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w3 congenital heart disorders Flashcards

1
Q

2 Hallmark s/s of cardiac issue =

A

poor weight and tachycardia

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2
Q

general s/s indicating issue with what organ:

  • Dyspnea
  • Feeding difficulty, failure to thrive
  • Stridor
  • Choking spells
A

all s/s of cardiac issues

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3
Q

general s/s indicating issue with what organ:

  • HR over 200
  • RR 60 in infant
  • Recurrent respiratory tract infections
  • Older child – poor physical development, delayed milestones, decreased exercise tolerance
A

all s/s of cardiac issues

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4
Q

general s/s indicating issue with what organ:

  • Cyanosis, clubbing
  • Squatting in knee to chest position
  • Heart murmurs
  • Excessive perspiration
  • Signs of heart failure
A

all s/s of cardiac issues

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5
Q

can infants hearts pump faster, harder or both?

can adults hearts pump faster, harder, or both?

A

Infants/small children’s hearts cant pump harder, only faster.

Adults hearts can do both

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6
Q

explain Blood flow of the heart =

A
  1. Blood (unoxygenated from body) enters RA
  2. Blood goes through tricuspid valve
  3. Blood enters RV
  4. Blood leaves heart through pulmonic valve and goes to the lungs where it becomes oxygenated
  5. Blood enters LA
  6. Blood goes through mitral/bicuspid valve
  7. Blood enters LV
  8. Blood (oxygenated) leaves heart through aortic valve and goes to the body
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7
Q

explain pressure gradient of heart

A
  • Right side of the heart receives unoxygenated blood from body and sends unoxygenated blood to the lungs
  • Right side doesn’t require much pressure or pumping = not as big/strong as the left side
  • Left side of the heart receives oxygenated blood from the lungs and sends it out to all of the body
  • Left side has a higher pressure gradient
  • If there is a hole between left and right side = blood will flow to the right side (high to low)
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8
Q

complications of what:

  • CHF
  • Dysrhythmias
  • Cardiac tamponade: fluid accumulation in heart
  • Atelectasis
  • Pneumothorax
  • Pulmonary edema
  • Pleural effusions
  • Cerebral edema and brain damage
  • Hemorrhage
  • Anemia
A

heart surgery

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9
Q

this would be included in discharge planning after what procedure:

No straining – picking up under arms is straining heart

A

Discharge planning after heart surgery:

  • Wound care
  • No straining – picking up under arms is straining heart
  • Med teaching
  • BE prophylaxis
  • s/s of medical emergency/when to call HCP
  • self-limit activity
  • meet g&d needs
    Cardiac catheterization
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10
Q

explain cardiac cath pre-procedural care:

  • Height
  • Weight
  • X with marker on skin where peripheral pulses are
  • NPO
  • Hold any AM meds
  • IV fluids
  • psychologically prep child for procedure
  • sedation
  • allergies
  • any s/s of infection
  • make plan for positioning after procedure
A
  • Height – so we know length of catheter
  • Weight – so we know med dose
  • X with marker on skin where peripheral pulses are – for easy assessment after procedure b/c they will be weak and hard to find
  • NPO 4-6 hours
  • Hold any AM meds?
  • IV fluids? – prevent dehydration
  • psychologically prep child for procedure based on developmental level
  • sedation
  • allergies – shellfish, iodine
  • any s/s of infection
  • make plan for child laying straight/flat after procedure – movies, etc.
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11
Q

explain cardiac cath post-procedural care:

  • observe for complications
  • color
  • LOC
  • Vital signs
  • Respiratory status
  • Hypertension =
  • Respiratory distress =
  • Distal extremity pulses
  • bleeding
  • Fluid intake
  • Hypoglycemia
  • Position
A

post procedural care

  • observe for complications
  • color
  • LOC
  • Vital signs
  • Respiratory status
  • Hypertension = hemorrhage
  • Respiratory distress = pulmonary embolism
  • Distal extremity pulses will be weaker first few hours
  • Circle bleeding on dressing w/ sharpie – check again to see if growing, put pressure above site
  • Fluid intake
  • Hypoglycemia
  • Position – lay straight/flat
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12
Q

cardiac cath Discharge planning:

Pressure dressing ____ hours

No tub baths ___ hours

Rest _______ , then resume normal activities

Teach s/s infection

A

Pressure dressing 24 hours

No tub baths 48 hours

Rest that night, then resume normal activities

Teach s/s infection

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13
Q

Inability of the heart to pump/circulate enough blood to meet body’s demand

A

CHF

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14
Q

Volume overload (common in kids)

Pressure overload (common in kids)

Decreased contractility

High cardiac output demands

causes what problem =

A

CHF

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15
Q

mom complains baby is breathing fast, has difficulty feeding, and is sweaty. After assessment you find crackles and slow weight gain.

what do we suspect

A

CHF

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16
Q

therapeutic managements of CHF:

increase/decrease
- cardiac function
- accumulation of fluid and sodium
- cardiac demands
- tissue oxygenation

A
  • improve cardiac function (meds)
  • remove accumulation of fluid and sodium
  • decrease cardiac demands
  • improve tissue oxygenation
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17
Q

meds used in CHF:

furosemide (Lasix) –

ace inhibitors (___prils) –

digitalis/digoxin –

A

meds used in CHF:

furosemide (Lasix) – diuretic to remove extra fluids

ace inhibitors (___prils) – lowers BP

digitalis/digoxin – causes heart to pump harder, not faster

18
Q

digoxin administration:

T/F

give whenever the child wakes up and whenever they go to bed

give with food

check HR before giving, hold if low

brush teeth after giving

if dose missed and you remember within 4 hours = give

if dose missed and you remember more than 4 hours later = hold

if 2 doses are missed = double up on next one

if child vomits = do not repeat dose

in hospital = check _________ levels before giving, hold if low

A
  • give in regular intervals
  • do not give with food or fluid, give 1 hour before or 2 hours after eating
  • check apical HR for 1 minute before giving – HOLD if infant/young kid HR <90, older kids <70
  • brush teeth after giving
  • if dose missed and you remember within 4 hours = give
  • if dose missed and you remember more than 4 hours later = hold
  • if 2 doses are missed = notify HCP
  • if child vomits = do not repeat dose
  • in hospital = check potassium levels before giving, hold if potassium is low
19
Q

pt took digoxin 30 mins ago

monitor for:

A
  • digoxin can cause hyperkalemia (high potassium) = monitor for dysrhythmias (b/c potassium think heart)
20
Q

pt took digoxin 30 mins ago

pt c/o
upset stomach
doesnt want to eat
vision is blurry
HR is low

what do we suspect?

what should we do?

A

digoxin toxicity s/s:
- nausea
- vomiting
- bradycardia
- anorexia
- neurologic and visual disturbances – seeing double, blurry vision

  • OD reversal agent = digibond = watch for rapidly dropping potassium levels
21
Q

Arterial septal defect (ASD)

s/s:

Treatment:

A

Hole in the wall that separates the RA and LA,

disrupting blood flow = blood will flow from LA to RA bc of pressure gradient

s/s:
- Asymptomatic
- Heart murmur
- CHF
- Dysrhythmias

Treatment:
- May close by itself
- Surgery

22
Q

Ventricular Septal Defect (VSD)

s/s:

treatment:

A

Hole in the wall that separates the RV and LV,

disrupting blood flow = blood will flow from LV to RV bc of pressure gradient

S/s:
- CHF
- Cyanosis
- Murmur
- RV hypertrophy
- Failure to thrive
- Fatigue
- Recurrent respiratory infections

Treatment:
- May close by itself
- Surgery

23
Q

Patent Ductus Arteriosus (PDA)

s/s:

treatment:

A

blood vessel called ductus arteriosus is supposed to close but doesn’t =

abnormal connection between aorta (carries oxygenated blood) and pulmonary artery (carries unoxygenated blood) =

creates a loop so instead of the aorta delivering oxygenated blood going to body, some of that blood is going into this connection and back to the lungs = too much blood is going to lungs and less blood is going to body

s/s:
- Murmur
- gurgle, junky, course lung sounds

treatments:
- meds (prostaglandin E inhibitor)
- cardiac cath
- surgery

24
Q

Coarctation of the aorta

treatment:

A

a part of the aorta is narrowed =

so everything before that narrowed section (head and UE) is getting lots of blood (increased pressure) and everything after that narrowed section (body and LE) is getting deprived of blood (decreased pressure)

can happen in 2 locations on aorta

treatment:
- meds (prostaglandin E inhibitor)
- balloon angioplasty – widens narrowed part
- surgery

25
Q

why is it important to take BP in arm and leg and compare readings?

what would we suspect if BP is high in arm and low in leg?

A

if BP is high in arm and low in leg = we think coarctation of the aorta

26
Q

s/s:

junky lung sounds

headache, dizzy, nose bleed, stroke, aneurism, high BP in arm

weak pedal pulses, cool mottled legs, delayed wound healing, leg pain, leg weakness, low BP in leg

A

coarctation of the aorta
increased pulmonary blood flow

increased blood flow to head and UE – headache, dizzy, nose bleed, stroke, aneurism, high BP in arm

decreased blood flow to trunk and LE – weak pedal pulses, cool mottled legs, delayed wound healing, leg pain, leg weakness, low BP in leg

27
Q

Aortic stenosis

treatment:

A

Aortic valve is narrowed =
disrupts LV outflow/cardiac output =

LV is working really hard to pump that blood through the narrowed valve and the muscles around LV hypertrophy =

blood backs up into right side of heart =

right side of heart enlarges

treatment:
- try to fix valve

28
Q

which heart defect is the only one that requires limited activity?

A

aortic stenosis

  • sudden episodes of low cardiac output = sudden death. this is why activity is limited (not restricted/bed rest)
29
Q

s/s infants:
- faint pulse
- hypotension (compensatory)
- tachycardia
- poor feeding

s/s: children:
- exercise intolerance
- chest pain
- dizziness when standing long time

A

aortic stenosis

30
Q

Pulmonic stenosis

A

Pulmonary artery valve is narrowed =

disrupts RV outflow/cardiac output =

blood is backing up in to RA and body =

not enough blood is going to lungs

s/s:
- murmur
- cyanosis
- CHF

treatment:
- try to fix valve

31
Q

acyontic defects:

arterial septal defect -
ventricular septal defect -

patent ductus arteriosus -

coarctation of the aorta-

aortic stenosis -
pulmonic stenosis -

A

acyantic defects: don’t significantly affect blood oxygen levels.

arterial septal defect - hole between RA and LA
ventricular septal defect - hole between RV and LV

patent ductus arteriosus - open ductus arteriosus = connects aorta and PA

coarctation of the aorta - part of aorta is narrowed

aortic stenosis - aortic valve is narrowed
pulmonic stenosis - PA valve is narrowed

32
Q

pt is

cyanosis
high RBC count
clubbing
altered ABG

we suspect

A

congenital heart disorders - cyanotic heart defects

s/s:
- cyanosis
- polycythemia = high RBC, dehydration, blood thickens, high risk for clots
- clubbing
- altered ABG

33
Q

tetralogy of Fallot

treatment:

A

combination of 4 defects

treatment: multiple surgeries

34
Q

s/s:

polycythemia
hypercyanotic spells
poor growth
clubbing exercise intolerance

which defect is it?

A

tetralogy of Fallot

s/s:
- heart murmur with thrill
- polycythemia
- hypoxic episodes/hyper cyanotic spells – squatting position reroutes blood to pulmonary artery, can put infant in this position if they are crying or cyanotic
- metabolic acidosis
- poor growth
- clubbing
- exercise intolerance

35
Q

nursing interventions for hypercyantic spell -
5 steps

A

guidelines for hypercyanotic spells:
1. knee to chest position
2. 100% oxygen face mask
3. Morphine
4. IV fluid replacement and volume expansion
5. Morphine

36
Q

tricuspid atresia

s/s:

treatment:

A

tricuspid valve doesn’t develop =

no communication between RA and RV =

no RV

s/s:
- Cyanosis
- Tachycardia
- SOA

Treatment:
- Meds – prostaglandin E, digoxin, diuretics
- Surgery

37
Q

transposition of the great vessels

s/s:

treatment:

A

pulmonary artery and aorta switch which ventricles they arise from =

pulmonary artery comes from LV and aorta comes from RV =

unoxygenated blood and oxygenated blood aren’t communicating, mixing, and circulating through heart like they should =

oxygenated blood going to lungs and unoxygenated blood going to body

s/s:
- Cyanosis

Treatment:
- Surgery

38
Q

truncus arteriosus

s/s:

treatment:

A

lazy!!!

pulmonary artery and aorta don’t divide so they’re just one big vessel arising from both ventricles

s/s:
- Cyanosis
- CHF
- Heart murmur

Treatment:
- Surgery

39
Q

hypoplastic left heart syndrome

s/s:

treatment:

A

the left side of the heart doesn’t develop =

small left ventricle =

aorta is underdeveloped =

aorta abnormally connects to the pulmonary artery

s/s:
- Cyanosis
- Weak peripheral pulses
- Cool extremities
- Respiratory distress

Treatment:
- Multiple surgeries
- Transplant

40
Q

Cyanotic Heart Defects:

Tetralogy of Fallot

Transposition of the great arteries

Hypoplastic left heart syndrome

Tricuspid atresia

truncus arteriosis

A

Cyanotic Heart Defects: a mixing of oxygen-rich and oxygen-poor blood in the heart reduces the amount of oxygen delivered to the body’s tissues, leading to cyanosis.

Tetralogy of Fallot (a combination of four heart abnormalities)

Transposition of the great arteries (swapped positions of the aorta and pulmonary artery)

Hypoplastic left heart syndrome (underdeveloped left side of the heart)

Tricuspid atresia (malformed tricuspid valve)

truncus arteriosis (lazy!!! aorta and pulmonary artery are one big vessel)

sav 331 (12 decks)

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