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ADN005 Pediatrics > Week 4 Chapter 41 > Flashcards

Week 4 Chapter 41 Flashcards

1
Q

Fetal heart rate is present around …

A

post conceptual day 17

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2
Q

When are the heart chambers and arteries formed?

A

During gestational weeks 2-8

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3
Q

Oxygenation of the fetus occurs

A

Via the placenta

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4
Q

Lungs are perfused but do not

A

Oxygenation and ventilation

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5
Q

The_______________ ______ allows blood flow from the right to left atrium

A

Foramen Ovale

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6
Q

This allows blood flow between the pulmonary artery and the aorta, shunting blood away from the pulmonary circulation

A

Ductus Arteriosus

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7
Q

As the newborn breathes for the first time, the lungs inflate, reducing pulmonary vascular resistance.

A

True

Results in change of pressure leads to closure of the foramen ovale and ductus arteriosus.

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8
Q

Lack of blood flow and vasoconstriction the__________ ___________ becomes ligaments and the umbilical arteries and vein atrophy

A

Ductus Arteriosus

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9
Q

HR in toddlers

A

80-115

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9
Q

Heart Rate in infancy is

A

90-160BPM

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10
Q

School Age/ Adolescent HR

A

60-100

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11
Q

Blood Pressure in Infancy

A

80/55 increases with age

HR and BP reaches adult levels by adolescence

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12
Q

AT birth the ventricle walls are similar in thickness, but with time the left ventricular wall thickens

A

True

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13
Q

The infants HR at rest exhibits a greater resting tension than adults, which means?

A

Volume Loading or increase stretch may actually lead to decreased Cardiac Output

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14
Q

Children younger than 7 years the heart lies…

A

Horizontally and higher in the chest below the 4 intercostal space

As the lungs grow the heart is displaced downward

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15
Q

Between 6-12 years old the heart

A

10x size it was at birth

But smaller proportionally at this time than any other stage in life

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16
Q

During school age years the heart grows

A

Vertically within the chest

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17
Q

During adolescence the hearts …

A

Continues to grow in relation to the teen’s rapid growth

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18
Q

_________________ improves ___________________ blood flow by increasing systematic vascular resistance

A

Squatting, pulmonary

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19
Q

History of Present Illness

A

When symptoms started and how they progressed

Treatments and medications used at home

Activity level compared to peers

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20
Q

History of:

A

Orthopnea
Dyspnea
Easily fatigued
Squatting
Growth Delay
Edema
Dizziness
Poor Feeding
Lethargy
Vomiting
Motor Delays
Cyanosis
Tachypnea

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21
Q

Past Health History of Cardiovascular

A

Problems occurring after birth
Congenital malformation
Birth History
Frequent Infections
Chromosomal abnormalities
Prematurity
Autoimmune Disorders
Uses of meds such as steroids

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22
Q

Risk Factors for CV Disorders include

A

Family History of CVD
- Investigate the heat further if heart disease occurred in a first degree relative

Sudden Death in a young family member
Hyperlipidemia
DM

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23
Q

Signs of a Cardiac Disorder may include___________ and ___________

A

Edema- face, presacral, extremities

Clubbing- softening of nail beds, rounding of nail ends, shininess and thickening of nail ends

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24
Q

Cyanosis
Irregular Heart Rate
Edema
Clubbing of fingertips
Fever
Retractions or increased work of breathing
Prominence of precordial chest wall
Visible, engorged or abdominal pulsations
Abdominal Distention

A

Signs of Cardiac Disorder

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25
Q

How are murmurs graded?

A

Grade I- soft and hard to hear
Grade II- Soft and easily heard
Grade III- Loud without thrill
Grade IV- Loud with precordial thrill
Grade V- Loud with precordial thrill, audible with a stethoscope partially off the chest.
Grade VI- Very loud, audible with stethoscope or with naked ear

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26
Q

Location where its heard

Relation to the heart cycle and duration

Quality- harsh, musical or rough; high, medium, or low pitch

Variation in sound with position ( sitting, lying, standing)

A

Characteristics of Heart Murmurs

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27
Q

Diagnostic Tests for Cardiovascular Disorders

A

Pulse Oximetry
ECG or Holter Monitoring
Echocardiogram
Chest Radiograph
Exercise Stress Testing
Lab test including:
CBC, BMP, CRP, ESR
Arteriogram and Cardiac Catheterization

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28
Q

Structural anomality’s that are present at birth

CHD accounts for the largest percentage of all birth defects

A

Congenital Heart Disease

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29
Q

Disorders that occur after birth

Develops from a wide range of causes, or can occur as a complication or long term effect of CHD

A

Acquired Heart Disease

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30
Q

Indications for this include hypoxemia, respiratory distress, or heart failure

A

Oxygen

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31
Q

Chest Physiotherapy used for

A

Mucous clearance by mobilizing secretions with percussion or vibration with postural drainage

May be used by RT

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32
Q

Chest Tube used

A

After open heart surgery

Pneumothorax

Drainage tube inserted into the pleural cavity to facilitate removal of air or fluid and allow full lung expansion

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33
Q

External wiring connected to a small generator used to electrophysiological correct arrhythmias or heart block

A

Pacing

Used for bradyarrhythmia’s, heart block, cardiomyopathy SA or AV node malfunction

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34
Q

How is CHD classified?

A

Based on hemodynamic characteristics

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35
Q

Disorders with decreased pulmonary blood flow (Cyanotic)

A

Tetralogy of Fallot
Tricuspid Atresia

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36
Q

Disorders with increased pulmonary blood flow (a cyanotic)

A

Atrial Septal Defect
Ventricular Septal Defect
AV Canal
PDA

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37
Q

Obstructive Disorders include

A

Coarctation of the aorta
Aortic Stenosis
Pulmonary Stenosis

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38
Q

Mixed Disorders Include

A

Transposition of Great Vessels
Total Anomalous Pulmonary Return
Truncus Arteriosus
Hypoplastic Left Heart Syndrome

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39
Q

Right to left blood flow includes

Hypoxia

A

TOF and TGA
Truncus Arteriosus
Tricuspid Atresia

These defects takes blood away from the lungs and push blood from the right to left side of the heart and results in hypoxia

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40
Q

S/S of hypoxia

A

Cyanosis
Poor Feeding and weight gain
Clubbing of fingers
Dyspnea and Tachypnea
Polcythemia - Blood clot risk with Hg over 22

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41
Q

Left to right include ASD, VSD, PDA, AVSD

A

True , Congestive Heart Failure

These effects are less deadly

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42
Q

S/S of CHF

A

Weight gain
pale and cool extremities
Puffiness around the eyes
Reduction in wet diapers
Dyspnea
Tachypnea and tachycardia
Poor weight gain

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43
Q

Characterized by 4 defects

A

Pulmonary Stenosis
VSD
Overriding Aorta
Right Ventricular Hypertrophy

Called Tetralogy Fallot

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44
Q

S/S of TOF

A

Color changes with feeding, activity or crying (cyanosis)

Murmur

Requires surgical intervention in 1st year of life

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45
Q

When is TOF usually diagnosed?

A

During the first few weeks of life due to presence of murmur or cyanosis

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46
Q

Most often infants with TOF have a PDA at birth

A

True

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47
Q

Aorta positioned directly over a VSD, instead of the left ventricle

A

Overriding Aorta

Receives some blood from the right ventricle, which reduces the amount of oxygen in the blood)

48
Q

If the infant’s oxygen is greater than the supply( such as crying) then the spell progresses to

A

Anoxia-LOC

49
Q

Characterized by uncontrollable crying or irritability
Tachypnea
Worsening hypoxia with cyanosis/ pallor
Decreased intensity of heart murmur
Limpness, LOC, convulsions

A

Hypercyanotic Spells “TET spell”

50
Q

How are TET spells relived?

A

Use a calm, comforting approach

Place infant/ child in knee to chest position

Provide supplemental oxygen
Administer morphine sulfate
0.1 mg/ kg IV IM or SubQ
Administer Propranolol
0.1 mg/ kg IV

51
Q

Valve between the right atrium and right ventricle fails to develop

A

Tricuspid Atresia

Associated with VSD

52
Q

s/s of Tricuspid Atresia

A

Cyanosis
Tachypnea
Difficulty with feeding

Requires surgical intervention in staging

53
Q

Closed Tricuspid valve =

A

No opening to allow blood from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs

54
Q

The positions of the pulmonary artery and aorta are reversed

A

Transposition of the Great Arteries

Oxygen poor blood goes back to the body and oxygen rich goes back to the lungs.

55
Q

What do we use to keep PDA open?

A

Prostaglandins

56
Q

S/S of Transposition of Great Arteries

A

Tachypnea
Tachycardia
Significant Cyanosis

Immediate balloon atrial septostomy, surgical correction to switch arteries by age 4-7 years

57
Q

Pulmonary veins do not connect normally to the left atrium, instead connect to the right atrium

A

Total Anomalous Pulmonary Venous Connection

58
Q

S/S of TAPVC

A

Cyanosis varies
Fatigue
Difficulty feeding

Requires surgical intervention

Incompatible with life unless there is patent foramen ovale of ASD

59
Q

During normal fetal development the aorta and pulmonary artery start as single blood vessel and then divides into 2 separate arteries. In this defect it fails to separate leaving a large connection between the aorta and pulmonary artery

A

Truncus Arteriosus

60
Q

S/S of Truncus Arteriosus

A

Cyanosis with activity
Fatigue
Difficulty feeding and poor growth

Requires surgical intervention

61
Q

Hole between the 2 upper chambers of the heart- right and left atria

Most children are asymptomatic

A

Atrial Septic Defect

62
Q

S/S of ASD

A

Heart Failure- SOB
Poor growth
Murmur- Normal and expected

63
Q

If detect murmur of ASD is small…

A

May close spontaneously within 18 months of life

If defect is large may be sutured closed or require patch

64
Q

Defects with connections involving the left and right sides will shunt blood from the higher pressure left side to lower pressure right side

A

True

  • Heart failure, pulmonary HTN, atrial arrhythmias, or stroke
65
Q

Most common and accounts for 25% of all congenital heart defects

Spontaneous closure of small VSDs occurs in half of children by age 2

A

Ventricular Septal Defect

66
Q

Hole between the 2 lower chambers of the heart- the right and left ventricles

Most children are asymptomatic

A

Ventricular Septal Defect

67
Q

S/S of VSD

A

Grunting and tires easily with feeds
Pulmonary Infections
SOB
Edema
Systolic Heart murmur (L Sternal Border)

68
Q

If defect is small in VSD ..

A

May close spontaneously by 2 years old

If large may require suture or require a patch

69
Q

At risk for heart failure, aortic valve regurgitation, ineffective endocarditis if unrepaired

A

True

70
Q

Occurs because of the failure of the endocardial cushions to fuse

Cushions are needed to separate the central part of the heart

A

Atrioventricular Canal Defect AV Canal

Causes large L-R shunt, increased workload of the L ventricle, high pulmonary arterial pressure- pulmonary edema

71
Q

Includes ASD, VSD, improperly formed mitral and/or tricuspid valves

A

AV Canal Defect

35-40% of children with Down Syndrome have this defect

Recirculation problem requires LV to pump 2-3 times more

72
Q

S/S of AV Canal Defect

A

Frequent respiratory infections
Difficulty feeding and gaining weight
Increased work of breathing

73
Q

Pulmonary Banding in infants surgical correction by

A

3-18 months patch closure

Valve repair

74
Q

Occurs when the normal closure of ductus arteriosus does not occur- connection between the aorta and pulmonary artery

A

PDA

75
Q

PDA occurs more frequently in premature infants and infants born at high altitudes

A

True

75
Q

S/S of PDA

A

Asymptomatic heart failure
Loud machine like murmur

76
Q

What medication is used to help close the PDA?

A

Indomethacin

Inhibits prostaglandin synthesis

77
Q

Medication to keep the PDA open ( vasodilation of the ductus arteriosus smooth muscle)

A

Prostaglandin

PDA corrected by coil embolization or surgical ligation

78
Q

_____________ _________________________ is a fetal circulatory structure which normally closes within the first few weeks of life

2nd most common defect and accounts for 10% of CHD cases

A

Ductus Arteriosus

79
Q

Narrowing of major vessel

Obstructive disorder

A

Coarctation of the Aorta

Accounts for 10% of congenital heart defects

BP may be 20mm Hg higher in upper extremities

80
Q

Narrowing of the aorta, the major blood vessel carrying oxygenated blood from left ventricle to the body

A

Coarctation of the Aorta

Narrowing - blood flow is impeded- decreased cardiac output

81
Q

Increased pressure in the area proximal to the defect

Decreased in the area distal to defect

A

Coarctation of the Aorta

82
Q

Symptoms of Coarctation of the Aorta

A

BP in increased in the heart and upper body (bounding pulses)

BP is decreased in lower portions of the body ( cool, diminished pulses)

Irritability, epistaxis, leg pain, dizziness, fainting, headaches, and murmur

83
Q

Balloon Angioplasty, surgical repair with stents, resection of narrowing and end to end anastomosis

A

Coarctation of the Aorta

84
Q

Occurs when the aortic valve between the left ventricle and aorta did not form properly

Causes pump problem

Typically child is asymptomatic

A

Aortic Stenosis

85
Q

S/S of Aortic Stenosis

A

Fatigue
Chest Pain
Dizziness
Difficulty feeding in infants

86
Q

Balloon dilation via umbilical artery or cardiac catheterization, possible valve replacement

A

Aortic Stenosis

87
Q

Occurs as a muscular obstruction below the pulmonary valve, at the valve, or a narrowing of the pulmonary artery

A

Pulmonary Stenosis

88
Q

Associated other heart anomalies and genetic syndromes

Most children are asymptomatic

A

Pulmonary Stenosis

89
Q

S/S of Pulmonary Stenosis

A

Dyspnea
Fatigue
Cyanosis with exertion
Loud systolic ejection heart murmur

90
Q

Balloon dilation valvuloplasty via cardiac catheterization

A

Pulmonary Stenosis

91
Q

Complex combination of abnormalities of the left side of the heart (including the left ventricle, mitral valve, aorta, and aortic valve) are small and underdeveloped

A

HLHS

Hypoplastic Left Heart Syndrome

92
Q

S/S of HLHS

A

Cyanosis
Fatigue
Poor feeding

Fatal without palliative surgery, heart transplant

93
Q

Nursing intervention for cardiac catheterization

A

Maintain bed rest
Keep extremity in straight position for 4-8 hours
Inspect the dressing every 15 min for the first hour

Assess child’s distal pulses bilaterally for presence and quality

Assess the color and temperature of the affected extremity

94
Q

Assessment of child undergoing cardiac surgery

A

Temperature
Weight Measurements
Extremity evaluation for : peripheral edema, clubbing, Peripheral pulses

95
Q

Heart anatomy and its function
Events before surgery
Location of the child after surgery
Appearance of the child after surgery
Location of the incision and coverage with dressings
Postoperative activity level
Nutritional Restrictions
Medications

A

Patient Teaching for Cardiac Surgery

96
Q

Congenital Risk Factors for CVD disorders in Childhood

A

Congenital Malformations
Genetic Syndromes
Family History
Maternal drug or alcohol exposure
Prematurity

97
Q

Acquired Risk Factors for CVD in Childhood

A

Infections ( Rheumatic fever, Kawasaki, endocarditis)
Obesity
Diabetes
Drug or alcohol exposure
HTN
Chemotherapy
Other Diseases (CT disorders, autoimmune or endocrine diseases)
Organ Transplant
Hyperlipidemia

98
Q

Failure to pump blood forward
Consequence of many congenital and acquired CV disorders

A

Heart Failure

99
Q

Poor feeding, gets tired easily, tachycardia and tachypnea

A

Early Signs of HF

100
Q

Pallor, HTN, edema, increased work of breathing, orthopnea, wheezing, cough, hepatomegaly, JVD

A

Late Signs of HF

101
Q

Nursing Management of HF

A

Promoting Oxygenation- Semi upright, suction, chest physiotherapy, supplemental oxygen

Supporting Cardiac Function- Administer digoxin, ACE inhibitors, and diuretics

Providing adequate nutrition- higher caloric intake, small frequent meals

Promoting rest- Limit activities, ensure adequate sleep, cluster care

102
Q

What is cardiac output controlled by?

A

Heavy fluid. Occurs most often in children with CHD and most common reason for admission to the hospital. 20% children with CHD experience HF.

Preload, afterload, myocardial contractility, and heart rate. Alterations in any of these may lead to HF.

103
Q

Cardiac Glycoside that increases contractility within the heart

A

Digoxin

Count apical pulse for 1 full minute, noting rate, rhythm, and quality

Withhold if apical pulse is less than 60 BPM in adolescents, or less than 90 in infants

104
Q

Avoid giving oral form with meals
Monitor serum digoxin levels

Note signs of toxicity- N/V/D, lethargy, bradycardia

Ginseng, hawthorn, and licorice increase risk of toxicity

Avoid rapid IV administration as this may lead to systemic and coronary artery vasoconstriction

A

Digoxin

105
Q

Bacterial infection of endothelial surfaces of the heart

Valves
Chamber Walls
Septum

Increased risk of prosthetic valves

A

Infective Endocarditis

Fungi or more commonly bacteria
- Alpha- hemolytic streptococcus, staph, aureus

S/S- Low grade fever, fatigue, anorexia, weight loss, flu like symptoms

Requires antibiotic or antifungal tx

106
Q

Can result after not treating strep throat or scarlet fever

Causes total body inflammation, damaging the heart valves-murmur

A

Acute Rheumatic Fever

Symptoms include fever, joint pain, sore throat within the past 2-3 weeks

Tx includes 10 day course of penicillin or erythromycin and is used along with NSAIDs and corticosteroids

107
Q

Children without valvular disease with receive continued prophylaxis with monthly IM injections or PCN-G or daily oral doses of PCN ( or erythromycin until adulthood)

A

True Acute Rheumatic Fever

108
Q

Most common in children and may result in heart failure

A

Dilated Cardiomyopathy

Hypertrophic more common in adolescence

Affects left ventricle, affecting the heart’s ability to fill, familial

109
Q

Condition in which the myocardium can not contract properly

A

Cardiomyopathy

110
Q

Risk Factors of Cardiomyopathy

A

Congenital Heart defect
Genetic Disorders
Inflammatory or infectious processes
Post transport or postoperatively after cardiac surgery
HTN
Duchenne and Becker muscular dystrophy

Most common unknown reason is called idiopathic

111
Q

May be present as heart failure or cardiac arrest

No cure- Heart can not be restored

A

Cardiomyopathy

112
Q

Therapeutic Management of Cardiomyopathy

A

Improving heart function
Vasoactive medications - ACE inhibitors, Beta Blockers, or calcium channel blockers
Pacemakers
Heart transplant only viable long term treatment option

113
Q

Acute Systematic Vasculitis
Affects children 6 months- 5 years
Self-limited syndrome but may cause coronary artery aneurysm and cardiomyopathy

A

Kawasaki Disease

114
Q

S/S of Kawasaki Disease

A

High fever for 5 days ( unresponsive to antibiotics)
Gallop heart rhythm
Headache
Malaise
Red eyes, lips, hands, and feet
Distinctive rashes (strawberry tongue, palmar erythema)
Skin peeling of perineum, fingers and toes
Vomiting, diarrhea
Decreased UOP
Abdominal and joint pain

115
Q

Treatment for Kawasaki disease

A

IV immunoglobulin IVIG and aspirin
- No live vaccines for 11 months after IVIG (MMR, varicella, influenza)
- Requires long term monitoring of coronary arteries

116
Q

Focus of nursing care for a child with a Cardiac Disorder

A

Improving oxygenation
Promoting adequate nutrition
Assisting the child and family with coping
Providing post op nursing care
Preventing infection
Providing family and child education

117
Q

Psychosocial Interventions include

A

Explain all that is happening with the child with understandable language

Allow the parents and child to voice their feelings, concerns or questions
Provide ample time to address questions and concerns
Encourage parents and child to participate in care as appropriate
Encourage child to be as active as appropriate

ADN005 Pediatrics (21 decks)

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