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NUR 440 Exam 2 > Cardiovascular Dysfunction > Flashcards

Cardiovascular Dysfunction Flashcards

1
Q

Digoxin Use

A

Improving force and contractility
Slowing heart rate and conduction
Available in elixir form

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2
Q

Digoxin Toxicity

A

Narrow margin for safety
Symtoms: bradycardia, dysrhythmias, anorexia, N/V
When in doubt: Send for level assessment

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3
Q

Digoxin Nursing Responsibilities

A 
Calculate correct dose
Check apical pulse prior to admin
Order to specify HR to be held
Infant 90-110 & Young children 70
Spontaneous throwing up- possible toxicity
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4
Q

Congenital Heart Disease

A

Increased pulmonary blood flow- Ventricular Septal Defect
Obstruction to systemic flow- Coarctation of the Aorta
Decreased pulmonary blood flow- Tetralogy of Fallot
Mixed blood flow- Transposition of the Great Arteries

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5
Q

Ventricular Septal Defect

A

Defects allows blood totravel from high pressure L to lower pressure R
Increased pulmonary blood flow
High risk for respiratory infections
Excess fluid, Murmur from hole, Blood is shunting
Care similar to heart failure

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6
Q

Coarctation of the Aorta

A

Blood exiting the heart meets an area of obstruction due to stenosis
Obstruction to blood flow
BP higher is upper extremities, lower in lower extremities
Decreased C.O.

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7
Q

Coarctation of the Aorta Symptoms

A

Leg pain especially with exercise, dizziness, HA, epistaxis

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8
Q

Coarctation of the Aorta Treatment

A

Surgery, Balloon angioplasty

6-8mo post op still have hypertension

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9
Q

Tetralogy of Fallot

A

Four Abnormalities
1. Pulmonic Stenosis
2. Ventricular Septal Defect
3. Overriding Aorta- blood comes from both left and right ventricle
4. Right Ventricular Hypertrophy- thickening of muscle
DECREASED pulmonary blood flow
Sending un-oxygenated blood back to the body

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10
Q

Tetralogy of Fallot Symptoms

A 
N/V, diarrhea, possible murmur
CYANOSIS
Boot shaped heart
Polycythemic- increases risk for thromboembolic events (stroke)
Clubbing 
High Hgb, Hct, RBCs
Low plasma
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11
Q

Tetralogy of Fallot Treatment for Parents

A 
Place infant in knee to chest position
Use a calm approach
Apply 100% O2
Give morphine IV or Subq
Give IVF to rebalance 1-5cc/kg
Repeat morphine as needed
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12
Q

Transposition of the Great Arteries

A

A mixed defect as blood flow pattern- blood from body comes to right atria to right ventricle to aorta out to body
TOTALLY un-oxygenated blod returning to the body

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13
Q

Transposition of the Great Arteries Treatment

A

Surgery within 1st week of life
Punch a hole between atria if Patent foramen ovale and Patent ductus arteries are not open
PFO and PDA give blood a place to mix

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14
Q

Heart Failure

A

Inability of the heart to pump adequate amount and flow of blood to meet the body’s demands
From volume overload, pressure overload, decreased contractility or presence of high cardiac output demands

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15
Q

Heart Failure Symptoms

A 
Tachycardic
Cool and pale
Excess fluid 
Weight loss- infants
Weight gain- child
Diaphoretic- mostly in infants
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16
Q

Heart Failure Causes

A

Congenital heart defects account for 90% of CHF in 6-12 months of life from volume overload
Acquired heart disease or decreased contractility- shock anemia, asphyxia, electrolyte imbalances, ischemia
Cardiomyopathy, Rheumatic Heart disease and Kawasaki disease

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17
Q

Heart Failure- Secondary Disease

A

Mostly secondary

Consequence of underlying cardiac issues

18
Q

Heart Failure Treatment

A

Medications for cardiac function- Digoxin, ACE Inhibitors (captopril or enalapril) and beta blockers (carvedilol)
Medication to decrease fluid and Na- Loop diuretic (furosemide), thiazide (chlorothiazide) and spironolactone
Decrease cardiac demands- monitor temp, semi fowlers
Improve tissue oxygenation- supplemental O2, URI, pulmonary HTN.

19
Q

Bacterial Endocarditis

A

Infection of the valves or inner lining of the heart

Causes: Strepto viridans, Staphlo aureus and Candida albicans

20
Q

Bacterial Endocarditis Symtoms

A

Low grade fever, pale, anorexia, recent weight loss, malaise, night sweats and chills, Janeway spots, murmur, dental history

21
Q

Bacterial Endocarditis Treatment

A

Administration of high dose antibiotic therapy for 2-8 weeks- Nafcillin is common
Follow up cultures to see progress
Support to preserve cardiac function
PIC lines, prophylactic antibiotics for dental work

22
Q

Bacterial Endocarditis Prevention

A

PREVENTION IS KEY!
Educate parents for high risk children- antibiotics before dental care, good oral health, signs and symptoms of the disease, IV therapy for long term antibiotics

23
Q

Rheumatic Fever

A

Inflammatory disease occurs 2-6 weeks after streptococcal pharyngitis
Carditis

24
Q

Rheumatic Fever Symptoms

A

Polyarthritis
Chorea- involuntary movement
Sore Throat

25
Q

Rheumatic Fever Treatment

A

Penicillin or erythomycin to treat infection
Antibiotic therapy is carditis is present
Aspirin is sued to reduce fever and discomfort from polyarthritis
Strep test
Passive ROM, good rest and nutrition and education

26
Q

Kawasaki Disease

A

Acute systemic vaculitis and often preceding upper respiratory infection

27
Q

Kawasaki Disease Symptoms

A

Fever, red conjunctivae, strawberry tongue, desquamating and edematous palms of hands and soles of feet
Irritability is most challenging

28
Q

Kawasaki Disease Heart Damage

A

Coronary artery damage that can lead to aneurysms or MI
Decreased LV function
CHF

29
Q

Kawasaki Disease Treatment

A

IV Ig High dose in 1st 7-10 days of illness helps to decrease chance of coronary artery issues
Aspirin therapy until the platelet count is normal

30
Q

Kawasaki Disease Nursing

A

Monitor VS w/temp and cardiac status.
Symptom relief with cool wash clothes, mouth care, chapstick, passive ROM in bathtub if arthritis present in large joints, emotional support, and medication administration

31
Q

Rheumatic Fever Nursing

A

Prevention! Strep test given to all with a sore throat and with a positive test to give all doses of the antibiotic.
Medications as ordered, passive ROM in tub for painful joints, promote rest, good nutrition and provide emotional support for family and child

32
Q

Cardiomyopathy

A

Abnormality in myocardium which impacts the ability for the muscle to contract

33
Q

Type of Cardiomyopathy

A

Dilated- most common- dilation of LV that tends to decrease contractility and reduce ejection fraction
Hypertonic- increase in muscle mass w/o increase cavity size
Restriction- rare

34
Q

Cardiomyopathy Symptoms

A 
Tachycardia
Dsypnea
Hepatoslenomegly
Fatigue 
Poor growth
35
Q

Cardiomyopathy Treatment

A 
Control heart failure 
Carvedilol
Treat dysrhythmias
Anti-coagulants to decrease risk of thromboembolism
IV inotropes, IV afterload reducer
LV assist device, ECMO
Heart Transplant
36
Q

Sympathetic and Parasympathetic

A

Sympathetic- increase HR

Parasympathetic- decrease HR

37
Q

Cardiac Output

A

Increase HR – Increase CO – Decrease Filling time

38
Q

Diagnostic Tools

A

Chest Xray- Heart size, have to hold your breath
EKG- Cant see as much, arrhythmia in children
ECHO- 1st to do, not painful, a window to the heart

39
Q

Cardiac Catheterization

A

Dye to view heart structures and functioning

40
Q

Cardiac Catheterization PreOP

A

NPO
Stop anticoagulants
Age-appropriate prep (teaching about it)
General anesthesia

41
Q

Cardiac Catheterization PostOP

A

Lying flat, leg straight 4-8hr
Check dressings for signs of bleeding- put pressure above site and call DR
Frequent pulse, CRT, warmth checks on extremities
Frequent VS

NUR 440 Exam 2 (4 decks)

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