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Peds/OB > Cardiovascular Disorders > Flashcards

Cardiovascular Disorders Flashcards

1
Q

Incidence: about 1 out of every 100 live births
About 2 or 3 of these cases are symptomatic in first year of life
25% require surgery within the first year
90% live into adulthood
Common
Major cause of death in first year of life (after prematurity)
Can be associated with prenatal factors (ex. Alcohol use, gestational diabetes)
Most common anomaly is ventricular septal defect
Often associated with other anomalies (trisomies 21, 13, 18)
Often not have do intervention - some cardiac defects not know have until in 40s - sometimes major - require surgery immediately
20 week US - hearts and pieces - see lot defects
PDA and PFO closes

A

Things to note:

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2
Q

History
Inspection
Not present at birth or present at birth
Gradual - can compensate - work harder to get O2 to blood to body

A

CHD

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3
Q

Poor feeding = due to activity intolerance; body having work extra hard to get blood out to be oxygenated - tire out quickly when feeding - not finish feedings - hard to wake up and tired; also have poor growth
Poor growth (FTT)
Activity intolerance
Developmental delays
Positive prenatal history = Uncontrolled diabetic; certain drugs - prescription or not - fam hx
Family history of cardiac disease

A

History

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4
Q

Color - Pale
Chest deformities - Phys deformities
Tachypnea
Tachycardia
Mummer - Murmur heard - normal after birth - PDA open to close first 24-48 hours
Unusual pulsations
Clubbing of fingers = later sign
Head bobbing
Sweat - not typ
Use at ECG - see structure of heart since structural issue - diagnosing want an echo
Respiratory excursion

A

Inspection

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5
Q

Acyanotic
Cyanotic

A

Classification of defects

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6
Q

Getting blood to lungs
Oxygenate to blood
Increased pulmonary blood flow
Obstruction to blood flow from ventricles

A

Acyanotic

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7
Q

Lot blood flow to lungs
Left to right shunting to lungs
Blood going to lungs still
Shunt = blood going between them in incorrect fashion; moving in way should not; heart deals with pressure; most pressure - LV - send out to body
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus

A

Increased pulmonary blood flow - Acyanotic

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8
Q

Something there preventing on how blood should flow
Worry about hypertrophy - bigger to pushcoarcation of aorta
Aortic stenosis
Pulmonic stenosis

A

Obstruction to blood flow from ventricles - Acyanotic

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9
Q

Not much or any blood to lungs
Decreased pulmonary blood flow

A

Cyanotic

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10
Q

Tetralogy of Fallot

A

Decreased pulmonary blood flow - Cyanotic

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11
Q

Transposition of great arteries

A

Mixed blood flow - Cyanotic

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12
Q

Common -
DA - fetal blood flow - diverts blood from going to lungs - not need blood going to lungs
Attaches pulm artery to aorta - open - mixing blood
Usually not big deal - sick and not getting better
Treat: med - close the DA; dehydrated; surgery to close it if very sick
Not Sick - not worried because no issues

A

Patent ductus arteriosus (acyanotic)

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13
Q

Hole in wall
Mixing blood - blood going to lungs
Small - majority life not noticing have this
Symptomatic - extra hard because mixing some blood going out - activity intolerance, hear murmur - do surgery and patch - try and give meds first so do surgery when older
Hole in heart

A

ventricular/atrial Septal defect (acyanotic)

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14
Q

Oxygenating blood
Work harder to get past stenotic area
Angioplasty - meds to make heart pump stronger
Do worry about hypertrophy

A

pulmonary/aortic Stenosis (acyanotic)

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15
Q

Narrowing usually begins after the left subclavian artery but before the PDA.
Dx: see in US; notice: discrepancy in vital - descending aorta - having issues - how much oxygen in it - completely constricted - getting blood if PDA open - having PDA open good - oxygenated blood in it - typ usually open - bounding upper pulses
Weak lower pulses
4 point BP - upper and lower extremities - high in UE and low in LE - may be blue in LE if severe

A

Coarctation (acyanotic)

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16
Q

“Tet” spells
When the infant’s oxygen requirements exceed the blood supply
Common during episodes of crying and feeding
Mix 4 diff heart heart defects
Ventricular Septal defect
RV Hypertrophy
RV Outflow obstruction
Aorta sitting over wrong place
Want open PDA - want mixed blood flow - meds to keep open until surgery - need right away is necessary
VSD - help get oxygenated and deoxy blood mixing - some oxy blood out
Anytime overworked, overwhelmed, upset unable to oxygenate body - Knee-chest position
100% O2
Morphine to relax them - quiet, calm environment
Older kids - Tet spells - cannot compensate - Cannot keep up go into tripod position

A

Tetralogy of Fallot (cyanotic)

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17
Q

Not crying, blue - stimulate - then pink up
Resp issue - when cry - pink up
Cardiac issue - cry - lose color - more cyanotic; needing more O2 - O2 requirement going through quicker and body cannot keep up

A

Determine if resp/cardiac

18
Q

Aorta is connected to the right ventricle (instead of left)
Pulmonary artery connected to the left ventricle (instead of the right)
PDA or Septal defect
Is a cycle - 2 sep sys working: extremities not getting O2 blood
Surgery ASAP
Keep PDA open - prostaglandins given - IV going - umbilical lines - central lines in umbilical cord - keep PDA open
If closes SOL
PDA allow deoxy and oxy to mix

A

Transposition of the great vessels (cyanotic)

19
Q

Caring for child with CHD
Nursing Interventions
Education
Medications
Surgery
Interventions are based on heart defect and the individual patients plan of care***

A

N. care

20
Q

Prevent infection
Rest
Education
Oxygen needs
Feeding plans
I/O, daily weights

A

Nursing Interventions

21
Q

Prevent from getting sick - harder - in overdrive already - not do daycare - prevent from getting sick - call pediatrician if get sick

A

Prevent infection

22
Q

Lot edu for parents
How read O2 sat probs

A

Education

23
Q

Timing
Caloric needs
Feeding - tire out easily - not want cardiac kids breastfeeding - work harder - get breastmilk via bottle - wider nipples - easier; increase calories of milk - add more powder to it

A

Feeding plans

24
Q

Hospital - monitor I/O - weigh diapers

A

I/O, daily weights

25
Q

Home care
s/s heart failure
recognize it and know something off
Sick child
Medication administration

A

Education

26
Q

Med administration - how count HR adequately
Meds - push off surgery
Prostaglandins - keep PDA open; hospital only
Digoxin
Diuretics
ACE inhibitors
Beta-Blockers

A

Medications

27
Q

Cardiac catheterization
Patching
Balloon angioplasty
Stents

A

Surgery

28
Q

Heart Failure
Hypoxemia

A

Comps

29
Q

The inability of the heart to adequately supply blood to meet the body’s needs.
Left sided
Right sided

A

Heart Failure

30
Q

Tachypnea
Dyspnea
Nasal flaring/retractions
Wheezing

A

Left sided

31
Q

systemic congestion
peripheral edema
Ascites
Hepatomegaly
jugular vein distension

A

Right sided

32
Q

Inadequate oxygenation of the blood
Common in our kids with congenital heart defects (also seen in kids with resp disorders and anemia)
Signs and symptoms
Cyanosis
Tachypnea
Dyspnea
Clubbing
Polycythemia

A

Hypoxemia

33
Q

Etiology- unknown
Clinical manifestations
Therapeutic management

A

Kawasaki Disease

34
Q

Acute systemic inflammatory illness
Usually resolves within 8 weeks

A

Etiology- unknown

35
Q

Acute phase
High fever, red eyes, bright red/chapped lips, strawberry tongue, oral mucosa irritation, rash, join pain
Cardiac manifestation: myocarditis, decreased left ventricular function, pericardial effusion, mitral regurgitation
Strawberry tongue
Rash hands and feet
Cardiac manifestations - myocarditis, LV - muscle not work as well, may need valve replaced
Subacute phase
Resolution of fever. Irritable, peeling skin, temporary arthritis
Convalescent
No manifestations; however, labs usually still abnormal

A

Clinical manifestations

36
Q

Gamma globulin
Aspirin
Monitor I & O
Monitor heart function
Promote comfort
IVIG, aspirin (one time give kids aspirin and is high dose - not typ give because Reye’s syndrome - in hospital)

A

Therapeutic management

37
Q

Inflammatory disease that occurs as a reaction to a Group A beta-hemolytic streptococcus infection (GABHS)
Diagnosed based on Jones criteria:
Major
Minor
Predisposed by strep throat
2-6 weeks after strep
Inflammatory disease
2 majors or 1 major and 2 minor
Cardiac valve issues - have be replaced

A

Rheumatic fever

38
Q

Carditis
Subcutaneous nodules
Polyarthritis
Rash
Chorea

A

Major

39
Q

Fever
Arthralgia

A

Minor

40
Q

Do on every single baby
See if have heart defect not know
Highlight if at risk
Not diagnostic - tells that might have something going on - get echo - that will diagnosis it
Sat prob on right hand - preductal - one on either foot - postductal - nothing greater than 3% in O2 - rescreen before order echo; between 95-100%; 24-48 hrs of life - cheap and noninvasive way; not check for all of them
Below 95% fail; greater difference than 3% between hand and foot fail

A

CCHD screening

Peds/OB (68 decks)

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