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children > Cardiovascular Dysfunction > Flashcards

Cardiovascular Dysfunction Flashcards

1
Q

Hypotension for neonate

A

Systolic BP : < 60mmHg

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2
Q

Hypotension for infants ( 1 -12 months )

A

Systolic BP : < 70mmHg

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3
Q

Hypotension for children 1 - 10 years

A

Systolic BP : < 70mmHg + ( 2x ( age in years )

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4
Q

Hypotension for children older than 10 years

A

Systolic BP : < 90mmHg

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5
Q

So what do we look out for in circulation?

A

heart rate, pulse quality, capillary refill time and blood pressure

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6
Q

What does tachycardia mean?

A

Tachycardia can be early sign of hypoxia, low perfusion, and can reflect fever, anxiety, pain or excitement

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7
Q

What does brachycardia in children <60bpm and neonates < 100bpm mean?

A

It indicates critical hypoxia and ischaemia

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8
Q

What are the early signs?

A
  • Tachycardia
  • Altered perfusion
    skin : prolonged capillary refill
    brain : altered level of consciousness
    kidneys : decreased urine output
    pulse : weak or thread
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9
Q

What are the late signs?

A
  • Cold & clammy
  • Poor capillary refill
  • Hypotension
  • Bradypnea
  • Acidosis
  • Flaccid tone
  • Decreased response to pain
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10
Q

What is the physical examination for circulation?

A
  1. Compensatory phase

Vital signs are within the normal range for
the patient’s age. If incongruent with the
child’s clinical need, considered to be in
some form impending respiratory or
circulatory distress

  1. Skin perfusion
    - Temperature
    - Colour : pale, cyanosis
  2. Peripheral pulses
    - Heart rate - quality e.g. weak or strong
    - Site
    Infant/ young children : brachial, femoral
    Older children : Carotid
  3. Capillary refill
    - Check : kneecap, foot, toes, hands or forearm ( ensure child is not cold from exposure )
  4. Level of consciousness
    - Alertness
    - Responsiveness
  5. Urine output
    - Renal perfusion
    - Normal 1-2ml/kg/hr
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11
Q

Fetal and postnatal circulation

A
  • fetal heart begin at 1st month of gestation
  • Heart rate and blood begins circulation at 21 days of gestation
  • Lungs : non-functional
  • Fetal oxygenation occurs via placenta
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12
Q

What are the circulatory changes occur during transition to extra uterine life?

A
  • Inspirated oxygen dilated pulmonary vessels, decrease vascular resistance and increasing pulmonary blood flow which facilitates lung expansion
  • Foramen ovale ductus venosus and ductus arteriosus close functionally soon after birth
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13
Q

Diagnosis of congenital heart disease

A
  • Antenatal check-up
  • After birth : heart murmurs
  • Electrocardiogram ( ECG )
  • 2D echocardiogram
  • Cardiac Catheterization
  • Cardiac magnetic resonance imaging
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14
Q

What are the known risk factors of congenital heart disease?

A
  • Environmental exposures
  • Drug exposures
  • Maternal diabetes
  • Maternal reproductive history
  • Family history - 15% parents have congenital heart disease
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15
Q

What are the types of congenital heart disease?

A
  1. Obstruction to blood flow
  2. Non-cyanotic heart ( left -> right shunt )
  3. cyanotic ( right -> left shunt )
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16
Q

Obstruction to blood flow

A
  • Aortic stenosis
  • Mitral / pulmonary valve stenosis
  • Coarctation of aorta
17
Q

Non-cyanotic heart disease

A
  • Patent ductus arteriosus

- Septal defects ( atrial and ventricular septal defect )

18
Q

Cyanotic heart disease

A 
Tetralogy of Fallot
• Transposition of great
vessel
• Total anomalous
pulmonary venous
return
19
Q

Non-cyanotic heart disease

A
  • present with signs of congestive heart failure and / or heart murmurs that are heard during physical examination
  • Left to right shunt lesion increases in pulmonary circulation eg atrial septal defect ( ASD ), Ventricular Septal Defect ( VSD ) or Patent Ductus Arteriosus ( PDA )

Obstructive lesions e.g. aortic stenosis, coarctation of aorta

20
Q

Cyanotic heart disease

A
  • It results from structural and flow anomalies, developed in-utero
  • Normal oxygen saturation on the right is 70-75% and on the left is 95-98%.
  • Right to left shunting - shunting of deoxygenated blood into the systemic circulation
  • Some cyanotic heart is highly dependent on ductus arterosus, cyanosis can be present when it begins to close
21
Q

What is heart failure?

A
  • It is the state where the cardiac output is inadequate to meet the demand of the body
22
Q

What is the difference between adults and children?

A

adults : causes usually ischemic and hypertensive

children : majority of heart failure is congestive, resulting from excessive left to right shunting

23
Q

Non-cyanotic heart disease

A

Blood shunts from left to right

Congenital heart disease

24
Q

Cyanotic heart disease

A

Blood shunts from right to left

25
Q

Congenital heart treatment

A

Surgery
- Total anomalous pulmonary venous drainage - at birth
- Transposition of great arteries - within a few days
- A few months or years later, depend on :
Age
Overall health, extent of disease
Expectations for the course of defects
Temporary shunt to redirect the blood flow

26
Q

What are the nursing care for CHD?

A
  • Ventilator
  • Intravenous catheters
  • Extracorporeal membrane oxygenation ( ECMO )
  • Arterial line
  • Nasogastric tube
  • Urinary catheter
  • Chest tubes
  • Cardiac monitor
  • Medication
  • Long term care management
27
Q

What is Kawasaki Disease?

A

Presentation : Cardiac abnormalities that present in similar manner to children with decreased myocardial contractility, myocarditis or coronary insufficiency.

  • Inflammation of blood vessels
  • Affects mucus membrane, lymph nodes, walls of blood vessels and the heart
28
Q

What is the specific clinical manifestation?

A

High fever persisting for at least 5 days
• Rash: Polymorphous exanthema, never vesicular
or bullous
• Red eyes without discharge
• Erythema and cracking of lips, strawberry tongue
• Cervical lymphadenopathy (>= 1.5cm in diameter)
• Acute: erythema and oedema of hands and feet.
Convalescent: skin desquamation of the tips of
fingers and toes

29
Q

What is the acute phrase?

A

7-14 days, characterized by fever and inflammatory changes

30
Q

What is the subacute phase?

A

Approximately next 10-25 days after onset of condition
• Irritablity, anorexia, conjunctival injection persist
• Desquamation of fingers and toes
• May have arthritis and arthralgia
• Myocardial dysfunction
• Thrombocytosis is common

31
Q

What is the convalescent phrase?

A

6-10 weeks when clinical signs returns to normal

32
Q

What is the criteria for complete KD/incomplete KD?

A
  1. Hematological
    - Raised ESR and CRP, mild anemia, thrombocytosis
  2. Cardiovascular and Respiratory
    - Cough, rhinorrhea
    - Echogram - structural abnormalities, cardiomegaly
    - Tachycardia, S3 gallop rhythm, murmur of mitral/aortic regurgitation
    - Chest radiography- cardiomegaly
    - Signs of cardiac failure
    - Pulmonary congestion
  3. Renal
    - Hypoalbuminemia
    - Occasional proteinuria
  4. Gastrointestinal
    - Diarrhea
    - Vomitting
    - Abdominal pain
33
Q

What is the management for Kawasaki Disease?

A

Intravenous Immunoglobulin (IVIG)
• Primary treatment in patient with KD
• Administered within first 10 days
• Dose: 2g/kg as a single infusion (start slow and increase rate gradually)
• Close monitoring during infusion eg. Vitals Q10mins x 3 then Q15mins, Q30mins
Aspirin
• Anti-inflammatory and anti-pyretic
• Stop after 6-8 weeks if echo is normal
2D Echogram
• During subacute phase to detect cardiovascular changes
• Day 14 2D echogram to review condition

34
Q

Nursing management for children with cardiovascular dsyfunction

A 
1. Promote adequate cardiac output and
oxygenation
• Monitor vital signs
• Observe and manage hypoxia
• Administer oxygen and medication
• Decrease cardiac workload
  1. Monitor for signs of altered cardiac output
    • Pulmonary edema
    • Arrythmias: tachycardia or bradycardia
  2. Monitor for signs of respiratory distress
    • Administer oxygen as prescribed
    • Elevate head of bed to facilitate breathing
    • Monitor blood gas
35
Q

Nursing problems for cardiovascular dysfunction

A 
Decreased cardiac output
• Ineffective tissue perfusion:
Cardiovascular
• Activity tolerance
• Imbalanced nutrition
• Risk for infection
• Delayed growth and development
• Ineffective breathing pattern
• Excess fluid volume
36
Q

Nursing management for children with cardiovascular dysfunction

A

Reduce cardiac demand
• Keep child warm
• Schedule nursing intervention
• Allow rest in-between feeds. Consider Speech Therapist referral
• Oral/Naso gastric feeding if infant becomes fatigue
Promote adequate nutrition
• Daily food intake and weight gain
• Well balanced diet, frequent feeding/meals
• Dietician referral: high calorie and low sodium diet
Evaluate fluid status
• Strict fluid intake and output measurement
• Monitor daily weight and edema
• Monitor electrolytes value
Prevent Infection
• Immunizations

children (12 decks)

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