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PNCB CPNP-PC > Cardiovascular Issues & Disorders > Flashcards

Cardiovascular Issues & Disorders Flashcards

1
Q

Blood flow through the heart:
From the superior vena cava –> right atrium –> tricuspid valve –> right ventricle –> -1- valve –> -1- artery –> -2- –> -1- veins –> left atrium –> -3- –> left ventricle –> -4- –> -5- –> body

A
  1. pulmonic/pulmonary
  2. lungs
  3. mitral valve
  4. aortic valve
  5. aorta
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2
Q

Heart Sounds & Anatomical Location

  1. S1
  2. S2
  3. S3
  4. S4; rare in children, indicative of -5-
A
  1. “lub,” closure of the “small” valves - mitral and tricuspid; beginning of systole
  2. “dub,” closure of the “large” valves - pulmonic and aortic; beginning of diastole
  3. “Arkansas,” Physiologic finding in children
  4. “Virginia,” indicative of heart failure, so exceedingly rare in children (outside of cardiac critical care)
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3
Q

Auscultation Areas

  • 1-: Aortic
  • 2-: Pulmonic
  • 3-: Mitral
  • 4-: Tricuspid, where -5- can be heard
A
  1. RUSB
  2. LUSB
  3. Erb’s point (apex)
  4. LLSB
  5. ventricular septal defect (VSD)
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4
Q

Notable Cardiac Characteristics

Blood flows from -1- to -2-; -3- a lot of pressure to -4-

A
  1. higher
  2. lower pressure
  3. the left ventricles need
  4. oxygenate the body
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5
Q

Notable Cardiac Characteristics
Resistance & flow
- Fetal: -1- <– -2-
- Neonatal: -3- <– -4-

A
  1. increased pulmonary/decreased systemic vascular resistance
  2. No lung flow
  3. decreased PVR/increased SVR
  4. lung flow!
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6
Q

Notable Cardiac Characteristics
-1- loudness scale: -2-
VSD: -3-

A
  1. Murmur
  2. I-VI/VI systolic
  3. Thrill
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7
Q

Notable Cardiac Characteristics
-1- defects
> -2- due to -3-
> -4- sound noted

A
  1. obstructive
  2. ejection clicks
  3. turbulence
  4. Referral/radiation of
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8
Q 
Murmur grades
I: only audible with -1-
II - IV: -2-
V: loud, heard -3-, thrill palpable
VI: very loud, heard -4-, thrill both palpable and visible
A
  1. specialized tools found in the ICU
  2. easily audible with steth
  3. with only part of the stethoscope on the chest wall
  4. without sethoscope
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9
Q

Congenital Heart Diseases/Anomalies
Result from abnormal -1- in the first trimester
Occurs in -2-
-3- most common of all congenital heart defects, indicated by -4-

A
  1. structural development
  2. approximately 1% of births/year
  3. VSD is the
  4. LLSB thrill
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10
Q

Atrial Septal Defect
Grade -1-/VI -2- murmur in the -4-
EKG: -3-

A
  1. II-III
  2. Systolic ejection
  3. Right ventricular hypertrophy (RVH)
  4. LUSB (pulmonic space)
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11
Q

Atrial Septal Defect
Mgmt
> -1- to pediatrician and -2-
> some small ASDs -3-; medium to large require -4-

A
  1. referral
  2. pediatric cardiologist
  3. close spontaneously
  4. surgical correction
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12
Q 
Ventricular Septal Defect (VSD)
> Murmur
-> Grade -1-/VI -2- murmur
-> A -3- may be -4-
> EKG: -5- progressing to biventricular hypertorphy if VSD is large
A
  1. II-V
  2. systolic ejection
  3. holosystolic thrill
  4. felt at the LLSB
  5. LVH
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13
Q

VSD
> X-ray: -1-, incrased pulmonary vascular markings
> Mgmt
-> Some small -2-; -3- require -4- (more -5-)

A
  1. cardiomegaly
  2. VSDs close spontaneously
  3. medium to large
  4. surgical correction
  5. than for ASD
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14
Q 
Patent Ductus Arteriosus (PDA)
5-10% of congenital herat defects in term infants; very -1-
> Murmur: -2-
-> II to IV/VI -3-
-> -4- sound (like a -5-)
A
  1. common among premature infants (Premies are Patent)
  2. LUSB left upper sternal border
  3. holosystolic
  4. Machinery
  5. washing machine
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15
Q

PDA
> EKG: -1- to biventricular
> X-ray findings: -2- and -3-

A
  1. LVH
  2. Cardiomegaly
  3. increased pulmonary vascular markings
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16
Q

PDA Mgmt
> referral to pediatrician and -1-
> for preterm infants, -2- inhibitors (ibuprofen, -3-) may be used
> -4- is preferred in -5-

A
  1. cardiologist
  2. prostaglandin
  3. indomethacin
  4. Percutaneous occlusion
  5. adolescents
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17
Q

Transposition of the Great Arteries
> -1-
-> Same -2-
> EKG: -3-

A
  1. Murmur
  2. as VSD (grade II-V systolic ejection)
  3. RVH
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18
Q

Transposition of the Great Arteries
> X-ray: -1- with -2- and increased -3-
> Mgmt
-> Supportive care via a -4-, then -5-

A
  1. “egg on a string”
  2. cardiomegaly
  3. pulmonary vascular markings
  4. ped cardiologist
  5. surgical repair
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19
Q

Transposition of the Great Arteries
> Mgmt
-> Long-term supportive care, including routine screening for -1- secondary to -2-

A
  1. developmental delays

2. perioperative hypoxemia

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20
Q 
Tetralogy of Fallot
Definition: -1-
> -2-
> -3-
> -4-
> -5-
A
  1. Four concurrent heart defects (children commonly running and squatting when playing)
  2. Large VSD
  3. Pulm stenosis
  4. overriding aorta
  5. (those three lead to) RVH
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21
Q

Tetralogy of Fallot
> Murmur: -1- at the -2- and -3-
> X-ray findings: -4-, no cardiomegaly or pulmonary vascular markings

A
  1. loud systolic ejection click
  2. middle
  3. upper left sternal border (M-LUSB)
  4. boot-shaped heart
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22
Q

Aortic Stenosis
> systolic -1-
-> Murmur -2- present which -3-
> EKG findings: -4-

A
  1. thrill at the RUSB
  2. systolic ejection click
  3. does not vary with respirations
  4. LVH
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23
Q

Aortic Stenosis Mgmt
> referral to pediatrician & -1-
> balloon -2-
> regular follow up, especially in regard to -3-

A
  1. pediatric cardiologist
  2. aortic valvuloplasty
  3. sports participation
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24
Q

Pulmonic Stenosis Murmur
-1-, -2- at the -3-
Grade II to V/VI -4-
Intensity of -5- w/ -6-

A
  1. Systolic
  2. Loudest
  3. LUSB
  4. ejection click
  5. click decreases
  6. inspiration and vice versa
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25
Q

Pulmonic Stenosis Murmur

-1- at the LUSB, -2- and -3-

A
  1. Thrill
  2. radiating to the back
  3. sides
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26
Q

Pulmonic Stenosis
> EKG: -1-
> Mgmt
-> regular follow-up to monitor improvement -3-
-> -4-; further evaluation needed in moderate/severe stenosis

A
  1. RVH
  2. every 6 mo. to 2-5 years
  3. sports participation generally not restricted
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27
Q

Coarctation of the Aorta Murmur

> II to III/VI -1- murmur with -2- to the -3-

A
  1. systolic ejection
  2. radiation
  3. left interscapular area
28
Q

Coarctation of the Aorta

> Decreased or absent pulses: -1-; -2- in -3- will be -4- than in -5-

A
  1. CARDINAL FINDING
  2. BP
  3. lower extremities
  4. lower
  5. upper extremities
29
Q

Coarctation of the Aorta
> EKG: -1- progressing to -2-
> X-ray: -3- due to -4-

A
  1. RVH
  2. LVH
  3. rib notching
  4. collateral circulation
30
Q 
Common Genetic Syndromes associated w/ Cardiac Defects
> -1- syndrome: -2-
> Trisomy conditions
-> -3-
-> -4-: -5-
A
  1. DiGeorge
  2. Aortic arch defects
  3. 18/Edward’s
  4. 21/Down
  5. AVSDs, VSD
31
Q

Common Genetic Syndromes associated w/ Cardiac Defects
Marfan: -1-, -2-
Turner: -3-, -4-

A
  1. aortic root disease
  2. MVP
  3. coarctation of the aorta
  4. bicuspid aortic valve
32
Q 
Cardiac Defect Presentations
Evaluate for these with -1- of heart defects:
> Frequent -2-
> -3- intolerance
> -4- during sleep
A
  1. prenatal, birth, and family history
  2. respiratory infections
  3. exercise
  4. tachypnea
33
Q

Cardiac Defect Presentations

  • 1- problems
  • 2-
  • 3- sounds
  • 4-
A
  1. feeding
  2. diaphoresis
  3. abnormal heart
  4. (periorbital) edema
34
Q

Cardiac Defect Presentations

  • 1-
  • 2-
  • 3-
A
  1. clubbing
  2. heart failure
  3. FTT
35
Q

Cardiac Defect MGMT
Referral to -1-
Ensure -2- and AG

A
  1. pediatric cardiologist

2. optimal primary care

36
Q

Innocent Murmurs (i.e., -1- or -2-)
No associated sympotms, FTT, or -3-
Occurs in -4- of children
> -5- wall

A
  1. functional, benign
  2. physiologic
  3. cyanosis
  4. up to 50%
  5. Thin chest
37
Q 
Innocent Murmurs
Low-intensity systolic murmurs (-1-/VI)
May vary with position (-2-)
-3- to neck/back/axilla
MGMT: clinical assessment -4- if PCP -5-
A
  1. I-III
  2. sitting > standing
  3. no radiation
  4. by a pediatric cardiologist
  5. has a concern
38
Q

Still’s Murmur
-1- murmur
-2- murmur
Heard during periods of -3-, -4-

A
  1. most common physiologic
  2. muscial systolic/vibratory
  3. anxiety/stress in older kids
  4. fever in infants and toddlers
39
Q

Still’s murmur
heard best between -1- & -2-
-3- murmur
louder -4-

A
  1. LLSB
  2. apex/Erb’s point
  3. systolic ejection
  4. when supine
40
Q 
Venous Hum
-1- murmur
-2-/infraclavicular area
-3- in the -4- in the supine position
Also -5- and/or compressing neck ipsilaterally
A
  1. continuous humming
  2. RUSB
  3. heard best
  4. sitting position; disappears
  5. obliterated by turning head
41
Q

Heart Failure Causes

  • 1-: -2- - VSD, PDA, AV canal
  • 3- children: -4-, pressure overload
A
  1. Infants
  2. volume overload
  3. older
  4. ventricular dysfunction
42
Q

HF S/S

  • 1-
  • 2-
  • 3-
A
  1. Diaphoresis
  2. FTT
  3. Rales/crackles
43
Q

HF S/S
-1-
-2-
Poor -3-

A
  1. Tachypnea
  2. Tachycardia
  3. perfusion
44
Q

HF S/S in infants/toddlers
Poor/prolonged -1-
-2-

A
  1. feedings

2. lethargy/irritability

45
Q 
HF S/S in Older children/adolescents
-1-
-2-
-3-
-4-
HF MGMT
Referral to -5- for long-term follow up
A
  1. exercise intolerance
  2. abdominal pain
  3. chest pain
  4. syncope
  5. pediatric cardiologist
46
Q

Acquired Heart Disease
HTN
> Primary: a persistent elevation of average blood pressure -1- with measurements obtained on -2- occasions per -3- w/o known cause
> HTN is most common in children -4- of -5-

A
  1. > 95th percentile
  2. 3+ separate
  3. (published tables for) age and sex
  4. as a symptom
  5. other organ dysfunction (secondary hypertension)
47
Q 
HTN S/S
-1-
-2-
-3-
Physical exam: -4-; peripheral edema may be present
A
  1. HA, dizziness
  2. visual problems
  3. nosebleed (epistaxis)
  4. S4 may be present
48
Q

HTN Labs/Dx
-1- (PA & lateral)
Plasma -2- level to rule out -2-ism
morning and evening -3- to rule out -4-

A
  1. CXR
  2. aldosteron/e
  3. cortisol levels
  4. Cushing’s syndrome
49
Q

HTN Labs/Dx
-1-, -2-, -3-, and -4-
EKG for dysrhythmias, i.e., -5-

A
  1. UA
  2. BMP
  3. lipid panel
  4. complete blood count (CBC)
  5. BBB, or LVH
50
Q

HTN MGMT
Referral to a -1-
-2- diet

A
  1. cardiologist

2. Dietary Approaches to Stop Hypertension (DASH)

51
Q

Rheumatic Fever/Heart Disease
Definition: A -1- that can affect the heart, joints, and CNS
> RF -2- URI, and is most common in children 5-15 years of age
> The -3- is most commonly affected
> Prevention with -4-

A
  1. post-infectious inflammatory disease
  2. follows a GABHS
  3. mitral valve
  4. adequate treatment of GABHS
52
Q

RF/HD S/S

Diagnosis of an intial attack of rheumatic fever plus -1- or -2-

A
  1. two major

2. one major & 2 minor Jones’ criteria

53
Q

RF/HD Major Jones’ criteria

-1-, -2-, -3-, -4-, -5-

A
  1. carditis
  2. polyarthritis
  3. subq nodules
  4. chorea
  5. erythema marginatum

“CaPiSCE?”

54
Q

RF/HD Minor Jones’ criteria
-1- objective -2-
-3-
Elevated levels of acute phase reactants (i.e., -4- and -5-)

A
  1. arthralgia w/o
  2. inflammation
  3. Fever > 39C (102.2F)
  4. erythrocyte sed rate (ESR)
  5. C-reactive protein (CRP)
55
Q 
RF/HD Labs/Dx
Acute phase reactants
> Rapid strep assay
-> -1-, -2-
> Increased or rising -3-
-4-
-5-
A
  1. if positive
  2. throat culture
  3. strep Ab titer (ASO)
  4. EKG
  5. Echo
56
Q

RF/HD Mgmt
Referral to a -1-
Aggressive -2-
-3- following completion of Ab therapy with a -4- to evaluate for the presence of RBCs which may indicate -5-

A
  1. peds cardiologist
  2. Tx of GABHS infection
  3. follow up 2 weeks
  4. UA
  5. secondary glomerulonephritis
57
Q

RF/HD Mgmt

  • 1- if acute -2- is present
  • 3- for -4-, as indicated
A
  1. Bed rest
  2. carditis
  3. prophylactic abx
  4. invasive procedures
58
Q

Kawasaki Disease
Defnition: -1- causing -2-
> The leading cause of -3- in children of an infectious etiology
> Most commonly noted in -4- years of age
> Occurs most commonly in children of -5-

A
  1. acute febrile syndrome
  2. vasculitis
  3. coronoary artery disease
  4. children under 2
  5. asian ethnicity, but much more diverse than other ethnically endemic disorders
59
Q

Kawasaki Dx Criteria
Patient must -1-, as well as -2-; if pt has > -2-, coronary vessel involvement is likely
> -3- for at least -4-

A
  1. have a fever
  2. 4+ of the criteria
  3. fever
  4. 5 days
60
Q

Kawasaki Dx Criteria

  • 1- without -2-
  • 3- which is -4-
A
  1. bilateral conjuctival injection
  2. exudate
  3. polymorphous rash
  4. confluent on extremities
61
Q

Kawasaki Dx Criteria
> Inflammatory -1- (e.g., -2-)
> Changes in extremities (e.g., erythema of -3-, edema, -4-)
> -5-

A
  1. changes of the lips and oral cavity
  2. peeling (not chapped) lips
  3. soles/palms
  4. peeling skin
  5. cervical lymphadenopathy
62
Q

Kawasaki Labs/Dx

  • 1-
  • 2-
  • 3-
A
  1. CBC
  2. ESR
  3. positive CRP
63
Q

Kawasaki Labs/Dx

-1-: -2- or -3- interval

A
  1. EKG
  2. prolonged PR
  3. QT
64
Q

Kawasaki mgmt
Immediate referral to -1-
-2-: 2 g/kg as a single infusion, usually given over -3-
High-dose -4-
> 80-100 mg/kg/day until afebrile for 48 hours
> Then -5- for antiplatelet response

A
  1. peds cardiologist/ED
  2. IVIG
  3. 10-12 hours
  4. ASA therapy
  5. lower ASA dose (3-5 mg/kg/day)
65
Q

Kawasaki mgmt

Sometimes -1- to poor -2- to -3- to the -4-

A
  1. requires hospitalization due
  2. oral intake related
  3. inflammatory changes
  4. lips/oral cavity
66
Q

When diagnosing hypertension in pediatric patients, the physiologic blood pressure range shifts based on the child’s -1-; therefore, a nurse practitioner would need to know the child’s -1- in addition to blood pressure measurement to determine if the child has hypertension. -2- and -3- are used to determine metabolic syndrome. -4- can be used to detect malnutrition in infants.

A
  1. height
  2. Waist circumference
  3. weight
  4. Mid upper-arm circumference

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