Cardiac Dysfunction in Children Flashcards by pamela pence

abnormalities present at birth are called

congenital

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abnormalities/disease processes that occur after birth are called

aquired

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what dx procedure is done first for suspected cardiac disease

electrocardiogram

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what nursing care should be done post cardiac cath

V/S Q15min
pulses for equality
assess pain
extremity temp and color
check insertion site
I and O
extremity straight for 4-8hrs
oral intake to flush dye out
get child to void

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where should you apply pressure if catheter entry site is bleeding

1 in above entry site

*position child flat and call doc

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what home care instructions are important for post cardiac cath

keep site clean
avoid tub baths after
limit activity for 24hrs
avoid strenuous exercise
regular diet
tylenol or ibuprofen for pain
follow up

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blood flows from area of higher pressure to lower pressure

left to right shunt

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change in pressure so that blood is shunted from the right side of the heart to the left

right to left shunt

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what 3 defects have left to right shunting of blood and cause increased pulmonary blood flow

atrial septal defect (ASD)
ventricular septal defect (VSD)
patent ductus arteriosus (PDA)

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abnormal opening between the atria

atrial septal defect

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abnormal opening between right and left ventricles

ventricular septal defect

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what is VSD’s percentage of spontaneous closure

20-60%

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failure of the fetal ductus arterioles to close within first few weeks of life

patent ductus arteriosus

*blood flows form aorta to pulmonary artery

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why is indomethacin (indocin) given to PDA pt’s

prostaglandin keeps PDA open so a prostaglandin inhibitor will help it close

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what defect has a decreased pulmonary blood flow, shunts desaturated blood right to left, and sends desaturated blood to system circulation

tetralogy of fallot

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what are the 4 cardiac defects that cause tetralogy of fallot

VSD
Pulmonary stenosis
Overriding Aorta
Right Ventricular Hypertrophy

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what is the “clinical picture” for Tetralogy of fallot

cyanosis
tachypnea
acute episodes of cyanosis and hypoxia(hyper cyanotic spells)
clubbing
growth retardation

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how are hyper cyanotic spells started in TOF

by feedings, crying, defecation, or stressful procedures

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what are nursing interventions for hyper cyanotic spells of TOF

“squatting” position
calm the infant
blow by 100% oxygen
get help

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what 3 defects are obstructive

coarctation of the aorta
aortic stenosis
pulmonic stenosis

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blood exiting heart meets area of anatomic narrowing (stenosis)

obstructive defects

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narrowing of the aorta at or near the insertion of the ductus arteriosus

coarctation of the aorta (COA)

increase pressure proximal to the defect
decreased pressure distal to the defect

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what is the “clinical picture” of a pt who has coarctation of the aorta

elevated BP in arms/bounding pulses in arms
decreased BP in legs/weak or absent pulses in lower extremities
cool lower extremities

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what defect will we take 4 different sites of BP in newborns

coarctation of the aorta

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narrowing of the aortic valve causing left vent enlargement, decreased cardiac output, increased left atrial pressure

aortic stenosis

what is the "clinical picture" for a NEWBORN with aortic stenosis

``` decreased cardiac output faint pulses hypotension tachycardia poor feeding ```

what is the "clinical picture" for a CHILD with aortic stenosis

exercise intolerance chest pain SOB syncope

what cardiac defect is the only one that has activity restrictions

aortic stenosis

narrowing of pulmonary artery that decreases pulmonary blood flow, and causes right vent hypertrophy

pulmonic stenosis

what cardiac defect is "mixed"

hypoplastic Left Heart Syndrome (HLHS)

underdevelopment of the left side of the heart | "single ventricle"

HLHS

why will a HLHS pt be on a prostaglandin drip

to keep PDA open because this is the only way they are getting blood flow systemically

what is the "clinical picture" for HLHS

``` mild cyanosis HF lethargy cold hands and feet once PDA closes it leads to cardiac collapse ```

is it normal to see HLHS pt with O2 sats of 70-80%

yes | *theres not an actual correction of this defect and they don't have a long term life expectancy

heart can't pump enough blood out to the rest of the body to meet the body's demand for energy

congestive heart failure

what are S/S of CHF

``` difficulty feeding (ftt) tachypnea at rest dyspnea retractions activity intolerance weight gain r/t fluid retention hepatomegaly ```

what classes of meds improve cardiac function

``` digitalis glycoside (digoxin) ACE inhibitors (capto, enla, and lisinopril) Beta Blockers (caredilol) ```

improve contraction of the heart (take a good strong beat)

digoxin

reduce after load and easier for heart to pump

ace inhibitors (prils)

decrease HR and BP causing vasodilation

carvedilol

before giving digoxin what should be done

apical pulse for 1 min *infant= don't give below 90-110bpm older child= don't give below 70bpm

what are S/S of digoxin toxicity to watch for at home

nausea, vomiting, anorexia, bradycardia, dysrhythmias

what is important to teach parents about digoxin

``` do NOT mix with fluids or food if dose is missed don't double up if child vomits don't give extra dose keep locked in safe place call poison control in accidental overdose ```

what are side effects of ACE inhibitors

hypotension dry cough renal dysfunction

what are used to decrease accumulated fluid volume treatment

Diuretics: furosemide, chlorothiazide, spironolactone

what are clinical manifestations of chronic hypoxemia

polycythemia and clubbing

infection of the valves and inner lining of the heart caused by bacteria that enter the blood stream and settle in the heart lining, heart valve, or blood vessel

infective endocarditis

what are the most common organisms that cause infective endocarditis

strep viridans and staph aureus

who are at higher risk for IE

children who have undergone surgical repair or palliative surgery

what is the "clinical picture" of IE

``` hx of dental procedure, urinary or intestinal tract procedure unexplained fever weight loss lethargy malaise anorexia new murmur or change in existing ```

what is the tx for IE

``` blood cultures (to see what type it is) abx (IV 2-8wks) EKG monitoring *could cause stoke because it could break off and lodge somewhere it is fatal if left untreated ```

how can IE be prevented

maintaining good oral hygiene

inflammatory disease that occurs from GABHS

rheumatic fever

what are risk factors for RH

hx of group A strep infection fam hx environmental factors

when is the onset of RF

2-4wks after a strep throat infection | *ASO titer to find out if it was strep or not

what is the "clinical picture" of RF

``` MAJOR: carditis polyarthritis erythema marginatum chorea subQ nodules MINOR: arthralgia fever elevated ESR and CRP ```

what is the dx criteria for RF

modified jones criteria= 2 MAJOR manifestations or 1 MAJOR and 2 MINOR manifestations *plus + for strep

what is the tx for RF

abx 10day course then prophylactic (PO daily or IM monthly) asprin to reduce fever, control inflammation bedrest during acute illness

acute systemic vasculitis

kawasaki disease | *principal are of involvement is coronary artery aneurysms

what are risk factors for KD

younger than 5 males asians or asian decent

what is the dx criteria for KD

no specific test but will have elevated CRP, ESR and CBC (platelet count)

what lab is different between KD and RF

KD has high platelet count

what is the acute phase of KD (first 10 days)

``` fever 5+days VERY IRRITABLE red on hands and feet strawberry tongue Bilateral conjunct inflammation polymorphous rash ```

what is the subacute phase of KD (greatest risk for developing coronary artery problems) 11-25 days

desquamation of fing and toe cont irritability thrombocytosis (>600,000-800,000

what is the convalescent phase of KD

all clinical signs resolved blood val normal beau's lines on finger and toe nails

what is the tx for KD

high doses of IV gamma globulin (reduces incidence of coronary artery abnorms) ASA

what nursing interventions can we do for KD pts

cool cloths, unscented lotions, loose clothing, mouth care including lubricant for lips clear liquids and soft foods during acute phase quiet environment so they can rest

Cardiac Dysfunction in Children Flashcards

(67 cards)