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NU 374 > Ch. 27 > Flashcards

Ch. 27 Flashcards

1
Q

PDA

A

patent ductus arterious
- allows mixing between the pulmonary artery and aorta as it is a passageway between these two major vessels

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2
Q

PFO

A

patent foramen ovale
- a hole between the two atriums
- it allows mixing blood between the two right and left atrium

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3
Q

arrhythmia

A

an alteration in rhythm of the heartbeat in either time or force

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4
Q

cardiomegaly

A

enlargement of the heart

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5
Q

chorea

A

a movement disorder marked by involuntary spasmodic movements especially of the limbs and facial muscles and typically symptomatic of neurological dysfunction (such as that associated with a neurodegenerative disease or metabolic disturbance)

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6
Q

clubbing

A

bulbous enlargement of the tip with convex overhanging nail

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7
Q

desquamation

A

to peel off in scales

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8
Q

dyspnea

A

difficult or labored breathing

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9
Q

heart failure

A

a condition in which the heart is unable to pump blood at an adequate rate or in adequate volume

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10
Q

ischemia

A

deficient supply of blood to a body part (such as the heart or brain) that is due to obstruction of the inflow of arterial blood

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11
Q

lymphadenopathy

A

abnormal enlargement of the lymph nodes

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12
Q

murmur

A

an atypical sound of the heart typically indicating a functional or structural abnormality

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13
Q

orthopnea

A

difficulty in breathing that occurs when lying down and is relieved upon changing to an upright position (as in congestive heart failure)

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14
Q

polycythemia

A

a condition marked by an abnormal increase in the number of circulating red blood cells

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15
Q

tachycardia

A

relatively rapid heart action whether physiological (as after exercise) or pathological

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16
Q

tachypnea

A

abnormally rapid breathing : increased rate of respiration

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17
Q

vasculitis

A

inflammation of a blood or lymph vessel

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18
Q

digoxin

A

cardiac glycoside
- used to treat heart failure (CHF), SVTs, dysrhythmias
- aids in contractibility of the heart
- very small therapeutic level: 0.8-2.0ng/ml
- peak and trough levels apply due to narrow therapeutic - toxic range

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19
Q

furosemide

A

loop diuretic
- given to relieve swelling/edema/fluid retention caused by CHF

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20
Q

spironolactone

A

potassium-sparing diuretic
- given to relieve HTN caused by CHF

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21
Q

prostaglandin E

A

synthetic prostaglandin
- given to keep the PDA open with coarc

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22
Q

indomethacin

A

NSAID
prostaglandin inhibitor
give for PDA closure

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23
Q

ibuprofen

A

NSAID

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24
Q

captopril

A

ACE inhibitor

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25
Q

aspirin

A

salicylate

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26
Q

IVIG

A

intravenous immunoglobulin: pooled antibody

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27
Q

digoxin s/sx of toxicity

A
  • N/V
  • diarrhea
  • bradycardia (if HR is <90 infant <70 child or <60 adolescent, hold dose and contact HCP)
  • give digiband for toxicity
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28
Q

digoxin dosing and measuring

A

therapeutic level: 0.8-2.0
avoid administering with meals
give PO 1hr before or 2hr after meal
give regularly Q12h,
if dose was missed by 4h, do not give med and administer next scheduled dose; if child misses two doses in a role- call HCP (HF may come back due to missed doses)
do not repeat dose if child vomits

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29
Q

what lab values affect digoxin?

A

hypokalemia (<3.5)
- increase dig level

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30
Q

hearts position in the chest

A

horizontal compared to adult until age 7
- apex is higher until age 7
- as heart and lungs grow downward placement of apex

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31
Q

which ventricle functionally dominates in the begin weeks of life?

A

the right ventricle

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32
Q

children have ___ baseline heart rates than adults

A

higher

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33
Q

innocent murmurs

A

heard in the 2nd and 3rd ICS
- disappear with changes in movement
- exacerbate with fever, stress, exercise, anemia

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34
Q

children have __ CO compared to adults

A

lower

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35
Q

assessment of cardiac output

A
  • color
  • skin
  • perfusion
  • level of consciousness
  • breathing
  • position of comfort
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36
Q

children are able to manage their CO by ____

A

increasing their heart rate

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37
Q

AR and RR increase with ____

A
  • stress
  • anxiety
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38
Q

hypotension is a ___ indicator of cardiac decomposition

A

late

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39
Q

hypotension by systolic BP

A

neonate: < 60mmHg
infants (1-12m): < 70mmHg
children (1-10y): < 70mmHg + (age in years x2) mmHg
children (>10y): < 90mmHg

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40
Q

5 areas to listen to the heart

A

aortic
pulmonic
erb’s point
tricuspid
mitral

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41
Q

indicators of cardiac dysfunction

A
  • poor feeding
  • tachycardia/tachypnea
  • FTT/poor weight gain/activity intolerance
  • developmental delays
  • prenatal hx: some risk factors include rubella exposure, alcoholism, DM, lupus, advanced maternal age, teratogenic meds: Dilantin
  • family hx of cardiac disease
  • co-exists with syndromes such as down’s
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42
Q

physical assessment findings of cardiac dysregulation

A
  • Tachycardia (know approximate normal ranges for age)
  • Decreased peripheral perfusion (cool, clubbing, <CR, weak pulses)
  • Murmurs
  • Thrills, Heaves
  • Enlarged heart with possible deformed chest
  • Dysrythmias
  • Pulmonary congestion – HF (heart failure) or CHF
  • Respiratory distress
  • FTT
  • Polycythemia
  • Anoxic spells
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43
Q

types of dysrythmias

A
  • bradycardia
  • tachycardia
  • SVT
  • normal sinus arrhythmia (increase with inspiration) and physiologic splitting (blow away)
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44
Q

cardiac testing: cardiac catheter

A
  • a test or treatment for certain heart or blood vessel problems, such as clogged arteries or irregular heartbeats.
  • It uses a thin, hollow tube called a catheter. The tube is guided through a blood vessel to the heart
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45
Q

cardiac testing: pulse oximetry

A

the amount of oxygen in the body

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46
Q

cardiac testing: labs

A

CBC
ABGs

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47
Q

cardiac testing: EKG

A

records the electrical signals from the heart. It shows how the heart is beating

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48
Q

cardiac testing: ECHO

A

ultrasound pictures of the heart

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49
Q

cardiac testing: CXR

A

detect presence of calcium in heart and blood vessels
- Its presence may indicate fats and other substances in your vessels, damage to your heart valves, coronary arteries, heart muscle or the protective sac that surrounds the heart

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50
Q

cardiac assessment post-cardiac catheterization

A
  • pulses distal to insertion site
  • temp and color of extremity
  • VS q15 min
  • monitor hypotension
  • HR: heart sounds, bradycardia, dysthymias
  • monitor s/ bleeding, if bleeding apply pressure 1” above insertion site
  • keep extremity still/bed rest for 4-8h, work with family and involve parent to maintain child extremity straight
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51
Q

d/c teaching for parent post cardiac catheterization

A
  • quiet activity up to 3 days after procedure
  • have a shower or sponge bath verses bath tub emersion
  • check temp 1x/day for 3 days; 100.5+ report to PCP
  • keep dressing on post procedure
  • check color/temperature of extremity in comparison
  • changes in skin color or temperature, or flutter in chest- report to PCP
  • acetaminophen and ibuprofen for pain
  • come back for FUP
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52
Q

CP monitor- If a 5 lead set is used: order of placement

A

RA=right arm (placed under the right clavicle MCL, white)
RL=right lower/leg (placed on the right lower abdomen, green)
LA=left arm (placed under the left clavicle MCL, gray)
LL=left lower/leg (placed on the left lower abdomen, red)
V1=ventricular lead (placed at the 4th ICS right sternal border, brown)

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53
Q

CP monitor- If a 3 lead set is used: order of placement

A

RA=right arm (placed under the right clavicle MCL, white)
LA=left arm (placed under the left clavicle MCL, gray)
LL=left leg (placed on the left lower abdomen, red)

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54
Q

normal ECG: P wave

A

depolarization of atria in response to SA node triggering

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55
Q

normal ECG: PR interval

A

delay of AV node to allow filling of ventricles

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56
Q

normal ECG: QRS complex

A

depolarization of ventricles, triggers main pumping contractions

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57
Q

normal ECG: ST segment

A

beginning of ventricle repolarization, should be flat

58
Q

normal ECG: T wave

A

ventricular repolarization

59
Q

arrhythmias: brady

A

too slow

60
Q

arrhythmias: tachy

A

too fast

61
Q

arrhythmias: absent

A

not present

62
Q

pre- cardiac catheterization nursing care

A
  • preoperation/explanation geared towards developmental level
  • sedation
  • NPO
63
Q

post-cardiac catheterization nursing care

A
  • cardiac and pulse oximetry monitoring
  • monitor pulses, temperature, color of extremity
  • VS q15m- heart rate, rhythm, BP
  • dressing for bleeding/hematoma
  • I&O
  • hypoglycemia
64
Q

prenatal heart

A
65
Q

post-natal heart

A
66
Q

CHD symptoms

A
  • increased pulse
  • increased respirations
  • retarded growth/FTT
  • dyspnea, orthopnea
  • fatigue/sick often
  • URI
  • aspiration risk
  • not a lot of energy/burn a lot of calories during feedings so they don’t feed well (little bits often, or increase calories, etc.)
67
Q

clues that something is wrong with baby (accronym)

A

FEAR

68
Q

FEAR: F

A

poorly feeding
- using lot of energy to extract fluid from bottle
- RR > 60bpm, unable to coordinate

focus on family coping

69
Q

FEAR: E

A

energy is low (fatigued)
- takes a few sips and then pauses
- head bobbing
- frequent napping

educate parents on topics like G&D, fluid and electrolyte balance and feeding interventions

70
Q

FEAR: A

A

always fussy (bc hungry)
- audible grunting may be confused as baby being fussy
- crying when hungry but no energy left to suck when bottle offered

activity intolerance can be improved with energy conversation

71
Q

FEAR: R

A

rapid respirations
- signs of respiratory distress
- low oxygen saturation
- RR above range for age

reinforce education and offer anticipatory guidance on topics like oxygenation, cyanosis, cold stress, signs of distress, and pharmacology

72
Q

what is the most frequent sign a nurse would observe in an infant with CHD?

A

increased WOB

73
Q

what is the most frequent complaint from parents of infants with CHD?

A

not eating well/poor feeding/tire quickly when feeding

74
Q

acyanotic: increased pulmonary blood flow

A
  • atrial septal defect
  • ventricular septal defect
  • patent ductus arteriosus
  • atrioventricular canal
75
Q

acyanotic: obstruction to blood flow from ventricles

A
  • coarctation of aorta
  • aortic stenosis
  • pulmonic stenosis
76
Q

cyanotic defects: decreased pulmonary blood flow

A
  • tetralogy of fallot
  • tricuspid atresia
77
Q

cyanotic: mixed blood flow

A
  • transposition of great arteries
  • total anomalous pulmonary venous return
  • truncus arteriosus
  • hypoplastic left heart syndrome
78
Q

acyanotic defects presentation

A
  • absence of cyanosis (unless CHF present)
  • typically presents as asymptomatic or signs of CHF
79
Q

acyanotic defects: treatments

A
  • wait and see
  • meds
  • simple surgery (only one stage)
80
Q

Abnormal circulation; oxygenated blood entering systemic circulation causes what type of blood flow pattern? (acyanotic)

A

left to right shunt

leading to increased pulmonary blood flow

81
Q

sx of increased pulmonary blood flow

A
  • increased fatigue
  • heart murmur
  • increased risk endocarditis
  • CHF
  • growth retardation
82
Q

atrial septal defects: clinical manifestations

A
  • fluid overload
  • pulmonary edema
  • pulmonary congestion
  • pulmonary HTN
  • resp. infection
  • pulmonary resistance
83
Q

what is atrial septal defect

A

hole between the L and R atrium
- movement of blood L to R
- mixing of oxygenated and deoxygenated blood into the lungs
- heart has to work harder
- fatigues
- hypertrophy of the R atrium (R side of the heart gets bigger)

84
Q

treatment of atrial septal defect

A
  • just watch if no signs of CHF, usually go away by 1 year
  • signs of CHF, intervene with pharmacologic measures: digoxin, and diuretics: furosemide, spironolactone
  • surgery: if pedi has a large defect and meds are not working; put band on pulmonary artery: less flow to the lung, OR put a patch in it
85
Q

what is ventricular septal defect

A

opening at the septum between the L and R ventricles
- blood moves L to R
- extra blood moves into the lung
- heart has to work harder
- fatigues
- hypertrophy of the R atrium (R side of the heart gets bigger)

86
Q

treatment of ventricular septal defect

A
  • dx with an echo
  • just watch if no signs of CHF, usually go away by 1 year
  • signs of CHF, intervene with pharmacologic measures: digoxin, and diuretics: furosemide, spironolactone
  • surgery: if pedi has a large defect and meds are not working; put band on pulmonary artery: less flow to the lung, OR put a patch in it
87
Q

sx of ventricular septal defect

A
  • fluid overload
  • pulmonary edema
  • pulmonary congestion
  • pulmonary HTN
  • resp. infection
  • pulmonary resistance
88
Q

what is PDA

A

for some reason there are prostaglandins circulating keeping the PDA open after birth
- blood moves L to R

term babies:
_ % close at _ hours
90% close at 48 hours
100% close at 72 hours

89
Q

treatment of PDA

A
  • watch
  • if it does not close, give indomethacin IV (prostaglandin inhibitor)
  • 3 courses of pharm, then do ligation surgery
90
Q

sx of PDA

A
  • fluid overload
  • pulmonary edema
  • pulmonary congestion
  • pulmonary HTN
  • resp. infection
  • pulmonary resistance
91
Q

what is coarctation of aorta

A

constriction of the aorta, narrowing of the aorta
- can be congenital or evolved later on in life
- can be cyanotic defect if bad enough
- decreased blood flow

92
Q

treatment for coarctation of aorta

A

surgical: cut out coarc piece of aorta and then sew the two segments of the aorta together

non-surgical: catheterization angioplasty: blow up balloon to open the narrowing (sometimes with stent); if PDA is open give prostaglandin E to keep open- even though blood is deoxygenates, it still allows blood to circulate to the lower extremities

93
Q

sx of coarctation of aorta

A
  • pulses: upper bounding, lower diminished/decreased
  • BP: upper HTN, lower hypotension
  • O2: upper high/normal, lower diminished/decreased
  • extremities: upper warm, lower cool/cold
  • pressure: upper increased (chi: HA, epistaxis, dizziness, diaphoretic, inf: crying/irritable, poor feeding, poor sleep, diaphoretic), lower decreased (ch. weakness, all signs of CHF can apply)
94
Q

cyanotic defects (presentation)

A
  • severe cyanosis and hypoxemia
  • “T” diagnoses including Tet spells
95
Q

cyanotic defects: treatment methods

A
  • pharmacology
  • complex surgeries (multiple stages)
96
Q

Abnormal circulation with unoxygenated blood entering systemic circulation causes what kind of blood flow pattern? (cyanotic)

A

right to left shunt
leads to decreased pulmonary blood flow

97
Q

sx of decreased pulmonary blood flow

A
  • squatting
  • cyanosis
  • clubbing: swollen end of fingers; cold, blue fingers
  • syncope
98
Q

hypoxemia

A

lower than normal arterial oxygen tension

99
Q

hypoxia

A

reduction in tissue oxygenation

100
Q

clinical presentation of hypoxemia

A
  • polycythemia: increased RBC –> clotting risk
  • clubbing
  • hypercyanotic spells (TET spells)
101
Q

cyanosis (infancy) treatment

A

initial treatment: prostaglandin E IV
purpose: increase pulmonary blood flow
effective tx outcome: stabilize oxygen saturation, await further treatment orders

102
Q

cyanosis (all pedi ages) treatment

A

initial treatment: IV/PO fluids
purpose: keep H&H viscosity w/in acceptable range to decrease CVA risk r/t decreased arterial oxygen carrying capacity
effective tx outcome: hct elevation to acceptable range. prepare to admin iron supplement and/or transfuse PRN. evidence of adequate hydration

103
Q

TET spell: treatment (all pedi ages)

A

initial treatment: positioning, oxygen, morphine
purpose: reduce venous return from lower extremities and increase SVR (shunt more blood to pulmonary artery)
effective tx outcome: resolution of cyanosis, respiratory distress, and irritability. no syncope or seizures

104
Q

what is tetralogy of fallot (hint: 4 conditions within the heart)

A

1 pulmonary stenosis: very narrow pulmonary artery (determines the severity of it)
2 VSD (very large)
3 overrriding aorta
4 R ventricle hypertrophy

  • cyanotic d/o- R to L shunt of deoxygenated blood causes mixing of blood and goes into the aorta; decreased pulm. BF
  • dx prenatally
105
Q

sx of tetralogy of fallot

A

normal O2 sat will be 70-80s (not 100%)
cyanotic: blue skin, lips
SOB

106
Q

treatment for tetralogy of fallot

A
  • surgery
  • supportive care
  • medications

(blank)

107
Q

what is a tet spell

A

a hypercyanotic spell in which O2 sat drops below 70-80s range
- triggered by crying episode or straining, something that makes them upset
- causes heart rate to raise and oxygen sat to drop

108
Q

tet spell management: medications

A

morphine
- to calm the baby down
- think resp depression will calm the baby

___ (blank) is used to push blood back into heart

109
Q

tet spell management: tone of voice and body positioning of child

A

stay calm
knee-to-chest position

110
Q

tet spell management: oxygen

A

give oxygen (low-bi)
goal is to get them back to their baseline (not 100%)

111
Q

tet spell management: IVF

A

we want to keep child hydrated
we need IV access for meds, etc.

112
Q

what is TOF repair

A

depends on degree of pulmonary stenosis (weeks after birth- a couple months- definitely by a year)
open up pulmonary artery (stenosis) and patch it
- allows for more blood flow to the lungs
will also patch up the VSD

good prognosis

113
Q

what is HLHS (hypoplastic left-heart syndrome)

A

the left side of the heart is hypoplastic or underdeveloped

  • left ventricle is very small
  • ASD
  • mitral valve is tiny/barely functioning (hypoplastic)
  • aortic valve is tiny/barely functioning (hypoplastic)
    *some babies mitral and aortic don’t function at all
114
Q

sx of HLHS

A

(blank)

115
Q

management of HLHS

A
  • prostaglandin E
  • immediate surgery
  • multiple stage approach to repair

best treatment: heart transplant (just a slim chance this will work)

116
Q

stages of HLHS repair

A

Norwood-first week of life
Bidirectional Glenn-age 3-6 months
Fontan-older than 2-4 years

117
Q

CHF patient problems

A
  1. impaired myocardial function
  2. pulmonary congestion
  3. systemic venous congestion
118
Q

CHF patient problems: impaired myocardial function symptoms

A
  • tachycardia
  • fatigue
  • weakness
  • restless
  • pale
  • cool extremities
  • decrease BP
  • decrease urine output
119
Q

CHF patient problems: pulmonary congestion symptoms

A
  • tachypnea
  • dyspnea
  • resp distress
  • exercise intolerance
  • cyanosis
  • difficulty feeding/sweating
120
Q

CHF patient problems: systemic venous congestion symptoms

A
  • peripheral and periorbital edema
  • weight gain
  • ascites
  • hepatomegaly
  • neck vein distention
121
Q

HF nursing management goals

A
  • Improve cardiac function
  • Decrease preload
  • Decrease cardiac demands
  • Improve tissue oxygenation
  • Decrease oxygen consumption
  • Nutrition status (NGT if RR >60bpm, small frequent, thickening feedings- adds calories and less likely to vomit)
  • diuretics
  • give O2
  • meds
  • # 1 sign of CHF: decreased UO
122
Q

hypokalemia causes (hint: DITCH)

A

D: drugs (loop diuretics, laxatives, glucocorticoids
I: inadequate consumption of K+
T: too much water intake
C: cushing’s syndrome
H: heavy fluid loss

123
Q

hypokalemia sx (hint: 7 L’s)

A

7 L’s
- lethargic
- low, shallow respirations..failure
- lethal cardiac dysrhythmias
- lots of urine
- leg cramps
- limp muscles
- low blood pressure (severe)

124
Q

treating hypokalemia: foods

A

Potatoes, pork
Oranges
Tomatoes
Avocadoes
Strawberries
Spinach
fIsh
mUshrooms
Musk melons: cantaloupe

carrots, raisins, bananas, green vegetables

125
Q

nursing management of a child with CHD

A
  • Help family adjust to diagnosis: let them mourn
  • Educate family about disorder (after mourning), use videos, print outs- explain tests, procedures, medications
  • Coping, supports
  • Preparation for surgery
  • Post op care and discharge teaching
126
Q

general cardiac surgery post-op care

A

VS (ex. continuous EKG monitoring, hypothermia, interarterial pressure, heparinized saline, CVP line) q1h post op, then q2h, maybe q4h when stable

Rest (provide sedation {immed. Post-op} to ↓ Cardiac workload; cluster your care being mindful of degree of cardiac demand {elevations in HR/RR})

Fluids (I/Os, daily weights, watch for s/sx renal failure, fluid restrictions to prevent hypervolemia (↑ cardiac demand), NPO while intubated, daily wt. {same conditions})

Pain (analgesics such as morphine, NSAIDS, perform treatments when med efficacy is high, decrease stress/stimulation) *Tylenol wont cut it

Anticoagulants (admin as ordered to maintain shunt patency and prevent clots around artificial valves etc., monitor coag. studies closely)

127
Q

congenital heart defects are caused by

A
  • family history
  • use of drugs/alcohol during pregnancy
128
Q

congenital heart defects are defects that the child

A

is born with

129
Q

murmur goes away when sitting up, concerned?

A

no

130
Q

acquired heart defects are defects that the child

A

develops after birth

131
Q

grade 1 murmur

A

faint

132
Q

grade 2 murmur

A

soft

133
Q

grade 3 murmur

A

moderate, loud, no thrill

134
Q

grade 4 murmur

A

loud, thrill

135
Q

grade 5 murmur

A

very loud, thrill

136
Q

grade 6 murmur

A

so loud can be heard without a stethoscope

137
Q

why use a cardiopulmonary monitor?

A
  • increased WOB
  • something is abnormal with vital signs
  • no order needed for monitor if you are concerned, get it after
138
Q

prenatal placenta functions

A

nutrients
oxygen- lungs of baby
blood
functions as a kidney

139
Q

foramen ovale

A

opening in the prenatal heart
constant movement of blood
goes into PDA

  • pressure changes after birth and the FO closes
140
Q

during pregnancy the placenta is in charge of secreting ___

A

secreting prostaglandins
keep PDA open, needed during pregnancy

PDA shrinks and closes after birth

141
Q

cyanotic defects: want PDA open?

A

yes because cyanotic defects mean less blood flow, if PDA is open, it will increase blood flow circulation
- therefore we treat with prostaglandins to keep the PDA open

NU 374 (18 decks)

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