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Pediatrics > Cardiac Issues > Flashcards

Cardiac Issues Flashcards

1
Q

What side is deoxygenated blood on?

A

Right side of heart

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2
Q

what two holes need to close after baby is born?

A

foramen ovale and ductus arteriosus

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3
Q

what are things you investigate in a child’s cardiac hx?

A

poor weight gain
poor feeding habits and fatigue during feeding
frequent respiratory tract infections
exercise intolerance

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4
Q

What is the most common cardiac disease?

A

Congenital heart disease

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5
Q

what are two major clinical consequences of congenital heart disease?

A

heart failure and hypoxemia

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6
Q

What is the foramen ovale?

A

an opening between the atria that allows blood flow from right to left atrium

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7
Q

What is ductus arteriosus?

A

opening that allows blood flow between pulmonary artery and aorta

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8
Q

When are the four chambers of the heart formed during gestation?

A

between 2 and 8 weeks

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9
Q

Where is the heart located in infants?

A

high in chest below the 4th intercostal

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10
Q

How do you do a cardiac assessment on a child?

A

obtain full med hx
birth complications
past med hx of parents
prenatal care
assess feedings and growth and development
dizziness
assess vitals
look for edema, clubbing, click or murmurs

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11
Q

between the ages of 1-6 the heart is […]

A

4x the size of birth

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12
Q

between the ages of 6-12 the heart is […]

A

10x the size of birth

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13
Q

What prenatal factors can predispose children to congenital heart disease?

A

maternal rubella, alcohol use, age older than 40, and type 1 diabetes

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14
Q

what are the 4 main groups of congenital heart defects?

A

1.) defects that result in increased pulmonary blood flow
2.) obstructive defects
3.) defects that decreased pulmonary blood flow
4.) mixed defects

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15
Q

What is atrial septal defect?

A

A hole located in septum between left and right atrium > which causes an increase in blood volume to the right atrium > which causes mixture of oxygenated and deoxygenated blood in right atrium

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16
Q

As a nurse what are you gonna do for Atrial Septal Defect?

A

assess feeding and growing
auscultate for loud and harsh heart sounds

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17
Q

What is a Ventricular septal defect?

A

opening between right and left ventricle that causes increased pulmonary blood flow which causes pulmonary hypertension

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18
Q

What are ventricular septal defect cues? What do you need to consider?

A

Symptoms may start at 4-8 weeks of age
infant may tire easily when feeding
failure to thrive
decreased appetite
fever
muscle joint pain
systolic murmur
frequent pulmonary infections
a chest radiography reveals cardiomegaly

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19
Q

VSD cues

Ventricular septal defect

A

loud/harsh murmur at the left sternal border
a thrill may be felt on chest
wet lung sounds if pulmonary edema present

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20
Q

What is the treatment for ASD and VSD?

A

low does aspirin after cathe lab procedure for ASD
surgery
closure in cathe lab
diuretics

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21
Q

Patent Ductus Arteriosus

A

ductus arteriosus fails to close at birth which causes blood flow in pulmonary artery from aorta instead of systemic circulation causing pulmonary vascular congestion

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22
Q

Patent ductus arteriosus cues

A

machine like hum murmur
bounding pulse
rales on auscultation
large gap between systolic and diastolic BP readings

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23
Q

patent ductus arteriosus treatment

A

Lasix
Extra calories for infants formula or breastmilk
Indomethacin

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24
Q

What is indomethacin?

A

NSAID normally used for arthritis but for PDA infants it causes constriction and closure of the PDA defect

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25
Q

Aortic Stenosis and what does it cause?

A

obstruction/narrowing of the aortic valve between the left ventricle and aorta
causes decreased cardiac output and left ventricular failure

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26
Q

Symptoms of aortic stenosis for infants

A

Hypotension, tachycardia, poor feeding

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27
Q

Symptoms of AS for children

A

activity intolerance, dizziness, chest pain,

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28
Q

Treatment for AS

A

dilation in cath lab
beta blockers or calcium channel blockers

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29
Q

Pulmonary stenosis and what does it cause?

A

Narrowing of pulmonary valve/artery causing obstruction from right ventricle to pulmonary arteries
Results in a backup of blood to right atrium

30
Q

Pulmonary stenosis symptoms

A

systolic ejection murmur, cyanosis depending on size of narrowing, lead to heart failure

31
Q

PS treatment

Pulmonary Stenosis

A

balloon angioplasty in cath lab

32
Q

What is tetralogy of fallot

A

Combination of 4 heart defects present at birth

33
Q

What are the 4 major defects of tetralogy of fallot?

A

1.) Pulmonary stenosis
2.) Right ventricular hypertrophy
3.) Overriding Aorta
4.) Ventricular Septal Defect

34
Q

What is an overriding aorta?

A

enlarged aortic valve so it sits over both sides of ventricles instead of only the left ventricle

35
Q

What is right ventricular hypertrophy?

A

enlargement/thickening of right ventricular muscle walls due to increased pressure

36
Q

When is tetralogy of fallot diagnosed?

A

Within the first weeks of life and when infant is showing signs of cyanosis

37
Q

What are cues of TOF?

A

color changes during feeding or crying
hyper cyanotic spells, dyspnea, agitation, hypoxemia

38
Q

What is a Tet spell what do you do?

A

dyspnea, agitation, hypoxemia
If this occurs you place infant in a knee-chest position

39
Q

What do you assess for TOF?

A

increased work of breathing
decreased o2 sat
clubbing of fingers (older child)

40
Q

What is a lab result for children with a Hx of TOF?

A

POLYCYTHEMIA

41
Q

what is transposition of the great arteries and what does it cause?

A

defect where the pulmonary artery and aorta are not in their normal position
Aorta is connected to right vent instead of left
Pulmonary artery is connected to left vent instead of right
Causes poorly oxygenated vital organs

42
Q

When is transposition of the great arteries diagnosed?

A

the first few days of life when infant has cyanosis
septal defect or PDA must exist to oxygenate blood

43
Q

What is the main medication given for TGA before corrective surgery is performed and what does it do?

A

PROSTAGLANDIN E1
-maintains ductal patency and ensure adequate systemic blood flow

44
Q

What is Truncus arteriosus and what does it cause?

A

Failure of the septum formation resulting in a single vessel between the left and right ventricle
Causes mixed blood which increases blood flow to lungs and decreases systemic circulation

45
Q

Cues of Truncus Arteriosus

A

HF, murmur, cyanosis, delayed growth, fatigue, lethargy, poor feeding

46
Q

What is hypoplastic left heart syndrome? What does it cause?

A

Defect where all structures on left side of heart are underdeveloped
Cannot supply blood for systemic circulation and blood is pumped thru PDA

47
Q

Symptoms of Hypoplastic left heart syndrome

A

HF, cyanosis, lethargy, cold hands and feet
When PDA closes there is a decrease in cardiac output which results in cardiac collapse

48
Q

Treatment of Hypoplastic left heart syndrome

A

3 separate reconstruction surgeries,
poor prognosis

49
Q

What is coarctation of aorta?

A

narrowing of the lumen of the aorta leading to obstruction

50
Q

What can result from coarctation of aorta?

A

aortic rupture, aneurysm, and stroke

51
Q

Symptoms of COTA

A

Elevated BP
bounding pulse in upper extremties
low BP and cool skin in lower extremities
HF in infants
Dizziness
headaches

52
Q

Rheumatic Fever

A

An inflammatory disease that is a reaction to BETA-HEMOLYTIC STREPTOCOCCUS (GABHS)

53
Q

How do you get rheumatic fever?

A

within 2-6 weeks of a untreated upper resp infection

54
Q

Symptoms of rheumatic fever

A

tachycardia
heart murmur
muffled heart sounds
chest pain

55
Q

What are 4 major signs of rheumatic fever?

A

large joints with painful swelling
Fever of 38.2 - 38.8 (100.8 - 102.0)
Erythema marginatum (non itchy rash)
Narrowed mitral value causing heart murmur

56
Q

How is rheumatic fever diagnosed?

A

throat culture for GABHS
elevated CRP/ESR
blood antistreptolysin O titer

57
Q

What is the nursing care for rheumatic fever?

A

bedrest during acute phase
administer antibiotics
Assess for chorea which is sudden involuntary muscle movement
monitor rash

58
Q

Infective bacterial endocarditis and what does it cause?

A

infection of inner lining of the heart that can enter the bloodstream

59
Q

What bacteria can cause bacterial endocarditis?

A

S. viridans, C. albicans, S. aureus

60
Q

S/s of bacterial endocarditis

A

fever
malaise
arthralgias
diaphoresis
weight loss
splinter hemorrhages under fingernails

61
Q

what is the nursing care for bacterial endocarditis?

A

high dose antibiotics for 2-8 weeks and may require a picc line

62
Q

What kids are high risk if they have bacterial endocarditis?

A

children with artificial heart valves, hx, unrepaired heart disease, repaired congenital heart disease and residual

63
Q

what is Kawasaki disease?

A

an acute systemic inflammation of small and medium blood vessels

64
Q

what are the symptoms during the acute phase of kawasaki disease?

name 3 specific to this disease

A

rash
fever for 5+ days/unresponsive to meds
chills
*red eyes with no drainage
*red chapped lips
*strawberry tongue
swelling hands and feet
enlarged lymph nodes

65
Q

What is happening in the subacute phase of kawasaki?

A

resolved fever
peeling of palms and soles
temp arthritis
irritability

66
Q

what is happening in the convalescent phase of kawasaki and when does it fully resolve?

A

no s/s
abnormal lab values
resolves in 6-8 weeks of onset

67
Q

what is the nursing care for kawasaki?

A

monitor vitals
I&O
Daily weight
cardiac status
IV fluids
oral care
keep room dark and quiet

68
Q

what are the main meds and dosages for kawasaki treatment?

A

Gamma globulin 2g/kg over 8-12 hrs
Asprin 80-100mg/kg/day q6hrs
then 3-5mg/kg/day until platelets stabilize

69
Q

What is the education for kawasaki?

A

Follow up
irritability may last for 2 months
parent may have to perform ROM as arthritis may last up to several weeks
avoid live immunizations for 11 months

70
Q

What is the nursing care preop for catheterization?

A

Asses for allergies to dye or shellfish
keep NPO 4-6 hrs
mark pedal and radial pulses
skin prep for older children

71
Q

What is the nursing care post cathe lab?

A

continuous pulse ox
ABCs
I&O
push fluids to flush out contrast
Assess insertion site

72
Q

Heart Failure

A

Volume overload
pressure overload
decreased contractility

Pediatrics (17 decks)

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