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
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
Signs of Cardiac Disorder
25
How are murmurs graded?
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
26
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)
Characteristics of Heart Murmurs
27
Diagnostic Tests for Cardiovascular Disorders
Pulse Oximetry ECG or Holter Monitoring Echocardiogram Chest Radiograph Exercise Stress Testing Lab test including: CBC, BMP, CRP, ESR Arteriogram and Cardiac Catheterization
28
Structural anomality's that are present at birth CHD accounts for the largest percentage of all birth defects
Congenital Heart Disease
29
Disorders that occur after birth Develops from a wide range of causes, or can occur as a complication or long term effect of CHD
Acquired Heart Disease
30
Indications for this include hypoxemia, respiratory distress, or heart failure
Oxygen
31
Chest Physiotherapy used for
Mucous clearance by mobilizing secretions with percussion or vibration with postural drainage May be used by RT
32
Chest Tube used
After open heart surgery Pneumothorax Drainage tube inserted into the pleural cavity to facilitate removal of air or fluid and allow full lung expansion
33
External wiring connected to a small generator used to electrophysiological correct arrhythmias or heart block
Pacing Used for bradyarrhythmia's, heart block, cardiomyopathy SA or AV node malfunction
34
How is CHD classified?
Based on hemodynamic characteristics
35
Disorders with decreased pulmonary blood flow (Cyanotic)
Tetralogy of Fallot Tricuspid Atresia
36
Disorders with increased pulmonary blood flow (a cyanotic)
Atrial Septal Defect Ventricular Septal Defect AV Canal PDA
37
Obstructive Disorders include
Coarctation of the aorta Aortic Stenosis Pulmonary Stenosis
38
Mixed Disorders Include
Transposition of Great Vessels Total Anomalous Pulmonary Return Truncus Arteriosus Hypoplastic Left Heart Syndrome
39
Right to left blood flow includes Hypoxia
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
40
S/S of hypoxia
Cyanosis Poor Feeding and weight gain Clubbing of fingers Dyspnea and Tachypnea Polcythemia - Blood clot risk with Hg over 22
41
Left to right include ASD, VSD, PDA, AVSD
True , Congestive Heart Failure These effects are less deadly
42
S/S of CHF
Weight gain pale and cool extremities Puffiness around the eyes Reduction in wet diapers Dyspnea Tachypnea and tachycardia Poor weight gain
43
Characterized by 4 defects
Pulmonary Stenosis VSD Overriding Aorta Right Ventricular Hypertrophy Called Tetralogy Fallot
44
S/S of TOF
Color changes with feeding, activity or crying (cyanosis) Murmur Requires surgical intervention in 1st year of life
45
When is TOF usually diagnosed?
During the first few weeks of life due to presence of murmur or cyanosis
46
Most often infants with TOF have a PDA at birth
True
47
Aorta positioned directly over a VSD, instead of the left ventricle
Overriding Aorta Receives some blood from the right ventricle, which reduces the amount of oxygen in the blood)
48
If the infant's oxygen is greater than the supply( such as crying) then the spell progresses to
Anoxia-LOC
49
Characterized by uncontrollable crying or irritability Tachypnea Worsening hypoxia with cyanosis/ pallor Decreased intensity of heart murmur Limpness, LOC, convulsions
Hypercyanotic Spells "TET spell"
50
How are TET spells relived?
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
Valve between the right atrium and right ventricle fails to develop
Tricuspid Atresia Associated with VSD
52
s/s of Tricuspid Atresia
Cyanosis Tachypnea Difficulty with feeding Requires surgical intervention in staging
53
Closed Tricuspid valve =
No opening to allow blood from the right atrium to the right ventricle and subsequently through the pulmonary artery into the lungs
54
The positions of the pulmonary artery and aorta are reversed
Transposition of the Great Arteries Oxygen poor blood goes back to the body and oxygen rich goes back to the lungs.
55
What do we use to keep PDA open?
Prostaglandins
56
S/S of Transposition of Great Arteries
Tachypnea Tachycardia Significant Cyanosis Immediate balloon atrial septostomy, surgical correction to switch arteries by age 4-7 years
57
Pulmonary veins do not connect normally to the left atrium, instead connect to the right atrium
Total Anomalous Pulmonary Venous Connection
58
S/S of TAPVC
Cyanosis varies Fatigue Difficulty feeding Requires surgical intervention Incompatible with life unless there is patent foramen ovale of ASD
59
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
Truncus Arteriosus
60
S/S of Truncus Arteriosus
Cyanosis with activity Fatigue Difficulty feeding and poor growth Requires surgical intervention
61
Hole between the 2 upper chambers of the heart- right and left atria Most children are asymptomatic
Atrial Septic Defect
62
S/S of ASD
Heart Failure- SOB Poor growth Murmur- Normal and expected
63
If detect murmur of ASD is small...
May close spontaneously within 18 months of life If defect is large may be sutured closed or require patch
64
Defects with connections involving the left and right sides will shunt blood from the higher pressure left side to lower pressure right side
True - Heart failure, pulmonary HTN, atrial arrhythmias, or stroke
65
Most common and accounts for 25% of all congenital heart defects Spontaneous closure of small VSDs occurs in half of children by age 2
Ventricular Septal Defect
66
Hole between the 2 lower chambers of the heart- the right and left ventricles Most children are asymptomatic
Ventricular Septal Defect
67
S/S of VSD
Grunting and tires easily with feeds Pulmonary Infections SOB Edema Systolic Heart murmur (L Sternal Border)
68
If defect is small in VSD ..
May close spontaneously by 2 years old If large may require suture or require a patch
69
At risk for heart failure, aortic valve regurgitation, ineffective endocarditis if unrepaired
True
70
Occurs because of the failure of the endocardial cushions to fuse Cushions are needed to separate the central part of the heart
Atrioventricular Canal Defect AV Canal Causes large L-R shunt, increased workload of the L ventricle, high pulmonary arterial pressure- pulmonary edema
71
Includes ASD, VSD, improperly formed mitral and/or tricuspid valves
AV Canal Defect 35-40% of children with Down Syndrome have this defect Recirculation problem requires LV to pump 2-3 times more
72
S/S of AV Canal Defect
Frequent respiratory infections Difficulty feeding and gaining weight Increased work of breathing
73
Pulmonary Banding in infants surgical correction by
3-18 months patch closure Valve repair
74
Occurs when the normal closure of ductus arteriosus does not occur- connection between the aorta and pulmonary artery
PDA
75
PDA occurs more frequently in premature infants and infants born at high altitudes
True
75
S/S of PDA
Asymptomatic heart failure Loud machine like murmur
76
What medication is used to help close the PDA?
Indomethacin Inhibits prostaglandin synthesis
77
Medication to keep the PDA open ( vasodilation of the ductus arteriosus smooth muscle)
Prostaglandin PDA corrected by coil embolization or surgical ligation
78
_____________ _________________________ 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
Ductus Arteriosus
79
Narrowing of major vessel Obstructive disorder
Coarctation of the Aorta Accounts for 10% of congenital heart defects BP may be 20mm Hg higher in upper extremities
80
Narrowing of the aorta, the major blood vessel carrying oxygenated blood from left ventricle to the body
Coarctation of the Aorta Narrowing - blood flow is impeded- decreased cardiac output
81
Increased pressure in the area proximal to the defect Decreased in the area distal to defect
Coarctation of the Aorta
82
Symptoms of Coarctation of the Aorta
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
Balloon Angioplasty, surgical repair with stents, resection of narrowing and end to end anastomosis
Coarctation of the Aorta
84
Occurs when the aortic valve between the left ventricle and aorta did not form properly Causes pump problem Typically child is asymptomatic
Aortic Stenosis
85
S/S of Aortic Stenosis
Fatigue Chest Pain Dizziness Difficulty feeding in infants
86
Balloon dilation via umbilical artery or cardiac catheterization, possible valve replacement
Aortic Stenosis
87
Occurs as a muscular obstruction below the pulmonary valve, at the valve, or a narrowing of the pulmonary artery
Pulmonary Stenosis
88
Associated other heart anomalies and genetic syndromes Most children are asymptomatic
Pulmonary Stenosis
89
S/S of Pulmonary Stenosis
Dyspnea Fatigue Cyanosis with exertion Loud systolic ejection heart murmur
90
Balloon dilation valvuloplasty via cardiac catheterization
Pulmonary Stenosis
91
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
HLHS Hypoplastic Left Heart Syndrome
92
S/S of HLHS
Cyanosis Fatigue Poor feeding Fatal without palliative surgery, heart transplant
93
Nursing intervention for cardiac catheterization
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
Assessment of child undergoing cardiac surgery
Temperature Weight Measurements Extremity evaluation for : peripheral edema, clubbing, Peripheral pulses
95
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
Patient Teaching for Cardiac Surgery
96
Congenital Risk Factors for CVD disorders in Childhood
Congenital Malformations Genetic Syndromes Family History Maternal drug or alcohol exposure Prematurity
97
Acquired Risk Factors for CVD in Childhood
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
Failure to pump blood forward Consequence of many congenital and acquired CV disorders
Heart Failure
99
Poor feeding, gets tired easily, tachycardia and tachypnea
Early Signs of HF
100
Pallor, HTN, edema, increased work of breathing, orthopnea, wheezing, cough, hepatomegaly, JVD
Late Signs of HF
101
Nursing Management of HF
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
What is cardiac output controlled by?
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
Cardiac Glycoside that increases contractility within the heart
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
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
Digoxin
105
Bacterial infection of endothelial surfaces of the heart Valves Chamber Walls Septum Increased risk of prosthetic valves
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
Can result after not treating strep throat or scarlet fever Causes total body inflammation, damaging the heart valves-murmur
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
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)
True Acute Rheumatic Fever
108
Most common in children and may result in heart failure
Dilated Cardiomyopathy Hypertrophic more common in adolescence Affects left ventricle, affecting the heart's ability to fill, familial
109
Condition in which the myocardium can not contract properly
Cardiomyopathy
110
Risk Factors of Cardiomyopathy
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
May be present as heart failure or cardiac arrest No cure- Heart can not be restored
Cardiomyopathy
112
Therapeutic Management of Cardiomyopathy
Improving heart function Vasoactive medications - ACE inhibitors, Beta Blockers, or calcium channel blockers Pacemakers Heart transplant only viable long term treatment option
113
Acute Systematic Vasculitis Affects children 6 months- 5 years Self-limited syndrome but may cause coronary artery aneurysm and cardiomyopathy
Kawasaki Disease
114
S/S of Kawasaki Disease
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
Treatment for Kawasaki disease
IV immunoglobulin IVIG and aspirin - No live vaccines for 11 months after IVIG (MMR, varicella, influenza) - Requires long term monitoring of coronary arteries
116
Focus of nursing care for a child with a Cardiac Disorder
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
Psychosocial Interventions include
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