnea, nasal flaring, retractions
Cough, crackles
Tachycardia
Cardiomegaly
Periorbital and facial edema
Decreased urine output
Cyanosis/pallor
What are some diagnostics for heart failure?
Physical Examination
Chest X-Ray
ECG
Echocardiogram
What are a BUTT LOAD of interventions for heart failure?
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
What are LEFT TO RIGHT SHUNTING DEFECTS?
Defects that cause an increased blood flow to the lungs
Lead to Pulmonary Hypertension
Untreated lead to Heart Failure, pulmonary hypertension and eventually death
What are assessments in general for LEFT TO RIGHT SHUNTING DEFECTS?
Increased heart rate – tachycardia, tachypnea
Feeding fatigue and diaphoresis during feeding
Poor weight gain
Murmur
Heart failure if untreated
What are some interventions for LEFT TO RIGHT SHUNTING DEFECTS?
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.
What are some treatment (not detailed, basic) for LEFT TO RIGHT SHUNTING DEFECTS?
Closure-
Spontaneous
Medication
Devices
Surgery
Will be on antibiotics prophylactically for at least 2 months following surgery
Patent Ductus Arteriosus (PDA) is a LEFT TO RIGHT SHUNTING DEFECT, What is it?
NOT PUBLIC DISPLAY OF AFFECTION :)
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.
Atrial septal defect is a LEFT TO RIGHT SHUNTING DEFECT, what is it?
A hole between the two top chambers of the heart (the atrium).
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.
Ventricular Septal Defect is a LEFT TO RIGHT SHUNTING DEFECT, what is it?
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.
Atrioventricular septal defect is a LEFT TO RIGHT SHUNTING DEFECT, what is it?
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.
Pulmonary stenosis is an OBSTRUCTIVE OR STENOTIC LESION DEFECT, what is it?
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.
Aortic Stenosis is a OBSTRUCTIVE OR STENOTIC LESION DEFECT, what is it?
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
Coarctation of the Aorta is an OBSTRUCTIVE OR STENOTIC LESION DEFECT, what is it?
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.
Tetralogy of Fallot is a CYANOTIC LESIONS WITH DECREASED PULMONARY BLOOD FLOW, What is it?
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.
Tricuspid Atresia is a CYANOTIC LESIONS WITH DECREASED PULMONARY BLOOD FLOW, What is it?
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.
Pulmonary atresia with intact ventricular system is a CYANOTIC LESIONS WITH DECREASED PULMONARY BLOOD FLOW DEFECT, what is it?
Failure of the pulmonary valve to develop, underdevelopment of the pulmonary artery and RT ventricle and possible underdeveloped tricuspid.
Total Anomalour Pulmonary Venous Return is a CYANOTIC LESIONS WITH DECREASED PULMONARY BLOOD FLOW DEFECT, What is it?
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.
Truncus Arteriosus is a CYANOTIC LESIONS WITH INCREASED PULMONARY BLOOD FLOW DEFECT, What is it?
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.
Hypoplastic Left Heart Syndrome is a CYANOTIC LESIONS WITH INCREASED PULMONARY BLOOD FLOW DEFECT, What is it?
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.
Transposition of the great arteries is a CYANOTIC LESIONS WITH INCREASED PULMONARY BLOOD FLOW DEFECT, What is it?
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.
What are some assessments for Rheumatic fever?
Rheumatic Fever Mnemonic
What are some assessments for Kawasaki Disease?
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
