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NURS 373 > Cardio, Neuro, Muscular > Flashcards

Cardio, Neuro, Muscular Flashcards

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1
Q

Symptoms of cardiac dysfunction (many)

A

tachypnea

tachycardia

pale, clammy

fatigue

confusion

resp distress

poor weight*

not meeting developmental milestones*

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2
Q

Symptoms of cardiac dysfunction in infants

A

sleepy, fatigued

not gaining weight

tachycardia

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3
Q

Cardiac assessment

A

heart sounds - murmur

lungs sound - crackles

family history - infant deaths, heart disease

medical history

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4
Q

Cardiac tests

A

echo - structural abnormalities

ECG - rhythm

chest x-ray

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5
Q

Types of cardiac defects (2)

A

1) Congenital

2) Acquired

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6
Q

Congenital cardiac defect

A

anatomic - abnormal function

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7
Q

Acquired cardiac defect

A

disease process

-infection

-autoimmune response

-environmental factors

-familial tendencies

-medications

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8
Q

Medication that commonly causes acquired cardiac defects

A

chemo meds

need to monitor heart function!

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9
Q

Congenital Heart defect

A

not always symptomatic right away

one of the top causes of death in 1st year of life

often have another anomaly (trisomy 21, 13, 18, +++)

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10
Q

Most common congenital heart defect

A

ventricular septal defect (VSD)

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11
Q

Biggest change between prenatal and postnatal period in regards to circulatory system

A

breathing!

going from not breathing to breathing

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12
Q

Circulatory changes at birth (4)

A

1) umbilical vein; umbilical arteries

2) foramen ovale

3) ductus arteriosus

4) ductus venosus

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13
Q

umbilical arteries

A

carry blood from hypogastric arteries TO placenta

severed with the cord at birth

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14
Q

umbilical vein

A

carry blood AWAY from placenta –> ductus venosus and liver

severed with the cord at birth

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15
Q

foramen ovale

A

valve opening that allows blood to flow directly to left atrium

right –> left atrium

closes at birth due to increased pressure in right atrium and decreased pressure in left atrium

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16
Q

ductus arteriosus

A

shunting of blood from pulmonary artery to descending aorta

closes almost immediately after birth due to increased oxygen content in blood

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17
Q

ductus venosis

A

connection of umbilical vein to inferior vena cava

closes after birth due to loss of blood flow from umbilical vein

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18
Q

Older classification for congenital heart disease

A

altered hemodynamics

1) acyanotic

2) cyanotic

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19
Q

Current classification for congenital heart disease (4)

A

1) increased pulmonary blood flow

2) decreased pulmonary blood flow

3) obstruction to blood flow (out of the heart)

4) mixed blood flow (saturated and desaturated blood mix within the heart)

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20
Q

1) increased pulmonary blood flow

A

abnormal connection between two sides of heart

either septum or great vessels

increased blood volume on RIGHT side of heart

increased pulmonary blood flow

decreased systemic blood flow

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21
Q

Symptoms of increased pulmonary blood flow

A

tachycardia

decreased urine output

crackles

edema

weight gain

cool extremities

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22
Q

Exampes of increased pulmonary blood flow defects (3)

A

1) Atrial Septal Defect

2) Ventricular Septal Defect

3) Patent ductus arteriosus

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23
Q

Which defect is common in premature babies?

A

Patent ductus arteriosus

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24
Q

2) decreased pulmonary blood flow

A

pulmonary blood flow obstructed ANDAnatomical defect (ASD or VSD) between the R & L sides of the heart

blood has difficulty exiting R side of heart

pressure on R side increases

allows desaturated blood to shunt R –> L

results in desaturation in L side of heart & systemic circulation

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25
decreased pulmonary blood flow defects (2)
1) Tetralogy of Fallot 2) Tricuspid atresia
26
Symptoms of decreased pulmonary blood flow defects
low oxygen saturation cyanosis cool limbs decreased urine output
27
Unique sign of Tetralogy of Fallot
squatting compensatory
28
3) obstruction to blood flow (out of the heart)
blood exiting the heart meets area of anatomical narrowing (stenosis) causing an obstruction to the blood flow increased pressure PROXIMAL to defect decreased pressure DISTAL to defect usually near the valve
29
Examples of obstruction to blood flow defects (3)
1) coarctation of the aorta 2) aortic stenosis 3) pulmonic stenosis
30
How to check for obstruction to blood flow
BP! arm BP will be HIGHER (proximal) leg BP will be LOWER (distal)
31
4) mixed blood flow (saturated and desaturated blood mix within the heart)
fully saturated systemic blood flow mixes with desaturated pulmonary blood flow causing relative desaturation of systemic blood flow pulmonary congestion occurs CO decreased
32
T or F: A child with a mixed blood flow heart defect will show signs right away.
FALSE will look ok until PDA closes
33
Congestive Heart Failure (CHF)
inability of the heart to pump an adequate amount of blood into the systemic circulation heart muscle becomes damaged if left untreated
34
Symptoms of CHF (many)
decreased urine output crackles decreased muscle strength fatigue tachycardia tachypnea edema diaphoresis poor feeding resp distress weight gain
35
Treatment Goals for CHF (many)
relieve symptoms decrease morbidity (including risk of hospitalization) slow progression of heart failure improve patient survival and quality of life
36
Main meds/interventions given for CHF (5)
1) oxygen -decrease demand 2) Digoxin -improves contractility 3) Captopril (ACE inhibitor) -decrease oxygen demand 4) Lasix -remove excess fluid and sodium 5) Beta-blockers
37
What to teach parents related to Digoxin?
how to check HR before giving Digoxin
38
Nursing care management for CHF (lots)
assist in measures to improve cardiac function monitor afterload reduction decrease cardiac demands reduce respiratory distress maintain nutritional status prevent infections assist in measures to promote fluid loss support child and family
39
What is a very important indicator of effective treatment in children with CHF?
weight!
40
Hypoxemia
symptom of many cardiac issues state where insufficient oxygen to meet metabolic demands can adversely affect every tissue in the body
41
Main signs of hypoxemia (4)
1) hypoxia 2) cyanosis 3) polycythemia 4) clubbing
42
polycythemia
increase in # of RBC but can increase viscosity of blood
43
Good place to check for cyanosis in multiple different skin tones
centrally in mouth!
44
Hypercyanotic Episode
SEVERE cyanotic episode associated with Tetralogy of Fallot can be spontaneous can be precipitated by events associated with decreased systemic vascular resistance
45
T or F: Hypercyanotic episodes are usually self-limiting.
TRUE
46
What to teach parents to do with kids having hypercyanotic episodes?
knee-chest position increases systemic vascular resistance
47
Endocarditis
caused by routine exposure to bacteremia associated with usual daily activities also: -dental work -invasive procedures -central lines -IV drugs
48
T of F: Endocarditis is normally seen in healthy kids.
FALSE most kids have other issues that increase their risk
49
Most common pathogens causing endocarditis (3)
1) Staphylococcus aureus 2) Streptococcus 3) Fungus
50
Endocarditis types (2)
1) acute 2) subacte
51
Signs of endocarditis
unexplained fever malaise weight loss Janeway Lesions Osler Nodes Roth Spots
52
Janeway Lesions
nontender erythematous macules on palms and soles more common in ACUTE
53
Osler Nodes
tender subcutaneous violet nodules mostly on pads of fingers and toes
54
Roth Spots
exudative, edematous hemorrhagic lesions of the retina with pale centers
55
Endocarditis diagnosis
CBC - elevated WBC EST - inflammatory process blood culture - which antibiotics or anti fungal
56
Endocarditis treatment
antibiotics -high dose and lengthy treatment* prophylaxis in high risk patient surgery
57
Cardiomyopathy
refers to abnormalities of the myocardium in which the ability of the muscle to contract is impaired
58
Causes of cardiomyopathy (many)
familial or genetic cause infection deficiency states metabolic abnormalities collagen vascular disease idiopathic
59
Hypertrophic Cardiomyopathy
one of most common forms of inherited cardiomyopathy hypertrophy of left ventricle
60
In which age group are signs and symptoms of cardiomyopathy most common? a) children under 1 b) older children
a) children under 1 older children can be asymptomatic
61
Clinical manifestations of cardiomyopathy
chest pain syncope palpitations heart failure symptoms sudden cardiac arrest physical exam may be normal
62
Diagnosis of cardiomyopathy
ECG exercise testing cardiac MRI genetic testing
63
Treatment of cardiomyopathy
based on symptoms correcting the cause
64
Therapies for cardiomyopathy
1st line: beta-blockers*** calcium channel blockers CAUTIOUS use of diuretics implantable cardioverter/defib heart transplant
65
Child with hypertension normally have: a) primary hypertension b) secondary hypertension
b) secondary hypertension secondary to structural abnormality or underlying pathology renal disease cardiovascular disease endocrine or neurologic disorders
66
Symptoms of hypertension
vision, gait headache - banging head*, holding head crying, irritability increased BP
67
Stage 1 hypertension
above 95th percentile for age group
68
Stage 2 hypertension
above 99th percentile for age group
69
Treatment for hypertension
find the cause pharmacological - 1 med at a time lifestyle
70
Kawasaki disease
aka monocutaneous lymph node syndrome acute systemic vasculitis affecting medium sized arteries, especially coronary arteries unknown cause self-limiting
71
How long does Kawasaki disease last without intervention?
12 days
72
Why do we still want to treat it?
could result in coronary artery disease want to identify early and treat
73
Diagnostic criteria for Kawasaki
1) at least 5 days of fever PLUS 2) 4/5 of the CRASH criteria
74
CRASH criteria for Kawasaki
Conjunctivitis Rash Adenopathy Strawberry tongue Hands and feet
75
Phases of Kawasaki Disease (3)
1) Acute 2) Subacute 3) Convalescence
76
Acute phase
onset of high fever, unresponsive to antibiotics & antipyretics
77
Subacute phase
resolution of fever & lasts until all clinical signs disappear
78
Convalescent
clinical signs resolved but lab values are not normal
79
Kawasaki disease treatment (2)
1) IV immunoglobulin 2) Aspirin*
80
Types of shock (3)
1) hypovolemic 2) distributive 3) cardiogenic
81
Causes of hypovolemic shock
blood loss, plasma loss, extracellular fluid loss
82
Causes of distributive shock
reduction in peripheral vascular - e.g. sepsis, anaphylaxis
83
Causes of cardiogenic shock
after surgery, dysrhythmias
84
Stages of shock (3)
1) Compensated shock 2) Decompensated shock 3) Irreversible or terminal shock
85
1) Compensated shock
initially compensated quite well, vital organs maintained tachy, decreased urine output
86
2) Decompensated shock
more symptoms may see changes in neuro status
87
3) Irreversible or terminal shock
NO urine thready, weak pulse very affected neurologically
88
Shock management
ventilation fluids -IV access super important! improvement of cardiac function
89
How much fluid to give for shock
20 mL/kg bolus then reassess
90
Cerebral palsy
group of permanent disorders of development of movement and postures causes activity limitations disturbances in the developing fetal or infant brain abnormal muscle tone and coordination
91
Common co-morbidity with cerebral palsy
epilepsy
92
T or F: Most cases of cerebral palsy are caused by unknown brain abnormalities.
TRUE
93
Etiology of cerebral palsy
unknown intrauterine exposure to chorioamnionitis prematurity periventricular leukomalacia shaken baby syndrome
94
Types of cerebral palsy (3)
1) Spastic 2) Dyskinetic 3) Ataxis
95
Spastic cerebral palsy
increased muscle tone, poor control of posture, balance and coordinated movements
96
Dyskinetic cerebral palsy
slow, worm-like movements of extremities, trunk, face and tongue
97
Ataxic cerebral palsy
rapid repetitive movements; wide gait, unable to hold objects
98
What is the most common type of cerebral palsy?
spastic
99
Cerebral palsy diagnosis
assessment of at-risk infants -e.g. difficult delivery, LBW, seizures, hypoglycaemia, emergency C-section, placental abnormalities neurologic examination and history neuroimaging metabolic and genetic testing
100
Possible signs of cerebral palsy (many)
poor head control after age 3 months clenched fists after age 3 months no smiling age by 3 months stiff or rigid limbs arching back/pushing away floppy tone unable to sit without support at age 8 months  excessive irritability persistent tongue thrusting frequent gagging or choking with feeds
101
Goals of therapy for cerebral palsy
locomotion, communication, self-help motor function correct defects education socializaiton
102
Therapeutic management of cerebral palsy
ankle braces surgery drugs for pain and seizures (Baclofen) botulinum A injections- localized spasticity Baclofen – implanted pump dental hygiene OT
103
Why is dental hygiene especially important in those with cerebral palsy?
seizure meds can erode gum tissue
104
Spina bifida
failure of osseous spine to close
105
Spina bifida types (2)
1) spina bifida occulta 2) spina bifida cystica
106
Spina bifida occulta
not visible externally
107
Spina bifida cystica
visible defect saclike protrusion
108
What condition is spina bifida commonly associated with?
hydrocephalus increased fluid in the brain associated with learning disabilities, seizures, UTIs, bowel dysfunction
109
Muscular dystrophy
genetic origin GRADUAL degeneration of muscle fibers, progressive weakness, and wasting of skeletal muscles increasing disability and deformity with loss of strength
110
Duchenne Muscular Dystrophy (DMD)
SEVERE X-linked inheritance pattern; one third are fresh mutations develop normally until about age 3
111
Characteristics of Duchenne Muscular Dystrophy
onset between ages 2 and 7 years progressive muscle weakness, wasting, and contractures calf muscles hypertrophy progressive generalized weakness in adolescence death from respiratory or cardiac failure
112
Diagnostic evaluation of Duchenne Muscular Dystrophy
most reliable: muscle biopsy elevated CK** EMG DNA test characteristics
113
Clinical manifestations of Duchenne Muscular Dystrophy
waddling gait, frequent falls, Gower sign lordosis enlarged muscles, especially thighs and upper arms profound muscular atrophy in later stages varying degrees of mild cognitive impairment
114
Primary goal of management for Duchenne muscular dystrophy
maintain function in unaffected muscles as long as possible
115
Therapeutic management for Duchenne muscular dystrophy
NO effective treatment established swimming!!* physio physical activity genetic counselling
116
T or F: Spinal cord injuries are usually the result of INDIRECT trauma.
TRUE MVA*
117
Paraplegia
complete or partial paralysis of lower extremities
118
Tetraplegia
lacking functional use of all four extremities (formerly called quadriplegia)
119
Which nerve do higher spinal cord injuries affect?
phrenic nerve paralyzes diaphragm ven dependent

NURS 373 (12 decks)

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