EXAM 2 cardiac dysfunction

Question 1

assessing cardiac fxn

Answer 1

nutrition, color, chest deformities, unusual pulses, resp excursion, digital clubbing

Question 2

cardiac catheterization

Answer 2

diagnostic, interventional, right side most common in kids

need accurate height and weight, npo for 4-6hrs, clarify am meds, iv fluid?

Question 3

postop cardiac cath

Answer 3

flat for 4-6 hours
observe color and consciousness, vital signs, distal pulses, weakened normal in affected side at first
pressure dressing
watch for hypoglycemia

pressure dressing change very 24 hours, no tubs for 48

Question 4

ACYANOTIC defects

Answer 4

VAP CAP

Ventricular septal defect
atrial septal defect
patent ductus arteriosis
coarcation of aorta
aortic stenosis
pulmonic stenosis

Question 5

CYANOTIC HEART DEFECTS

Answer 5

5 T’s
tetrology of fallot
tricuspid atresia
transposition of great vessel
hypoplastic left heart
truncus arteriosis

Question 6

clinical manifestations of CHF

Answer 6

pulmonary venous congestion=tachypnea, wheezing, crackles, retractions, flaring, cyanosis, diff feeding irritability

systemic venous congestion
hepatomegaly, ascites, edema, weight gain, neck vein distension

impaired cardiac output, high metabolic rate

Question 7

management of CHF

Answer 7

furosemide (lasix)-eliminate extra fluid
ace inhibitors-decrease resisting pressure
digitalis-makes heart beat harder (increase contractility

Question 8

digitalis admin(digoxin)

Answer 8

regular intervals, 1 hour before or 2 after eating
check heart rate for one minute. hold if under 90 in infant/young, 70 if older

do not mix with food or fluid
brush teeth
over four hours wait until next dose, if two missed must notify provider
do not give again if child vomits
check k levels in hospital

Question 9

digoxin toxicity

Answer 9

nausea, vomiting, bradycardia, anorexia, neurological and visual disturbances, monitor for dysrhythmia, digibind can be administered if needed

Question 10

nursing for CHF

Answer 10

anticipate hunger, give small but frequent feedings, feed for under 30 at a time, semi erect position for feeding, burp before during and after, formula with increased calories

assess RR, position to encourage chest expansion, avoid constriction, humidified o2

Question 11

acyanotic defects (increased pulmonary blood flow)

Answer 11

Atrial septal defect
ventricular septal defect
patent ductus arteriosis

Question 12

acyanotic defects (decreased flow to body)

Answer 12

coarcation of aorta
aortic stenosis
pulmonic stenosis

Question 13

atrial septal defect

Answer 13

hold between r and l atrium

could be asymptomatic, at risk for dysrhythmia, CHF, heart murmur

treatment: close on own or can be surgically closed

Question 14

ventricular septal defect

Answer 14

hold between ventricles, left pushes into right which sends more blood to the lungs

chf, murmur heard, r ventricular hypertrophy, failure to thrive, fatigue, recurrent resp infections

treatment: pulm artery banding, can close by 3 yr, septal ocluder, surg correction

Question 15

patent ductus arteriosis

Answer 15

pulmonic artery and aorta are connected , aorta pushes more blood into pulm sending extra blood to the lungs

murmur, chf, or asymtomatic

can be closed by prostoglandin E INHIBITOR(ibuprofen)
heart cath with coil

Question 16

coarcation of aorta

Answer 16

restricts blood flow

narrowing of aorta after the ductus arteriosis, upper extremities have more , lower have less

increases pulmonary blood flow

balloon angioplasty, prostoglandin to mainain patent ductus arteriosis

Question 17

aortic stenosis

Answer 17

narrowing of aortic valve, blood does not leave heart correctly, backs up in the right side, right side enlargement and decreased output and left ventricular hypertrophy

SERIOUS-progressive obstruction, sudden myocardial ischemia, surgery is not super effective

infants - faint pulse, low bp, tachy, poor feeding
children-exercise intolerance, cp, dizzy

treatment: balloon dilation or valve replacement

Question 18

pulmonic stenosis

Answer 18

pulmonary valve restricts flow to lungs

could be asymptomatic, mild cyanosis or chf, murmur

treatment: balloon or surgery

Question 19

cyanotic heart defects (decreased pulm blood flow)

Answer 19

tetrology of fallot
tricuspid atresia

Question 20

cyanotic heart defects(mixed flow)

Answer 20

transposition of great vessels
hypoplastic left heart
truncus arteriosis

Question 21

cyanotic heart defect symtoms

Answer 21

cyanosis
polycythemia
digital clubbingtetr

Question 22

tetrology of fallot

Answer 22

combination:
overriding aorta
pulmonic stenosis
ventricular septal defect
r ventricular hypertrophy

murmur, polycythemia, hypoxia, acidosis, poor growth, clubbing, exercise intolerance

surgery, squatting position helps if hypoxic

Question 23

guidelines for hypercyanotic spells

Answer 23

knee-chest, 100% o2 by face mask, give morphine because it relaxes heart
fluid replacement

Question 24

tricuspid atresia

Answer 24

failure of tricuspid valve to develop=no communication between right atrium and ventricle, small or no right ventricle

cyanosis!!
prostoglandin E to maintain ductus arteriosis, digoxin and diuretics, surgical repair

Question 25

transposition of great arteries

Answer 25

pulmonary and aorta switch, no communication must have another defect that allows life, increasing cyanosis as foramen ovale closes, surgery in first few weeks prostoglandin E to keep foramen ovale open

Question 26

truncus arteriosis

Answer 26

pulmonary and aorta fail to divide, one vessel empties both ventricles cyanosis, chf, murmur surgery, digoxin, diuretics

Question 27

hypoplastic left heart

Answer 27

small or absent left ventricle, severe hypoplasia of aorta and aortic arch, NEED TRANSPLANT cyanosis, weak pulses, cool extremeties, resp distress, usually no murmur prostoglandin E to keep PDA surgery or transplant soon